Upper limb isometric exercise protocolled programme and arteriovenous fistula maturation process

Abstract Introduction Arteriovenous fistula (AVF) is the gold standard for vascular access (VA) for end-stage chronic kidney disease (CKD) patients. Post-operative exercises may help to improve maturation. Nevertheless, scarce scientific evidence has been reported about their utility to date. Our objective was to assess the effect of a post-operative isometric exercise programme on native VA maturation in patients with stage 5–5D CKD. Methods We performed a 24-month prospective study. After surgery, patients were randomized to the isometric exercise group (EG) or control group (CG). An isometric exercise protocolled programme was performed in the EG. The CG received usual care. Demographic data, muscle strength using a hand-grip (HG) dynamometer, main Doppler ultrasound (DUS) measurements, clinical and DUS maturation and VA complications were assessed at 4 and 8 weeks post-operatively. Results For 60 sixty patients (30 in the EG), demographic data and HG and DUS measurements at baseline were similar. A significant increase in HG was observed only in the EG at the end of the study (20.7 ± 8.1 versus 25.1 ± 10.3 kg, P = 0.001). The EG obtained the highest clinical maturation at 4 (CG 33.3% versus EG 70%, P = 0.009) and 8 weeks (CG 33.3% versus EG 76.7%, P = 0.002). Similarly, DUS maturation was better in the EG at 4 (CG 40% versus EG 80%, P = 0.003) and 8 weeks (CG 43.3% versus EG 83.3%, P = 0.003) and remained so in the EG for both distal and proximal VA territories for all these periods. Conclusions The upper limb isometric exercise protocolled programme improved clinical and DUS maturation in our patients in both the distal and proximal VA territories. Further studies are required to support these results.

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P1338ELDERLY PATIENTS, UPPER LIMB ISOMETRIC EXERCISES AND ARTERIOVENOUS FISTULA MATURATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1338 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Irati Tapia González ◽

Vicent Esteve Simo ◽

Sara Ibañez Pallares ◽

Sandra Rubio ◽

Fatima Moreno Guzman ◽

...

Keyword(s):

Elderly Patients ◽

Arteriovenous Fistula ◽

Upper Limb ◽

Elderly Population ◽

Scientific Evidence ◽

Demographic Data ◽

Isometric Exercise ◽

Blood Flow Rate ◽

Exercise Group ◽

Control Group

Abstract Background and Aims: Introduction Arteriovenous fistula (AVF) creation may be controversial in elderly population, given their comorbidities, reduced life expectancy and vascular access (VA) complications. Postoperative upper limbs isometric exercise improves AVF maturation. Nevertheless, scarce scientific evidence has been reported about their utility in elderly population until date. Objectives To assess the effect of a postoperative isometric exercises program on native VA maturation in our patients older than 75 years old with stages 5-5D chronic kidney disease. Method A 24 months prospective single-center study. After surgery, all patients were randomized to an isometric exercise group (EG) or a control group (CG). Isometric exercises protocolled programm, was performed in EG. CO received usual care. Demographical data, muscle strength using handgrip (HG) dynamometer, main Doppler ultrasound (DUS) measurements (outflow vein (OV) diameter and humeral artery blood flow rate (BFR), clinical and DUS maturation as well as medical (hematoma, stenosis, thrombosis, pseudoaneurysm, aneurysm) or surgical VA complications were assessed at 8 weeks postoperatively. Results 27 patients. 14 EG, 13 CO. 74,1% men. Mean age 79,9±2,8 years. 59,2% Radiocephalic AVF. Demographic data, HG and DUS measurement at baseline were similar. A significant increase in HG was observed only in EG at the end of study (19,1±7,8 vs 22,9±9,7Kg, p=0,001). DUS measurements statistically increased for both groups (OV diameter: EG 3,1 ± 0,8 vs. 5,9 ± 1,7 mm; CG 2,9 ± 0,6 vs. 5,8 ± 1,4mm; humeral artery BFR: EG 150,7± 42,7 vs. 1165,0 ± 664,5 ml/min; CG 132,9± 30,3 vs. 1310,2 ± 691,8ml/min) at the end of study. EG group obtained highest clinical (CG 46,2% vs EG 78,6%;p=0,049) and DUS maturation (CG 30,8% vs EG 71,4%; p=0,041) at 8 weeks, significantly. Despite no significant differences, the number of complications was lower in the EG, mainly hematomas and significant stenosis. Conclusion The upper limb isometric exercises protocolled program improved clinical and DUS maturation in our elderly patients. With our results, isometric exercises should be guaranteed in elderly patients in order to obtain a correct maturation of the performed AVF. Further studies are required to support these outcomes in this population.

