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
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
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 .