The effectiveness of education or behavioral interventions on adherence to phosphate control in adults receiving hemodialysis: a systematic review protocol Impact of intradialytic exercise on arterial compliance and B‐type natriuretic peptide levels in hemodialysis patients The Impact of Different Types of Assistive Devices on Gait Measures and Safety in Huntington's Disease Nutrition and hydration status improve with exercise training using stationary cycling during hemodialysis (HD) in patients with end-stage renal disease (ESRD). Improvements in gait characteristics after intensive resistance and functional training in people with dementia: a randomised controlled trial Effects of exercise training during hemodialysis on cardiac baroreflex sensitivity. Efficacy of gait training using a treadmill with and without visual biofeedback in patients after stroke: A randomized study. Effectiveness of intradialytic exercise on dialysis adequacy, physiological parameters, biochemical markers and quality of life - A pilot study. Exercise training in patients with end-stage renal disease on hemodialysis: comparison of three rehabilitation programs. Assessment of gait characteristics and orthotic management in children with Developmental Coordination Disorder: preliminary findings to inform multidisciplinary care. Exercise training during hemodialysis improves dialysis efficacy and physical performance. Assessment of spatio-temporal parameters during unconstrained walking Effects of intradialytic exercise on systemic cytokine in patients with chronic kidney disease The effects of resistance exercise and oral nutritional supplementation during hemodialysis on indicators of nutritional status and quality of life. Haemodiafiltration, haemofiltration and haemodialysis for end-stage kidney disease. Importance of low serum intact parathyroid hormone as a predictor of mortality in hemodialysis and peritoneal dialysis patients: 14 years of prospective observation. Effects of high efficiency post-dilution on-line hemodiafiltration or conventional hemodialysis on residual renal function and left ventricular hypertrophy Effect of lipid-lowering dietary recommendations on the nutritional intake and lipid profiles of chronic peritoneal dialysis and hemodialysis patients. The life readiness program: a physical rehabilitation program for patients on hemodialysis. Effect of textured insoles on balance and gait in people with multiple sclerosis: an exploratory trial. Impact of Modality Choice on Rates of Hospitalization in Patients Eligible for Both Peritoneal Dialysis and Hemodialysis Electrolyzed-reduced water reduced hemodialysis-induced erythrocyte impairment in end-stage renal disease patients. Effects of augmented proprioceptive cues on the parameters of gait of individuals with Parkinson's disease
Review question / objective The objective of this review is to identify the effectiveness of education or behavioral interventions on adherence to phosphate control in adults with end stage kidney disease ( ESKD ) receiving hemodialysis ( HD ) . Background Hyperphosphatemia occurs in people with ESKD as a result of the kidneys ' reduced ability to excrete an ingested phosphate load.1,2 Hyperphosphatemia significantly lowers the serum calcium concentration , stimulating the release of parathyroid hormone ( PTH ) , causing secondary hyperparathyroidism.3–6 In ESKD , hyperphosphatemia also slows the activation of vitamin D which leads to impaired absorption of calcium from the gastrointestinal tract , result ing in reduced mobilization of calcium and phosphate from the bones , and causing metabolic bone disease.2,6,7 The reduced mobilization of both phosphate and calcium enables these two minerals to bind together creating a calcium‐phosphate product . At a serum concentration of > 1.78mmol/L the calcium‐phosphate product crystallizes and is deposited within the soft tissue and vasculature.6,8,9 In ESKD the development of vascular calcification of the arterial media ( i.e. calciphylaxis ) is a major contributing factor of morbidity and mortality.4,5,9,10 Methods of phosphate control Hyperphosphatemia is a wellrecognized risk factor for renal osteodystrophy and cardiovascular mortality in people with ESKD.1,4,11 Collectively this is called chronic kidney disease ‐ mineral bone disorder ( CKD‐MBD ) . Treatment of hyperphosphatemia requires a combination of dietary phosphate restrictions , use of oral phosphate binder therapy to reduce intestinal phosphate absorption , vitamin D3 ( calcitriol ) supplementation and adequate dialysis prescription to promote removal of phosphate.12–15 The treatment goal is to maintain serum phosphate levels at near normal , 0.7 ‐ 1.6mmol/L ( 3.5 ‐ 5.5 mg/dL)16 , and that sustained control of serum phosphate is a strong predictor of improved survival in people receiving HD.11 However approximately 40 % of patients receiving HD have a serum phosphate level of > 1.6mmol/L.16 Dietary phosphate restriction The implementation of dietary phosphate restrictions is the first step in treating hyperphosphatemia . The average daily adult diet contains approximately 800‐1500 mg of phosphate which is absorbed mostly in the duodenum and jejunum.17 However , there is a linear relationship between phosphate and protein intake.1 In general , foods high in phosphate such as milk and meat are rich in protein . For each gram of protein , there is approximately 13‐15 mg of phosphate.17 The recommended protein intake for a HD patient is 0.8 g per kg of body weight per day.7,18 However , the dietary restrictions necessary to sustain acceptable serum phosphate in HD patients could lead to protein malnutrition.4,7,19 Therefore , dietary phosphate restriction is not sufficient to control serum phosphate levels to current national/international guidelines .19 Phosphate binders The mainstay treatment of hyperphosphatemia is the use of oral phosphate binder medication.1,20 Phosphate binders lower phosphate absorption in the intestines by binding to and sequestering phosphate in the gastrointestinal tract , forming insoluble products that are not readily absorbed.21 The Dialysis Outcomes and Practice Patterns Study ( DOPPS ) involving 23,898 patients on HD at 923 facilities in 12 countries found that 88 % of patients were prescribed phosphate binders and 12 % were not . This study found a 25 % lower mortality rate ( HR , 0.75 ; 95 % CI , 0.68‐0.83 ) in patients who were prescribed phosphate binders versus those not prescribed phosphate binder medication.11 However , most people receiving