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MO776THE USE OF HAND GRIP DEVICE IN ELDERLY PATIENTS ON ARTERIOVENOUS FISTULA MATURATION PROCESS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab103.0014 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Irati Tapia González ◽

Vicent Esteve ◽

Sara Ibañez ◽

Sandra Rubio ◽

Fatima Moreno Guzman ◽

...

Keyword(s):

Elderly Patients ◽

Training Program ◽

Arteriovenous Fistula ◽

Elderly Population ◽

Therapeutic Option ◽

Demographic Data ◽

Blood Flow Rate ◽

Control Group ◽

Maturation Process ◽

Hand Grip

Abstract Introduction The indication of creation arteriovenous fistula(AVF) may be controversial in elderly population with advanced chronic kidney disease (CKD). Postoperative exercises improve maturation. However, sometimes these exercises could be difficult to perform in the elderly CKD patients. The hand grip device is easy to use, inexpensive and able to increase the muscles of the hand and foream. Nevertheless, scarce scientific evidence has been reported about the role of hand grip device on AVF maturation process in elderly population. Objectives To evaluate the efficacy of a hand grip training program on AVF maturation in our patients older than 75 years old with stages 5-5D CKD. Methodology A 15 months prospective study. After surgery, all patients were randomized to hand grip group (HG) or control group (CG). HG performed a training program using a hand grip device. CO received usual care. Demographics data, upper limb muscle strength (ULMS), Doppler ultrasound (DUS), measurements (outflow vein (OV) diameter and humeral artery blood flow rate (BFR), DUS and clinical AVF maturation as well as VA related complications (hematoma, stenosis, thrombosis, pseudoaneurysm, aneurysm) were assessed at 4 and 8 weeks postoperatively. Results 29 patients. 16 HG, 13 CO. 69% men. Mean age 80,5±2,9 years. 41,4% Radiocephalic AVF. Demographic data, ULMS and DUS measurement at baseline were similar. A significant increase was observed in ULMS only in HG at the end of study (18,8±6,5 vs 21,3±7,1Kg, p=0,005). DUS measurements statistically increased for both groups (OV diameter: CG 2,9 ± 0,6 vs. 5,8 ± 1,4mm; HG 2,9 ± 0,8 vs. 7,2 ± 2,2 mm; humeral artery BFR: CG 132,9± 30,3 vs. 1310,2 ± 691,8ml/min; HG 128,1± 28,9 vs. 1530,7 ± 708,9 ml/min) at the end of study. HG group obtained highest clinical (CG 21,4% vs HG 78,6%;p=0,018) and DUS maturation (CG 27,8% vs HG 72,2%; p=0,011) at 4 weeks and highest clinical (CG 20% vs HG 80%;p=0,007) and DUS maturation (CG 25% vs HG 75%; p=0,002) at 8 weeks, significantly. Despite no significant differences, the number of complications was lower in the HG, mainly significant stenosis (CG 60% vs HG 40%; p=0,428). Conclusions The hand grip device is a useful, safety and easy to use training device to improve the AVF maturation in elderly patients. This device results a novel therapeutic option for the AVF maturation in elderly patients. Further studies are required to support these outcomes in this population.

