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Purpose
The mortality of dialysis patients treated with high-volume online hemodiafiltration (OL-HDF) is better than hemodialysis, but is still higher than healthy population. Low daily physical activity increases cardiovascular mortality. Addition of intradialytic exercise (IDX) program might improve physical activity and health status in OL-HDF patients. This pilot open-labeled randomized-controlled trial was conducted to evaluate the effects of IDX on physical activity and other clinical parameters in OL-HDF patients.
Methods
Twelve OL-HDF patients were randomized into control (
n
 = 6) or IDX (
n
 = 6) groups. The subjects in IDX group were trained to exercise using a cycle ergometer for 60 min during each OL-HDF session. Physical activity measured as daily step count using a wrist-worn triaxial accelerometer, physical fitness, or cardiorespiratory fitness assessed by VO
2
max and other physical performance tests, lean body mass determined by the Dual-energy X-ray absorptiometry (DXA), quality of life (QOL), and various parameters were compared between baseline and 6 months.
Results
The baseline physical activity status was comparable. Following 6-month IDX, the physical activity was significantly improved in IDX group [+ 1048.79 (+ 741.50, + 2792.54) vs. − 362.06 (− 1626.82, − 167.47) steps/day,
p
 = 0.01], while physical fitness and QOL were unchanged. The lean body mass parameters were preserved in the IDX group while seemed to decrease in the control group. Serum albumin was significantly increased in the IDX group (
p
 = 0.01). The hemoglobin changes were significantly better (
p
 = 0.01) and the erythropoietin resistance index was significantly lower in the IDX group (
p
 = 0.03). Phosphate reduction was significantly greater in the IDX group (
p
 = 0.04).
Conclusions
IDX could improve physical activity and other metabolic parameters in OL-HDF patients and these might contribute to further improvement in clinical and survival outcomes.
Trial registration
ClinicalTrials.gov Registration: NCT03353844.

International urology and nephrology, 2021-02, Vol.53 (2), p.359-371

Effects of intradialytic cycling exercise on daily physical activity, physical fitness, body composition, and clinical parameters in high-volume online hemodiafiltration patients: a pilot randomized-controlled trial

Several kinds of anti-oxidants have drawn a lot of intention for their benefits on vascular protection. In addition, it has been demonstrated that exercise training could improve endothelial function by up-regulating endothelial nitric oxide synthase (eNOS) protein. Therefore, the present study aims to investigate the effects of genistein, a potent phyto-antioxidant, and exercise training on age-induced endothelial dysfunction in relation to NO bioavailability using in situ NO-sensitive fluorescent dye detection.
Male Wistar rats (20-22-month old) were divided into four groups: aged rats treated with corn oil, (Aged+Veh, n = 5), aged rats treated with genistein (Aged+Gen, n = 5, (0.25 mg/kg BW/day, s.c.)), aged rats with and without exercise training (Aged+Ex, n = 5, swimming 40 min/day, 5 days/week for 8 weeks) (Aged+Without-Ex, n = 5). Cremaster arterioles (15-35 micrometer) were visualized by fluorescein isothiocyanate labeled dextran (5 microgram/ml). The vascular response to acetylcholine (Ach; 10(-5)M, 5 ml/5 min) was accessed after 1-min norepinephrine preconstriction (10 micro molar). To determine NO bioavailability, the Krebs-Ringer buffer with 4, 5-diaminofluorescein-diacetate (3 micro molar DAF-2DA), and 10 micro- molar Ach saturated with 95%N2 and 5%CO2 were used. Changes of DAF-2T-intensities along the cremaster arterioles were analyzed by the Image Pro-Plus Software (Media Cybernatics, Inc, USA). Liver malondialdehyde (MDA) level was measured by thiobarbituric acid reaction and used as an indicator for oxidative stress.
The results showed that means arterial blood pressure for both Aged+Gen and Aged+Ex groups were significantly reduced when compared to the Aged groups, Aged+Veh and Aged+Without-Ex (P < 0.05). Among the treated groups, Ach-induced vasodilatation were significantly increased (P < 0.05) and was associated with increased NO-associated fluorescent intensities (P < 0.05). On the other hand, MDA levels were significantly reduced (P < 0.05) when Aged+Veh was compared to Aged+Without-Ex.
These findings showed that genistein and exercise training could improve age-induced endothelial dysfunction and is related to the increased NO bioavailability.