phosphate binding medication do not achieve target serum phosphate level.3 Hemodialysis The basic conventional four‐hour thrice‐weekly HD removes approximately 700‐1,000 mg of phosphate per session , result ing in a weekly reduction of 2100‐3000mg.8,21,22 Effective phosphate removal through HD is complicated by phosphate 's biphasic elimination from the body . Kinetic studies have shown that serum phosphate levels drop rapidly in the first one to two hours of HD treatment and then reach a plateau.8,22 Soon after HD , a rebound of serum phosphate occurs to a rise of about 30‐40 % . This is because of the slow influx of elements to the extracellular space after a st and ard HD session.3,8,22 It has been recognized that increasing dialysis frequency or duration leads to reduced serum phosphate.19 Data from the Frequent Haemodialysis Network nocturnal trial showed that daily or extended nocturnal HD led to an average decrease in serum phosphate levels of 0.4mmol/L ( 95 % CI : 0.3‐0.7mmol/L ) compared with conventional four‐hour thrice‐weekly HD treatment.23 In spite of the relatively low removal rates of phosphorus achieved by HD it is indicative that HD alone can not correct the phosphate levels that are associated with the usual dietary content of phosphate.21,22 Therefore , successful treatment of hyperphosphatemia requires patients adhering to a combination of dietary phosphate restrictions,8 use of oral phosphate binder therapy to reduce intestinal phosphate absorption21 and adequate HD prescription to promote removal of phosphate.24 Adherence to phosphate control Research on adherence to phosphate control date s back to 1960.14 However , the use of education and behavioral interventions to improve long term adherence to phosphate control has been subjected to less investigation in people with ESKD . Several research studies indicate education and behavioral interventions could help individuals change their behavior and hence increase adherence to phosphate control.5,13,20,25,26 A number of studies have used different educational interventions , carried out by either nurses or dieticians . The education sessions were one‐on‐one or group , and verbal or video was used to provide the education.13,14,27,28 Also , structured psychological approaches aim ed at helping patients to change their beliefs , consequently developing healthy behavior , have been used to produce positive results in improving adherence to diet , medication and HD treatment.28–31 These studies illustrate that theoretical and empirically based behavioral approaches are feasible and can result in a positive reduction of serum phosphate level . However , further developments of clinical ly useful behavioral and educational strategies are needed to sustain long term adherence with phosphate control . A literature search of the Cochrane central register of controlled trials , JBI , Prospero international prospect i ve register of systematic review and Campbell collaboration systematic review s was conducted and only one systematic review of relevance to this topic was found . This systematic review was of r and omized controlled trials of educational and counselling interventions to improve dietary phosphate adherence in both HD and pre‐dialysis patients .26 However , this systematic review did not include all treatment methods that are used in combination to control phosphate . The control of serum phosphate levels in people receiving HD continues to be a challenge for practitioners and is of clinical significance to patient outcomes . If left untreated hyperphosphatemia significantly increases the risk of morbidity and mortality in people with ESKD.12 It is important to review studies that have been undertaken comparing the outcomes of education and behavioral interventions , regardless of study design , targeting patient adherence to dietary phosphate intake , phosphate binder medication and HD treatment Cardiovascular ( CV ) disease is the most common cause of mortality in end‐stage kidney disease ( ESKD ) , and arterial stiffness , measured by pulse wave velocity ( PWV ) , is an independent predictor of all‐cause and CV mortality . B‐type natriuretic peptide ( BNP ) levels are high in patients with CV disease and ESKD , and increases in BNP may also be a marker of CV risk . Regular exercise has many benefits on quality of life and physical strength and may also improve CV risk , but few studies have addressed the impact of exercise on CV risk in ESKD . We performed a prospect i ve cross‐over trial in 19 hemodialysis ( HD ) patients to assess the impact of regular exercise on surrogate markers of CV risk‐arterial compliance and BNP levels . Exercise involved the use of a bicycle ergometer for minimum 30 min at each HD session for 3 months , with a 1‐month washout period . Group A ( n=9 )  exercised for the first 3 months only , while group B ( n=10 )  performed no intradialytic exercise initially and exercised for 3 months at cross‐over ( month 4 ) . Pulse wave velocity was performed using a SphygmoCor device , with concurrent measurements of BNP and other serum markers , at the commencement of the study , at 3 months , and on completion . The mean PWV ( A : 10.4±3.1 m/s , B : 9.8±3.8 at baseline ) showed a trend toward improvement with exercise ( A : 8.7±2.7 , p=0.07 ) , and no significant change without ( B : 10.5±3.6 , p=0.31 ) . After cross‐over , there was an increase in PWV in group A with cessation of exercise ( 9.75±2.4 , p=0.01 vs. 3 months ) and an improvement in group B with exercise ( 9.33±2.3 , p=0.11 vs. 3 months ) . When comparing PWV after 3 months of exercise vs. 3 months of no exercise ( paired t test ) , there was a significant difference in favor of exercise ( 9.04±0.59 vs. 10.16±0.74 , p=0.008 ) . The mean BNP levels following 3 months of exercise were also lower than those after 3 months of no exercise ( 504.4±101.2 vs. 809.4±196.1[N<100 ] , p=0.047 ) . There was an overall improvement in PWV , and to a lesser extent BNP levels , with 3 months of intradialytic exercise compared with no exercise , suggesting that regular exercise in ESKD may be associated with improvements in arterial compliance and a reduction in CV risk Background Gait and balance impairments lead to frequent falls and injuries in individuals with Huntington 's disease ( HD ) .  