Lonnie Edwards

Aerobic exercise in obese diabetic patients with chronic kidney disease: a randomized and controlled pilot study

BackgroundPatients with obesity, diabetes, and chronic kidney disease (CKD) are generally physically inactive, have a high mortality rate, and may benefit from an exercise program.MethodsWe performed a 24-week randomized controlled feasibility study comparing aerobic exercise plus optimal medical management to medical management alone in patients with type 2 diabetes, obesity (body mass index [BMI] > 30 kg/m2), and stage 2-4 CKD (estimated glomerular filtration rate [eGFR] 15-90 mL/min/1.73 m2 with persistent proteinuria). Subjects randomized to exercise underwent thrice weekly aerobic training for 6 followed by 18 weeks of supervised home exercise. The primary outcome variable was change in proteinuria.ResultsSeven subjects randomized to exercise and 4 control subjects completed the study. Exercise training resulted in an increase in exercise duration during treadmill testing, which was accompanied by slight but insignificant decreases in resting systolic blood pressure and 24-hour proteinuria. Exercise did not alter GFR, hemoglobin, glycated hemoglobin, serum lipids, or C-reactive protein (CRP). Caloric intake and body weight and composition also did not change with exercise training.ConclusionExercise training in obese diabetic patients with CKD is feasible and may have clinical benefits. A large-scale randomized controlled trial to determine the effects of exercise on renal functions, cardiovascular fitness, inflammation, and oxidative stress in diabetic patients with CKD is planned.

Cardiovascular training effect associated with polestriding exercise in patients with peripheral arterial disease.

Because individuals with claudication pain secondary to peripheral arterial disease (PAD) are limited in both walking speed and duration, the benefits of walking exercise may be insufficient to yield a cardiovascular training effect. The objectives of this analysis were to determine whether polestriding exercise training, performed by persons with PAD, would improve exercise endurance, elicit a cardiovascular training benefit, and improve quality of life (QoL). Persons (n = 49) whose claudication pain limited their exercise capacity were randomized into a 24-week polestriding training program (n = 25, 65.8 ± 7.1 years of age) or a nonexercise attention control group (n = 24, 68.0 ± 8.6 years of age). Those assigned to the polestriding group trained 3 times weekly. Control group subjects came to the laboratory biweekly for ankle blood pressure measurements. A symptom-limited ramp treadmill test, ratings of perceived leg pain, and QoL data (using the Short Form-36) were obtained at baseline and upon completion of training. After 24 weeks of polestriding training, subjects increased their exercise endurance from 10.3 ± 4.1 minute to 15.1 ± 4.5 minute. This was significantly greater than control group subjects whose exercise endurance declined (from 11.2 ± 4.7 to 10.3 ± 4.7 minute; P < .001). Relationships between systolic blood pressure (P < .001), heart rate (P = .04), rate pressure product (P = .05), oxygen uptake (P = .016), and perceived leg pain (P = .02) and exercise time improved from the baseline symptom-limited treadmill test to the 6-month symptom-limited treadmill test in the polestriding group compared to the control group. The improvement in the physical component summary score of the Short Form-36 was also greater in the polestriding group (P = .031). Polestriding training significantly improved the clinical indicators of cardiovascular fitness and QoL, and decreased symptoms of claudication pain during exertion.

Can ventilation-feedback training augment exercise tolerance in patients with chronic obstructive pulmonary disease?

RATIONALE Exercise-induced dynamic hyperinflation contributes to decreased exercise tolerance in chronic obstructive pulmonary disease (COPD). It is unknown whether respiratory retraining (ventilation-feedback [VF] training) can affect exercise-induced dynamic hyperinflation and increase exercise tolerance. OBJECTIVES To determine whether patients with COPD would achieve longer exercise duration if randomized to a combination of exercise training plus VF training than either form of training on its own. METHODS A total of 64 patients randomized to 1 of 3 groups: VF plus exercise (n = 22), exercise alone (n = 20), and VF alone (n = 22). MEASUREMENTS AND MAIN RESULTS Exercise duration before and after 36 training sessions and exercise-induced dynamic hyperinflation and respiratory pattern before and after training were measured. In the 49 patients who completed training, duration of constant work-rate exercise was 40.0 (+/- 20.4) minutes (mean +/- SD) with VF plus exercise, 31.5 (+/- 17.3) minutes with exercise alone, and 16.1 (+/- 19.3) minutes with VF alone. Exercise duration was longer in VF plus exercise than in VF alone (P < 0.0001), but did not reach predetermined statistical significance when VF plus exercise was compared with exercise alone (P = 0.022) (because of multiple comparisons, P </= 0.0167 was used for statistical significance). After training, exercise-induced dynamic hyperinflation, measured at isotime, in VF plus exercise was less than in exercise alone (P = 0.014 for between-group changes) and less than in VF alone (P = 0.019 for between-group changes). After training, expiratory time was longer in VF plus exercise training (P < 0.001), and it was not significantly changed in the other two groups. CONCLUSIONS The combination of VF plus exercise training decreases exercise-induced dynamic hyperinflation and increases exercise duration more than VF alone. An additive effect to exercise training from VF was not demonstrated by predetermined statistical criteria.