Reproductive biology and endocrinology, 2009-09, Vol.7 (1), p.93-93, Article 93

Increased NO bioavailability in aging male rats by genistein and exercise training: using 4, 5-diaminofluorescein diacetate

Jansang S, Eksakulkla S. The Effect of a Breathing Training Program using a Toy Blower on Lung Function, Respiratory Muscles Strength, 6-Minute Walking Test, and Functional Capacity in Obesity Level 2. JEPonline 2023;26(3):15-27. Introduction: Obesity is a common condition in all genders and ages, and it has become a major health problem for Thai people. Obesity increases the breast fat layer that may affect lung function and respiratory muscle strength (14,22). Obesity also causes several complications with negative effects on quality of life that may lead to premature death. Some of the complications of respiratory disease include obstructive sleep apnea and respiratory distress syndrome, which is linked to pulmonary hypertension and heart failure (20). However, even though recent studies have found an association between obesity and pulmonary function abnormalities (18), there are limited studies on the relationship between obesity and lung function, waist circumference in different age groups, and lung function that worsens with weight gain. Although there are studies that focus on research to find solutions that address the problems of obesity in a variety of ways, they are expensive and can be challenging for individuals who need help. Because the inflatable toys are readily accessible on the market for a reasonable price and since they are useful for patients with respiratory issues, it is likely they should be used by obese people at level 2. Objective: This study determined the effects of breathing exercises using an inflatable toy that was approved by a specialist to determine the effects after a breathing training program on lung function, respiratory muscle strength, and performance in obese level 2 subjects aged 30 to 65 years. Methods: Eight-seven subjects were obese patients at level 2 with a body mass index (BMI) [greater than or equal to]30. They were randomized by hierarchical stratification using the highest to the lowest order and randomly assigned by the researchers. The samples were grouped by stratified random sampling, and then simple random sampling was used to select the Experimental Group or the Control Group. The researchers drew the lottery themselves to prevent bias from the lottery by writing the code as the number represents each research participant and the box used for the draw was an opaque box. The random details are as follows. The sample was randomly grouped into stratified groups selected by 2 indicators, which were Age and BMI. Then, they were divided into three groups: the Control Group, the Triflow Training Group, and the Toy Blower Group. The training style of the group trained with the triflow device and the group trained with a toy blower device was the same way for both groups. By inhaling and exhaling normally 3 to 5 times and exhaling through the device for 10 times per set, doing 10 sets per training program, which was practiced 3 times a week for a total of 12 weeks for a period of 3 months (i.e., a total of 36 training sessions in all 3 experimental groups were assessed for pulmonary function). Respiratory muscle strength, ability to assessed 6-minute walk distance and physical activity level before and after 12 weeks of training were determined. Results: Although the workouts were constrained by dyspnea symptoms and physical function, pulmonary rehabilitation employing the breathing exercises in conjunction with a toy blowing program is an effective strategy to improve physiological performance and quality of life in obesity level 2 subjects. Because of their limited exercise ability and increased metabolic needs, the subjects were unable to appropriately enhance their ventilation. However, the findings of this study indicate a beneficial relationship between total respiratory rate and intraalveolar respiration during inspiration, with a reduction in respiratory rate and an increase in breathing efficiency in the obesity level 2 subjects. It has been shown that tidal volume increases are accompanied by a reduction in airway obstruction, airway resistance, and elevation. By lowering asthenia and the use of the respiratory muscles, these changes have been shown to ameliorate dyspnea in the Toy Blower and the Triflow Groups. Moreover, using a toy blower for breathing exercises may help to increase exercise capacity. Conclusions: The use of breathing exercises with a toy blower to improve lung function, inspiratory muscle efficiency, and physical activities for obesity level 2 subjects improved many physical values after 12 weeks as physiological modifications from long-term training and effective breathing exercises could contribute to higher efficient use of oxygen consumption, and they are easy to use, inexpensive, and accessible. Therefore, using a toy blower to practice breathing exercises is a novel, non-invasive, user-friendly, and efficient way to strengthen the respiratory muscles and improve lung function. This method also helps to promote daily physical performance that improves the quality of life for people who are obese level 2 and want to extend their life. Key Words; A Toy Blower, Functional Capacity, Lung Function, Obesity Level 2, Respiratory Muscle Strength, 6-Minute Walking Test

Journal of exercise physiology online, 2023-06, Vol.26 (3), p.15

The Effect of a Breathing Training Program using a Toy Blower on Lung Function, Respiratory Muscles Strength, 6-Minute Walking Test, and Functional Capacity in Obesity Level 2

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Effects of intradialytic cycling exercise on daily physical activity, physical fitness, body composition, and clinical parameters in high-volume online hemodiafiltration patients: a pilot randomized-c...

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Export record to excel

Increased NO bioavailability in aging male rats by genistein and exercise training: using 4, 5-diaminofluorescein diacetate

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Export record to excel

The Effect of a Breathing Training Program using a Toy Blower on Lung Function, Respiratory Muscles Strength, 6-Minute Walking Test, and Functional Capacity in Obesity Level 2

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