Assistive devices ( ADs ) such as canes and walkers are often prescribed to prevent falls , but their efficacy is unknown . We systematic ally examined the effects of different types of ADs on quantitative gait measures during walking in a straight path and around obstacles . Methods Spatial and temporal gait parameters were measured in 21 subjects with HD as they walked across a GAITRite walkway under 7 conditions ( i.e. , using no AD and 6  commonly prescribed ADs : a cane , a weighted cane , a st and ard walker , and a 2 , 3 or 4 wheeled walker ) . Subjects also were timed and observed for number of stumbles and falls while walking around two obstacles in a figure-of-eight pattern . Results Gait measure variability ( i.e. , coefficient of variation ) , an indicator of fall risk , was consistently better when using the 4WW compared to other ADs . Subjects also walked the fastest and had the fewest number of stumbles and falls when using the 4WW in the figure-of-eight course . Subjects walked significantly slower using ADs compared to no AD both across the GAITRite and in the figure-of-eight . Measures reflecting gait stability and safety improved with the 4WW but were made worse by some other ADs Patients with end-stage renal disease ( ESRD ) undergoing hemodialysis and peritoneal dialysis are functionally limited as a consequence of their physical , emotional , and social problems . Exercise intolerance is a major problem in chronic renal failure . Stationary cycle training during hemodialysis is recommended as safe , effective , and practical in ESRD patients treated on hemodialysis . The aim of the present study was to evaluate the effect of cycling exercises in 10 HD patients during 6-month period ( including each of dialysis sessions ) on nutrition , dialysis adequacy , and fluid parameters as measured by biochemical , and bioimpedance parameters . A significant increase in serum albumin concentration , Kt/V , and nPCR , and decrease in serum CRP have been observed after 6 months of regular stationary cycling during hemodialysis . Relative changes ( pre-post HD ) in extracellular water compartment and ECW/TBW ratio have significantly increased after 6 months of observation period Background Preventing and rehabilitating gait disorders in people with dementia during early disease stage is of high importance for staying independent and ambulating safely . However , the evidence gathered in r and omized controlled trials ( RCTs ) on the effectiveness of exercise training for improving spatio-temporal gait parameters in people with dementia is scarce . The aim of the present study was to determine whether a specific , st and ardized training regimen can improve gait characteristics in people with dementia . Methods Sixty-one individuals ( mean age : 81.9 years ) with confirmed mild to moderate stage dementia took part in a 3-month double-blinded outpatient RCT . Subjects in the intervention group ( IG ) received supervised , progressive resistance and functional group training for 3 months ( 2 times per week for two hours ) specifically developed for people with dementia . Subjects in the control group ( CG ) conducted a low-intensity motor placebo activity program .  Gait characteristics were measured before and after the intervention period using a computerized gait analysis system ( GAITRite ® ) . Results Adherence to the intervention was excellent , averaging 91.9 % in the IG and 94.4 % in the CG . The exercise training significantly improved gait speed ( P < 0.001 ) , cadence ( P = 0.002 ) , stride length ( P = 0.008 ) , stride time ( P = 0.001 ) , and double support ( P = 0.001 ) in the IG compared to the CG . Effect sizes were large for all gait parameters that improved significantly ( Cohen ’s d : 0.80 - 1.27 ) . No improvements were found for step width ( P = 0.999 ) , step time variability ( P = 0.425 ) and Walk-Ratio ( P = 0.554 ) . Interestingly , low baseline motor status , but not cognitive status , predicted positive training response ( relative change in gait speed from baseline ) . Conclusion The intensive , dementia-adjusted training was feasible and improved clinical ly meaningful gait variables in people with dementia . The exercise program may represent a model for preventing and rehabilitating gait deficits in the target group . Further research is required for improving specific gait characteristics such as gait variability in people with dementia . Trial registration IS RCT BACKGROUND Arterial baroreflex sensitivity ( BRS ) evaluation has been increasingly used as an index of cardiac autonomic control . Cardiac autonomic dysfunction leading to depressed BRS has been associated with an increased risk of ventricular arrhythmias and sudden death in patients with chronic kidney disease ( CKD ) on hemodialysis ( HD ) . AIM The purpose of this study was to investigate the effects of an exercise training program during hemodialysis on BRS in CKD patients . PATIENTS AND METHODS 43 HD patients participated in the study . They were r and omly assigned into either a 7-month exercise training program during HD ( Group A : n=22 patients ) or a sedentary control group ( Group B : n=21 patients ) . Additionally , 20 sex- and age-matched sedentary individuals comprised a healthy control group ( Group C ) . All patients at the beginning and the end of the study underwent a tilt test for evaluation of BRS  and an exercise testing with spiroergometric study for cardiorespiratory capacity estimation . The level of Hb , medications and the HD procedure remained stable during the study . RESULTS At baseline BRS was found to be reduced by 51.5 % ( p<0.05 ) and baroreflex effectiveness index ( BEI ) by 36.4 % ( p<0.05 ) in Group A compared with Group C. Initially , all HD patients had also significantly lower exercise time and VO2 peak than the healthy subjects . After training , Group A showed a significant improvement in BRS by 23.0 % ( p<0.05 ) , in BEI by 27.0 % ( p<0.05 ) , in event and ramp count by 35.0 % ( p<0.05 ) and 29.0 % ( p<0.05 ) , respectively as well as in VO2 peak by 22.4 % ( p<0.05 ) and in exercise time by 40.9 % ( p<0.05 ) . Significant correlations were found between BRS and METs ( r=0.476 , p<0.05 ) , BRS and VO2 peak ( r=0.443 , p<0.05 ) , BEI and METs ( r = 0.492 , p<0.05 ) , BEI and VO2 peak ( r=0.467 , p<0.05 ) , event count and VO2 peak ( r=0.715 , p<0.01 ) , event count and exercise time ( r=0.799 , p<0.01 ) , in Group A at the end of the study . CONCLUSIONS Our results indicate that HD patients had considerably reduced cardiorespiratory capacity and impaired cardiac BRS compared to healthy sedentary individuals . Importantly , exercise training during HD yielded a marked increase of the indices representing baroreflex activity in