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Effects of Arterial Needle Placement in Arteriovenous Fistula on Dialysis Adequacy of End-Stage Renal Disease Patients Undergoing Maintenance Hemodialysis

Journal of Nursing & Healthcare ◽

10.33140/jnh/01/02/00010 ◽

2016 ◽

Vol 1 (2) ◽

Keyword(s):

Blood Flow ◽

Arteriovenous Fistula ◽

Intervention Group ◽

Maintenance Hemodialysis ◽

Control Group ◽

Needle Placement ◽

Dialysis Adequacy ◽

Significant Difference ◽

Stage Renal Disease ◽

End Stage

Objective: The arterial needle placement in arteriovenous fistula (AVF) can either be antegrade (in the direction of blood flow or pointing towards the heart) or retrograde (against the direction of blood flow) while venous needle placement should always be in the same direction as the blood flow. This study determined the effects of arterial needle placement in the arteriovenous fistula on dialysis adequacy of End-Stage Renal Disease (ESRD) patients undergoing maintenance hemodialysis in United Candelaria Doctors Hospital - Nephro Synergies Inc. (UCDHNSI) Hemodialysis Center. Methods: A randomized controlled trial design was used in the study. A total of 20 non-diabetic, non-cardiac patients on maintenance hemodialysis for more than 6 months were randomized either to the intervention group (patients’ AVF were cannulated in a retrograde manner) or the control group (patients’ AVF were cannulated in an antegrade manner). Urea reduction ratio (URR) and Kt/V as well as access recirculation percentage were used to determine dialysis adequacy. Pre-dialysis, in the first 30 minutes of dialysis initiation and post-dialysis blood samples were obtained in each patient in 6 succeeding hemodialysis considering dialyzer reuse up to fifth reuse. Means were compared by independent t-test. Results: The findings of the study revealed that the mean URR and Kt/V of the subjects cannulated in retrograde manner and antegrade manner were 69.35% and 1.45, and 74.65% and 1.70, respectively. The mean access recirculation percentage of the subjects was 4.65% in the intervention group and 3.02% in the control group. There was a significant difference on URR and Kt/V of the subjects using retrograde and antegrade arterial needle placement in 6 succeeding hemodialysis sessions. There was no significant difference on access recirculation percentage of the subjects using retrograde and antegrade arterial needle placement in 6 succeeding hemodialysis sessions. Conclusions: Antegrade arterial needle placement provides more adequate hemodialysis than retrograde arterial needle placement in terms of URR and Kt/V values among non-diabetic, non-cardiac patients undergoing maintenance hemodialysis in 6 succeeding hemodialysis sessions. The directions of the arterial needle either retrograde and antegrade did not have significant effects on access recirculation.

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Impact of Resistance Exercise On Hand Grip: An Experimental study

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl4.3818 ◽

2020 ◽

Vol 11 (SPL4) ◽

pp. 371-375

Author(s):

Bhuvaneshwari G ◽

Nithya Manogaran

Keyword(s):

Resistance Exercise ◽

Research Design ◽

Elderly Population ◽

Demographic Data ◽

The Elderly ◽

Muscle Quality ◽

Control Group ◽

Hand Grip ◽

The Impact ◽

Experimental Group

Sarcopenia is a significant medical issue related with aging, characterized as loss of bulk and capacity. It is a condition portrayed by loss of skeletal bulk and quality, with a danger of antagonistic results, for example, handicap, improvement of delicacy, low quality of life and death. Its etiology is still inadequately comprehended. Opposition preparing intercession is sheltered and compelling for checking sarcopenia. Resistance exercise (RE) programs improve muscle anabolism, bulk and muscle quality. The present study aims to assess the impact of resistance exercise on hand grip among the elderly population with sarcopenia. A quasi experimental research design with non-randomized control research design was conducted among 30 elderly population in Arrakonam among which 15 were chosen for the experimental group and 15 were chosen as the control group. A purposive sampling technique was used to select samples. Structured questionnaires were used to collect demographic data and BMI and hand grip was assessed. The resistance exercises were taught to the elderly population and they were asked to perform the exercise every day for one week. After a week, the BMI and hand grip was re-assessed. The studies thus indicates that the experimental group had a reduction in the hand grip and increase in the BMI value after resistance exercise and is also an effective method to prevent further complications that can be caused due to sarcopenia.