Risk factors for death after lung transplant in the US

Abstract We previously analyzed UNOS data from patients (pts) having lung transplant (LTX) with the 4 most common diagnoses to identify risk factors (RF) for death after LTX, limiting the analysis to 11 yrs should be grouped with adults. Analysis of waitlist and post-LTX survival for other diagnoses resulted in 4 adult diagnostic groups and a 5th pediatric group. RF associated with increased risk of death while waitig were identified by another analysis. All pts having LTX from Jan.1/97 to Dec. 31/98 were studied. Group A(n=863): COPD and other obstructive diseases including sarcoid, mean PA 30, BOOP. Group E(n=59): pts

Predictors of death on the unos lung transplant waiting list

31/98 were studied. Group A(n 863): COPD and other obstructive diseases including sarcoid, mean PA 30. Group B(n 216): PPH and pulmonary vascular disease (1995-1998). Group C(n 294): CF, Group D(n 401): all pulmonary fibrosis, sarcoid, mean PA 30, BOOP. Group E(n 59): pts 12 years. To investigate if RF associated with increased risk of death on the waitlist were associated with risk of deatrh after LTX, group-specific Cox regression models were fitted with post LTX death as the outcome. Variables collected at listing or LTX were included in the models: demographic (age, height, weight, body mass index), hemodynamic (PA systolic, diastolic, mean, CO, wedge), pulmonary function (% FVC, FEV-1) or clinical (in hospital or ICU, functional status). One-year estimated survival was: Group A:81.6%, Group B:57.7%, Group C:81.7%, Group D:69%, (p 0.000). Death occurred in 466 pts. Group A:151 deaths, RF: increasing age, in ICU, CMV mismatch. Group B:104 deaths, RF: on ventilator. Group C:62 deaths, RF: previous transfusions, creatinine. Group D:136 deaths, RF: increasing PA systolic. Group E: only 13 deaths, RF incalculable. No variable associated with poor pulmonary function predicted increased risk of death after LTX. Hazard ratios for post-LTX death may be useful to develop a donor distribution algorithm that incorporates risk of death on the waiting list.

The effects of smoking status on walking ability and health-related quality of life in patients with peripheral arterial disease.

BACKGROUND Smoking is a leading risk factor for peripheral arterial disease (PAD), yet little is known about the interrelationships among smoking status, walking endurance, calf muscle tissue oxygenation, and quality of life in patients with PAD. OBJECTIVE The aim of this study was to explore the differences in factors associated with walking endurance including walk distance, perceived walking ability, measures of skeletal muscle tissue oxygenation (StO2), claudication pain, peak oxygen consumption per unit time, and quality of life in smokers versus nonsmokers. METHODS A total of 105 patients with PAD performed progressive, symptom-limited treadmill test. Ankle-brachial index was measured at baseline. Calf muscle tissue oxygenation measures were obtained during testing. The RAND Short Form-36 and Walking Impairment Questionnaire were used to measure health-related quality of life (HR-QoL). RESULTS In the total sample (36 current smokers, 69 nonsmokers), smokers had steeper declines in StO2 from baseline to 2 minutes (42.3% vs 33%, P = .05) and shorter distance walked to onset of claudication pain (142.6 vs 247.7 m) than did nonsmokers (P < .0125), despite having no differences in ankle-brachial index, peak oxygen consumption per unit time, or any momentary measure of StO2 during walking. Smokers reported significantly lower HR-QoL on the Short Form-36 in several domains but no differences in the Walking Impairment Questionnaire measures. The smokers were younger than the nonsmokers; however, when age was entered as a covariate in the analyses, the results remained unchanged. CONCLUSIONS These findings suggest that smokers have lower HR-QoL than do nonsmokers with PAD and that smoking confers risks for disrupted tissue oxygenation above those seen in patients who do not smoke.

Structured Exercise in Obese Diabetic Patients with Chronic Kidney Disease: A Randomized Controlled Trial

Background: Patients with type 2 diabetes mellitus (DM), obesity, and chronic kidney disease (CKD) are generally physically inactive and may benefit from exercise. Our objective was to determine the effects of structured exercise on physical fitness, kidney function, endothelial function, inflammation, and body composition in such patients. Methods: In this randomized, controlled trial, 36 male patients (age 49-81) were randomly assigned to exercise + diet management (n = 18) or diet alone (n = 18). Participants were eligible if they had type 2 DM, body mass index >30 kg/m2, CKD stages 2-4, and persistent proteinuria (>200 mg/g creatinine for >3 months). The exercise intervention was a 12-week (3 days per week) program of aerobic and resistance training followed by 40 weeks of home exercise. The primary outcome measure was change from baseline in urine protein to creatinine ratio (UPCR) at 12 and 52 weeks. Results: Thirty-two participants completed the study (14 exercise + diet, 18 diet-alone group). The change from baseline in UPCR was slightly greater in the diet-alone group at 12 weeks but not at 52 weeks. Changes in both symptom-limited and constant-workrate treadmill times were significantly higher in the exercise + diet group at 12 weeks but not at 52 weeks. There were no significant differences in urine albumin to creatinine ratio, estimated glomerular filtration rate, endothelial function, inflammation, or body composition between the groups. Conclusions: In obese diabetic subjects with CKD, structured exercise improved exercise capacity but not body composition or renal function. This is a work of the US Government and is not subject to copyright protection in the USA. Foreign copyrights may apply. Published by S. Karger AG, Basel