association to the improvement of their functional capacity OBJECTIVES To evaluate the effects of gait training using a treadmill with and without visual biofeedback in patients in the late period after stroke , and to compare both training methods . DESIGN A r and omized , controlled study . SUBJECTS Fifty people at least 6 months after stroke , r and omly enrolled into groups with a rehabilitation programme of treadmill training with or without visual biofeedback . METHODS Spatio-temporal gait parameters , walking speed , walking distance , self-reliant mobility and functional capacity were evaluated during a programme of 10 sessions over 2 weeks . RESULTS Patients in both groups achieved statistically significant improvement . Participants in the intervention group revealed a significantly greater improvement in the shortening of the stance phase ( p = 0.0045 ) and lengthening of the swing phase of the unaffected limb ( p = 0.0042 ) and an increase in the unaffected limb cycle length ( p = 0.0021 ) . There were no significant differences between groups in other spatio-temporal parameters of gait or additionally assessed parameters . CONCLUSION Gait training using a treadmill result ed in improvements in the gait and functional capacity of patients . The use of biofeedback gives better results in improving gait cycle length , duration of gait phases and swing phase speed compared with exercise on a treadmill alone End-stage renal disease is emerging as a major public health problem in the developing countries . It must be treated with renal replacement therapy and hemodialysis ( HD ) is the most widely used therapy and the only maintenance treatment if kidney transplant is not feasible . This study aim ed to determine the effectiveness of intradialytic exercise on dialysis efficacy , physiological parameters , biochemical markers , and quality of life among patients on HD . Experimental research design was adopted to conduct the study with 20 patients in our HD unit who met the inclusion criteria and patients were r and omly allocated into experimental group and control group . The experimental group received intradialytic exercise during the first 2 h of HD besides receiving routine care compared to the control group . Data were tabulated and analyzed using the SPSS package . The finding of the present pilot study reveals that the prescribed intradialytic exercise intervention result ed in significant improvement in Kt/V , serum creatinine , blood urea , serum potassium , phosphorous , and quality of life . Based on the findings of the present study , it can be concluded that intradialytic exercise program is a safe complementary intervention and does not need an extra time of the patient and showed improvement in patients ' outcome Functional capacity of end-stage renal disease patients is dramatically impaired . Although exercise training programs appear to have beneficial morphological , functional and psychosocial effects in end-stage renal disease patients on hemodialysis ( HD ) , the adherence rate is high . The purpose of this study was to compare the effects of three modes of exercise training on aerobic capacity and to identify the most favourable , efficient and preferable to patients on HD with regard to functional improvements and participation rate in the programs . Fifty-eight volunteer patients were screened for low-risk status and selected from the dialysis population . The 48 patients who completed the study protocol were r and omly assigned either to one of the three training groups or to a control group .  Sixteen of them ( Group A - mean age 46.4+/-13.9 years ) completed a 6-month supervised outpatient exercise renal rehabilitation program consisting of three weekly sessions of aerobic and strengthening training on the non-dialysis days ; 10 ( Group B - mean age 48.3+/-12.1 years ) completed a 6-month exercise program during HD ; 10 ( Group C - mean age 51.4+/-12.5 years ) followed an unsupervised moderate exercise program at home , and 12 patients ( Group D-mean age 50.2+/-7.9 years ) were used as patient controls . The level of anemia , the medications and the HD prescription remained stable during the study . Fifteen sex- and age-matched sedentary individuals ( Group E - mean age 46.9+/-6.4 years ) comprised a healthy control group for baseline data . All subjects at the beginning and end of the study underwent clinical examination , laboratory tests and a treadmill exercise test to fatigue endpoints with direct measurement of aerobic capacity . Group A had a higher dropout rate ( 24 % ) compared to groups B ( 17 % ) and C ( 17 % ) . Peak oxygen consumption ( VO2 peak ) increased by 43 % ( p < 0.05 ) , anaerobic threshold ( VO2AT ) by 37 % ( p < 0.05 ) and exercise time by 33 % ( p < 0.05 ) after training in Group A ; by 24 % ( p < 0.05 ) , 18 % ( p < 0.05 ) and 22 % ( p < 0.05 ) , respectively , in B ; and by 17 % ( p < 0.05 ) , 8 % ( p < 0.05 ) and 14 % ( p < 0.05 ) , respectively , in C ; while both remained almost unchanged in Group D. These results demonstrate that intense exercise training on non-dialysis days is the most effective way of training , whereas exercise during HD is also effective and preferable Developmental Coordination Disorder ( DCD ) is a neurodevelopmental disorder characterised by impaired motor co-ordination and awkward gait . Despite self-reported findings of pes planus and joint hypermobility in children with DCD , there is little objective evidence regarding the clinical management of the foot in children with DCD . The aims of this research were to report clinical findings of foot posture and lower limb hypermobility in children with DCD and to evaluate the impact of foot orthoses on spatio-temporal gait parameters . Children with DCD were recruited into the study . Participants were r and omly assigned to an intervention group who received foot orthoses at the start of their rehabilitation programme or to a second group who received foot orthoses at the end of their intervention programme . Foot posture was assessed with the Foot Posture Index and lower limb hypermobility assessed with the Lower Limb Assessment Score . The effect of foot orthoses  was evaluated through assessment of spatio-temporal gait characteristics at baseline and post-rehabilitation programme . Fourteen children were recruited ( mdn age 7.5 years ) with nine children assigned to the group receiving orthoses early ( mdn age 8 years ) and five children assigned to the post-rehabilitation orthoses group ( mdn age 6.5 years ) . A pes planus foot posture ( FPI score=8 ) and lower limb hypermobility ( LLAS score=11 ) were observed . Changes in spatio-temporal gait parameters failed to reach significance ( p>.012 ) following orthotic invention but demonstrated a trend towards a decreased cadence and increased double support duration . Despite non-significant findings this work offers preliminary support for podiatric intervention in the rehabilitation of children with DCD . Further work is required to underst and the biomechanics of gait in children with DCD and appreciate the role of podiatry as a component of multidisciplinary care OBJECTIVE To determine the impact of a 20-week intradialytic exercise program , consisting of 60 minutes of cumulative duration , low-intensity exercise during the first 2 hours of dialysis , on dialysis efficacy , physical performance , and quality of life in self-care hemodialysis ( HD ) patients . DESIGN One-group repeated measures . SETTING Satellite HD units affiliated with a Canadian teaching hospital . PARTICIPANTS A convenience sample of 13 self-care HD patients who were stable on dialysis for a minimum of 6 months and were medically screened for significant cardiac , pulmonary , and /or musculoskeletal pathology that would preclude exercise . INTERVENTION A 5-month intradialytic exercise program in which subjects exercised 3 times a week ( cycle ergometer , mini-stepper ) for 30 minutes in each of the first 2 hours of HD . MAIN OUTCOME MEASURES Dialysis efficacy ( in single-pool model of urea kinetics [ spKt/V ] ) was assessed prior to and at the end of each month of the exercise program . Physical function ( 6-minute walk test [ 6MWT ] ) , and quality of life . ( Kidney Disease Quality of Life-Short Form [ KDQOL ] ) were determined at baseline and at weeks 10 and 20 of the exercise program . RESULTS SpKt/V increased 11 % at the end of the first month of the program ( P<.05 ) and remained elevated for the duration of the program ( 18%-19 % ) . Distance walked on the 6MWT increased by 14 % at both weeks 10 and 20 ( P<.05 ) . No changes were noted in KDQOL scores . CONCLUSIONS A low-intensity intradialytic exercise program is a viable adjunctive therapy , which improves HD efficacy and physical function in HD patients This paper presents an analysis of spatio-temporal gait parameters during overground walking based upon a method that needs only lower trunk accelerations . Twenty-six healthy young subjects and 15 healthy elderly subjects participated in an experiment where overground walking was studied at different speeds .  Accelerations of the lower trunk were measured by a tri-axial accelerometer connected to a portable data logger carried on the body . An analysis of trunk acceleration data produced temporal gait parameters ( duration of subsequent stride cycles and left/right steps ) and convincing estimations of spatial parameters ( step length and walking speed ) . Typical differences in spatio-temporal gait parameters between young and elderly subjects could be demonstrated , i.e. a limited range of walking speeds , smaller step lengths , and a somewhat higher variability of temporal parameters in elderly subjects . It is concluded from these results that essential spatio-temporal gait parameters can be determined during overground walking using only one tri-axial accelerometer . The method is easy-to-use and does not interfere with regular walking patterns . Both the accelerometer and the data logger can be miniaturised to one small instrument that can be carried on the trunk during hours of walking . Thus , the method can easily be incorporated in current activity monitors so that 24-h monitoring of postures and activities can be combined with assessment of gait characteristics during these monitoring periods . In addition , the presented method can be a basis for more sophisticated gait analyses during overground walking , e.g. an analysis of kinematic signals or muscle activity within subsequent stride cycles Abstract Background : Immunological dysfunctions and a pro-inflammatory environment are associated with higher risk of cardiovascular diseases in chronic kidney disease ( CKD ) .  Physical exercise can be an important anti-inflammatory strategy , but the effects in CKD remain poorly investigated . Objective : Evaluate the acute inflammatory response to intradialytic exercise in the peripheral blood of individuals with CKD . Methods : Nine patients , of both genders , with CKD and allocated in the ambulatory of hemodialysis of Hospital Ernesto Dornelles ( Brazil ) , performed two sessions of hemodialysis ( HD ) in r and om form :  aerobic intradialytic exercise sessions ( EX , 20 min of moderate exercise in cycle-ergometer ) and a control hemodialysis session ( CON ) . Peripheral blood collection was made at the baseline , during and immediately after HD to evaluate the cytokine profile : interleukin-6 , interleukin-10 ( IL-10 ) , interleukin-17a ( IL-17a ) , interferon-gamma ( INF-γ ) and tumoral necrosis factor-alpha ( TNF-α ) . Results : INF-γ decreased during HD when compared with the pre moment in both sessions , while an increase in post HD was only found in the CON session . IL-17 was higher in post when compared with during HD in both sessions . In addition to the time effect , IL-10 presented a time × group interaction and the relative changes were significantly higher in EX when compared with the CON session . The relative changes in TNF-α tended to be higher in CON when compared with EX immediately post HD session . Conclusions : These data indicate that 20 min of intradialytic exercise have modest effect in systemic inflammation . However , the significant increase in IL-10 may indicate an immunoregulatory effect of physical exercise BACKGROUND Protein-energy wasting ( PEW ) is common in patients undergoing hemodialysis ( HD ) . Studies have assessed the positive effect of oral nutritional supplementation ( ONS ) or resistance exercise ( RE ) on nutritional status ( NS ) markers in patients undergoing HD . METHODS The aim of this study was to assess the effect of ONS and RE on NS and the quality of life ( QOL ) of 36 patients undergoing HD . In a r and omized clinical trial , patients were divided into the following two groups : a control group ( ONS ) that received a can of ONS during their HD sessions and an intervention group ( ONS + RE ) that received a can of ONS and underwent a 40-min session of RE during their HD sessions . Both interventions lasted 12 weeks . The patients ' anthropometric , biochemical , dietetic and bioelectrical impedance measurements as well as their QOL , evaluated using the Kidney Disease Quality of Life Short Form , were recorded . RESULTS At baseline , 55.5 % of patients presented with PEW according to International Society of Renal Nutrition and Metabolism criteria ( 20 patients ) . We found statistically significant changes from baseline in both groups , such as increases in body weight , body mass index , midarm circumference , midarm muscle circumference , triceps skinfold thickness , fat mass percentage , h and grip strength , phase angle and serum albumin . A decrease in the prevalence of PEW was observed in both groups at the end of the intervention . A delta comparison between groups showed no statistically significant differences in the anthropometric and biochemical parameters . No significant improvement was observed in QOL and body composition measured by bioimpedance vector analysis . Dietary energy and protein intake increased significantly during the study period for all patients . CONCLUSION Oral nutritional supplementation during HD improves NS . The addition of RE during HD does not seem to augment the acute anabolic effects of intradialytic ONS on NS Background Convective dialysis modalities ( haemofiltration ( HF ) , haemodiafiltration ( HDF ) , and acetate-free biofiltration ( AFB ) ) removed excess body fluid across the dialysis membrane with positive pressure and accumulated middle- and larger-size accumulated solutes more efficiently than haemodialysis ( HD ) . This increased larger solute removal combined with use of ultra-pure dialysis fluid in convective dialysis is hypothesised to reduce the frequency and severity of symptoms during dialysis as well as improve clinical outcomes . Convective dialysis therapies ( HDF and HF ) are associated with lower mortality compared to diffusive therapy ( HD ) in observational studies . This is an up date of a review first published in 2006 . Objectives To compare convective ( HF , HDF , or AFB ) with diffusive ( HD ) dialysis modalities on clinical outcomes ( mortality , major cardiovascular events , hospitalisation and treatment-related adverse events ) in men and women with end-stage kidney disease ( ESKD ) . Search methods We search ed the Cochrane Renal Group 's Specialised Register ( to 18 February 2015 ) through contact with a Trials ' Search Co-ordinator using search terms relevant to this review . Selection criteria We included r and omised controlled trials comparing convective therapy ( HF , HDF , AFB ) with another convective therapy or diffusive therapy ( HD ) for treatment of ESKD . Data collection and analysis Two independent authors identified studies , extracted data and assessed study risk of bias . We summarised treatment effects using the r and om effects model . We reported results as a risk ratio ( RR ) for dichotomous outcomes and mean difference ( MD ) for continuous data together with 95 % confidence intervals ( CI ) . We assessed for heterogeneity using the Chi2 test and explored the amount of variation in treatment estimates beyond that expected by chance using the I2 statistic . Main results Twenty studies comprising 667 participants were included in the 2006 review . In that review , there was insufficient evidence of treatment effects on major clinical outcomes to draw clinical ly meaningful conclusions . Search ing to February 2015 identified 40 eligible studies comprising 3483 participants overall . In total , 35 studies ( 4039 participants ) compared HF , HDF or AFB with HD , three studies ( 54 participants ) compared AFB with HDF , and three studies ( 129 participants ) compared HDF with HF . Risks of bias in all studies were generally high result ing in low confidence in estimated treatment effects . Convective dialysis had no significant effect on all-cause mortality ( 11 studies , 3396 participants : RR 0.87 , 95 % CI 0.72 to 1.05 ; I2 = 34 % ) , but significantly reduced cardiovascular mortality ( 6 studies , 2889 participants : RR 0.75 , 95 % CI 0.61 to 0.92 ; I2 = 0 % ) . One study reported no significant effect on rates of nonfatal cardiovascular events ( 714 participants : RR 1.14 , 95 % CI 0.86 to 1.50 ) and two studies showed no significant difference in hospitalisation ( 2 studies , 1688 participants : RR 1.23 , 95 % CI 0.93 to 1.63 ; I2 = 0 % ) . One study reported rates of hypotension during dialysis were significantly reduced with convective therapy ( 906 participants : RR 0.72 , 95 % CI 0.66 to 0.80 ) . Adverse events were not systematic ally evaluated in most studies and data for health-related quality of life were sparse . Convective therapies significantly reduced predialysis levels of B2 microglobulin ( 12 studies , 1813 participants : MD -5.55 mg/dL , 95 % CI -9.11 to -1.98 ; I2 = 94 % ) and increased dialysis dose ( Kt/V urea ) ( 14 studies , 2022 participants : MD 0.07 , 95 % CI -0.00 to 0.14 ; I2 = 90 % ) compared to diffusive therapy , but results across studies were very heterogeneous . Sensitivity analyses limited to studies comparing HDF with HD showed very similar results . Directly comparative data for differing types of convective dialysis were insufficient to draw conclusions . Studies had important risks of bias leading to low confidence in the summary estimates and were generally limited to patients who had adequate dialysis vascular access . Authors ' conclusions Convective dialysis may reduce cardiovascular but not all-cause mortality and effects on nonfatal cardiovascular events and hospitalisation are inconclusive . However , any treatment benefits of convective dialysis on all patient outcomes including cardiovascular death are unreliable due to limitations in study methods and reporting . Future studies which assess treatment effects of convection dose on patient outcomes including mortality and cardiovascular events would be informative Excess parathyroid hormone ( PTH ) has long been considered detrimental to the health of patients with end-stage renal disease . PTH has been implicated as a multisystem uremic toxin , and hyperparathyroidism can be a debilitating complication in dialyzed patients . We have studied prospect ively the relationship of enrollment serum intact PTH and various demographic characteristics and other biochemical parameters to all-cause mortality in 345 hemodialysis ( HD ) and 277 peritoneal dialysis ( PD ) patients . We monitored the patients for 14 years . Observed survival and survival after adjustment for age , race , gender , months on dialysis at enrollment , diabetic status , and nutritional markers were significantly better for patients with enrollment PTH greater than 200 pg/mL than for patients with PTH 65 to 199 pg/mL and patients with PTH less than 65 pg/mL. Enrollment serum PTH  was an independent predictor of survival in HD and PD patients . For HD patients , age and months on HD at enrollment were associated inversely with PTH level , whereas black race , creatinine , and phosphorus were associated directly with PTH . For PD patients , age , diabetes , and months on PD at enrollment were inverse predictors , whereas black race , albumin , creatinine , and phosphorus were associated positively with PTH . Lower than expected levels of PTH in uremic patients is associated with increased mortality . We hypothesize that inadequate protein intake or phosphorus intake or both result in impaired development of the expected secondary hyperparathyroidism and in the excess mortality risk inherent with malnutrition Purpose Residual renal function ( RRF ) contributes to dialysis adequacy , quality of life and survival of hemodialysis patients . There is an ongoing debate whether better preservation of residual renal function is the result of chronic fluid volume overload . Our prospect i ve investigation analyzed the effects of different dialytic therapies on RRF and left ventricular hypertrophy , which may be considered — at least in part — a surrogate marker of chronic fluid overload . Methods Two cohorts of end-stage renal disease patients initiating renal replacement therapy ( high efficiency post-dilution on-line hemodiafiltration ( HDF ) in 58 patients , conventional hemodialysis ( HD ) in 60 patients ) were prospect ively followed up . RRF was determined at baseline , 12 and 24 months , left ventricular mass index ( LVMI ) at baseline and after 24 months . Results Demographic and renal characteristics , medication or exposure to nephrotoxins were comparable among the two cohorts of patients . RRF declined in all patients throughout the 2-year study period . In HDF patients , the decline was less pronounced ( 28 % ) than in conventional HD patients ( 68 % ) . More patients undergoing HD received cardio- and renoprotective antihypertensive drugs . CRP levels were significantly higher in conventional HD .  Hypotensive episodes were fewer in HDF . LVMI decreased in 90 % of HDF compared to only 25 % of HD patients . Conclusions Our data clearly indicate that better preservation of RRF by high efficiency hemodiafiltration is not associated with left ventricular hypertrophy Patients with end-stage renal failure are a high-risk group for atherosclerotic cardiovascular disease and commonly have dyslipidemia as a major factor . Dietary manipulation is the recommended first line of therapy for reducing lipid levels in people with normal renal function ; however , complex dietary requirements of dialysis-treated patients with end-stage renal failure impose significant constraints . In this study , we evaluated the effect of trying to comply with established lipid-lowering recommendations superimposed on our normally prescribed dialysis diet over 14 weeks in stable subjects treated with either hemodialysis ( HD ) or chronic peritoneal dialysis ( PD ) . Of 306 dialysis patients screened , 75 subjects were enrolled ; 8 subjects did not complete the study . In the remainder , HD subjects ( n = 41 ) decreased saturated fat intakes by 18 % overall and cholesterol intakes by 16 % . This was associated with a decrease in total cholesterol levels from 232 + /- 8 to 209 + /- 4 mg/dL ( mean + /- SEM ; P = 0.007 ) and low-density lipoprotein cholesterol levels from 147 + /- 4 to 131 + /- 4 mg/dL ( P = 0.009 ) . However , energy intakes decreased by almost 10 % . There were no statistically significant changes in PD patients ( n = 26 ) . Only 24.4 % of HD ( 10 of 41 patients ) and 15.4 % of PD patients ( 4 of 26 patients ) normalized their lipid levels . Considerable problems were encountered in maintaining compliance with the modified dialysis diets . This study shows that if adhered to , properly constructed dialysis diets are close to optimal lipid-lowering recommendations . Further dietary manipulation is difficult , leads to little benefit in the majority , and is accompanied by added problems of adherence . We conclude that the vast majority of dyslipidemic patients with end-stage renal failure require pharmacological therapy Patients with end-stage renal disease ( ESRD ) undergoing hemodialysis ( HD ) are typically sedentary and functionally limited as a consequence of their condition . The purpose of this study is to test the effect of a lifestyle physical rehabilitation program ( The Life Readiness Program ) on physical function in patients with ESRD undergoing HD .  Physical function was measured by the Kidney Disease Quality of Life Short Form ( KDQOL-SF ) physical function score ( range , 0 to 100 ) . Eighty-two patients were r and omly assigned to a 6-month rehabilitation program ( intervention ; n = 39 ) or to st and ard clinical management alone ( control ; n = 43 ) . The groups were frequency matched by age , sex , ethnicity , and diabetes as the cause of ESRD . General linear modeling of the change in physical function score was used for multivariate analysis . Physical function scores were not different between groups at baseline . Change in physical function score increased significantly in the intervention group compared with the control group when data were adjusted for the matching variables and adequacy of dialysis ( 3.2 , -3.6 ; P = 0.04 ) . Additionally , the control group reported more problems with work or daily functions because of emotional problems ( P : < /= 0.05 ) . In this brief 6-month intervention , The Life Readiness Program showed the therapeutic benefit of a  lifestyle rehabilitation program  on functional outcomes and health-related quality of life for patients with ESRD undergoing hemodialysis OBJECTIVES To investigate the immediate effects of textured insoles on balance and gait in people with multiple sclerosis ( MS ) , and to explore any effects after 2 weeks of wear . STUDY DESIGN Within-session repeated- measures design with an exploratory follow-up period . SETTING Hospital gait laboratory . PARTICIPANTS Forty-six individuals with MS ( 34 females , 12 males ) , with a mean ( SD ) age of 49 ( 7 ) years , who could walk 100 m unassisted or using one stick/crutch . INTERVENTION Participants were tested wearing three types of insoles in a r and om order : control ( smooth ) , Texture 1 ( Algeos ) or Texture 2 ( Crocs ™ ) . Participants were allocated at r and om to wear one type of textured insoles for 2 weeks , after which they were retested . MAIN OUTCOME MEASURES St and ing balance ( centre of pressure excursions and velocity ) was measured with eyes open and eyes closed on a Kistler force platform . Spatio-temporal parameters of gait were measured using a GAITRite system . RESULTS The textured insoles had no significant immediate effects on balance or gait , apart from an increase in anteroposterior sway range with eyes open for Texture 2 insoles [ mean difference 4.5 ( 95 % confidence interval 0.6 to 8.4)mm ] . After 2 weeks , balance was not significantly different , but both types of textured insoles showed significant effects on spatio-temporal parameters of gait , with mean stride length increases of 3.5 cm ( Texture 1 ) and 5.3 cm ( Texture 2 ) when wearing the insoles . CONCLUSIONS After 2 weeks of wear , there were improvements in spatio-temporal parameters of gait . However , it is unclear whether this was a placebo effect or a learning effect ♦ Background : Hospitalization rates are a relevant consideration when choosing or recommending a dialysis modality . Previous comparisons of peritoneal dialysis ( PD ) and hemodialysis ( HD ) have not been restricted to individuals who were eligible for both therapies . ♦ Methods : We conducted a multicenter prospect i ve cohort study of people 18 years of age and older who were eligible for both PD and HD , and who started outpatient dialysis between 2007 and 2010 in four Canadian dialysis programs . Zero-inflated negative binomial models , adjusted for baseline patient characteristics , were used to examine the association between modality choice and rates of hospitalization . ♦ Results : The study enrolled 314 patients . A trend in the HD group toward higher rates of hospitalization , observed in the primary analysis , became significant when modality was treated as a time-varying exposure or when the population was restricted to elective outpatient starts in patients with at least 4 months of pre-dialysis care . Cardiovascular disease , infectious complications , and elective surgery were the most common reasons for hospital admission ; only 23 % of hospital stays were directly related to complications of dialysis or kidney disease . ♦ Conclusions : Efforts to promote PD utilization are unlikely to result in increased rates of hospitalization , and efforts to reduce hospital admissions should focus on potentially avoidable causes of cardiovascular disease and infectious complications Chronic hemodialysis ( HD ) patients increase erythrocyte susceptibility to hemolysis and impair cell survival . We explored whether electrolyte-reduced water ( ERW ) could palliate HD-evoked erythrocyte impairment and anemia .  Forty-three patients undergoing chronic HD were enrolled and received ERW administration for 6 month . We evaluated oxidative stress in blood and plasma , erythrocyte methemoglobin (metHb)/ferricyanide reductase activity , plasma metHb , and proinflammatory cytokines in the chronic HD patients without treatment ( n=15 ) or with vitamin C (VC)- ( n=15 ) , vitamin E (VE)-coated dialyzer ( n=15 ) , or ERW treatment ( n=15 ) during an HD course . The patients showed marked increases ( 15-fold ) in blood reactive oxygen species , mostly H(2)O(2 ) , after HD without any treatment . HD result ed in decreased plasma VC , total antioxidant status , and erythrocyte metHb/ferricyanide reductase activity and increased erythrocyte levels of phosphatidylcholine hydroperoxide ( PCOOH ) and plasma metHb . Antioxidants treatment significantly palliated single HD course-induced oxidative stress , plasma and RBC PCOOH , and plasma metHb levels , and preserved erythrocyte metHb /ferricyanide reductase activity in an order VC > ERW > VE-coated dialyzer . However , ERW had no side effects of oxalate accumulation easily induced by VC . Six-month ERW treatment increased hematocrit and attenuated proinflammatory cytokines profile in the HD patients . In conclusion , ERW treatment administration is effective in palliating HD-evoked oxidative stress , as indicated by lipid peroxidation , hemolysis , and overexpression of proinflammatory cytokines in HD patients Context : Impairment of initiating sequential movements and processing of proprioception contribute to characteristic Parkinson 's disease ( PD ) gait abnormalities . Many studies have used a single external cue or 2 different cues to correct PD gait . Aim : An aim of this study was to determine the influence of paired proprioceptive cues on gait parameters of individuals with PD . Setting and Design : Double-blind r and omized controlled trial . Material s and Methods : Subjects were 30 PD patients who had mild to moderate impairment according to the United Parkinson 's Disease Rating Scale ( UPDRS ) . They were r and omly assigned to either a routine physiotherapy program or treadmill training with vibratory stimuli applied to the feet plantar surfaces and proprioceptive neuromuscular facilitation ( PNF ) as well as the same physiotherapy program . All Participants received a 45-minutes session of low intensity physiotherapy program , 3 times a week , for 8 weeks . The duration of treadmill training was 5 minutes at baseline and 25 minutes at the end of treatment . Walking speed and distance were recorded from the treadmill control panel for both groups before and immediately after the end of treatment . The Qualysis ProReflex motion analysis system was used to measure cadence , stride length , hip , knee , and ankle joints ’ angular excursion . Results : The cadence , stride length , and lower limb joints ’ angular excursion showed a significant improvement in both groups ( P ≤ 0.05 ) . These improvements in spatio-temporal parameters and angular excursion were higher in the study group than in the control group ( P ≤ 0.05 ) . Conclusion : Potentiated proprioceptive feedback improves parkinsonian gait kinematics , the hip , knee , and ankle joints ’ angular excursion
Conclusions : Compared to age-matched population s , people with ESKD/HD had significantly slower GS and reduced walk distances ; with intervention , the change in the distance walked was significant .
Background : People with end-stage kidney disease ( ESKD ) on hemodialysis ( HD )  commonly have functional impairments .
The purpose of this systematic review was to evaluate the effect of HD on spatio-temporal characteristics of gait , and effect of exercise on these parameters .