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Effect of local papaverine on arteriovenous fistula maturation in patients with end-stage renal disease

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2018-0170 ◽

2019 ◽

Vol 41 (2) ◽

pp. 185-192 ◽

Cited By ~ 1

Author(s):

Reza Manani ◽

Gholamreza Kazemzadeh ◽

Ali Saberi ◽

Fatemeh Sadeghipour ◽

Asghar Rahmani

Keyword(s):

Renal Disease ◽

Arteriovenous Fistula ◽

End Stage Renal Disease ◽

Control Group ◽

Case Group ◽

Maturation Time ◽

Stage Renal Disease ◽

End Stage ◽

And Control ◽

Fistula Maturation

Abstract Background: Arteriovenous fistula (AVF) maturation is one of the main concerns in patients with end-stage renal disease (ESRD) and finding a strategy for increasing success rate and accelerating fistula maturation is valuable. The aim of this study was to evaluate the effects of papaverine injection on AVF maturation and success rate. Method: This study was a randomized clinical trial that involved 110 patients with ESRD that were referred for AVF construction. Patients were allocated in papaverine group and control group with block randomization according to age and sex. In the case group, papaverine (0.1 or 0.2 cc) was injected locally within the subadventitia of artery and vein after proximal and distal control during AVF construction and in the control group, AVF construction was done routinely without papaverine injection. Results: Maturation time in case and control groups was 37.94 ± 11.49 and 44.23 ± 9.57 days, respectively (p=0.004). Hematoma was not seen in the case group but occurred in one patient in the control group. One patient of the case group developed venous hypertension. Four functional fistulas, 1 (1.8%) in the case group and 3 (5.5%) in the control group, failed to mature (p=0.618). Maturation rate did not differ between the two groups statistically (p=0.101). Conclusion: Local papaverine injection increased vessel diameter and blood flow, increasing shearing stress in both arterial and venous segment of recently created AVF. In this way, papaverine probably can decrease AVF maturation time without an increase in complications.

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Effects of Multicomponent Exercise Training on Physical Functioning among Institutionalized Elderly

ISRN Rehabilitation ◽

10.5402/2012/124916 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 9

Author(s):

Maria Justine ◽

Tengku Aizan Hamid ◽

Vikram Mohan ◽

Madhanagopal Jagannathan

Keyword(s):

Exercise Training ◽

Grip Strength ◽

Upper Limb ◽

Physical Functioning ◽

Lower Limb ◽

Exercise Group ◽

Institutionalized Elderly ◽

Hand Grip ◽

Lower Limb Strength ◽

Cardiorespiratory Endurance

This quasiexperimental study aimed to measure the effects of 12-week multicomponent exercise training on physical functioning among institutionalized elderly. Forty-three participants (age = 70.88 ± 7.82 years) were self-assigned to an intervention (n=23) or control (n=20) group. Before and after training, cardiorespiratory endurance, arm curl strength, grip strength, lower limb strength, upper and lower limb flexibility, balance, and mobility were assessed. The training included aerobic, resistance, balance and flexibility exercises, performed 3 times per week. Significant increases (P<0.05) were observed in the exercise group on cardiorespiratory endurance (41.79%), right arm curl strength (25%), left arm curl strength (30.79%), right hand grip strength (13.65%), left hand grip strength (9.93%), lower limb strength (46.19%), balance (49.58%), and mobility (26.37%). Measures of flexibility in the exercise group also showed improvement (right lower limb (63.57%), left lower limb (44.17%), right upper limb (36.67%), and left upper limb (63.1%)) but were not statistically significant (all, P>0.05). The control group did not show any significant changes (P>0.05) in any variables. The data suggested that 12-week multicomponent exercise training may improve physical functioning among institutionalized elderly.

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Physical exercise and goal attainment after shunt surgery in idiopathic normal pressure hydrocephalus: a randomised clinical trial

Fluids and Barriers of the CNS ◽

10.1186/s12987-021-00287-8 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Johanna Rydja ◽

Lena Kollén ◽

Per Hellström ◽

Katarina Owen ◽

Åsa Lundgren Nilsson ◽

...

Keyword(s):

Physical Exercise ◽

Goal Attainment ◽

Normal Pressure ◽

Exercise Programme ◽

Exercise Group ◽

Attrition Rate ◽

University Hospital ◽

Control Group ◽

Shunt Surgery ◽

Post Intervention

Abstract Background Rehabilitation in iNPH is suggested to be an important factor to improve patients’ functions but there are lack of clinical trials evaluating the effect of rehabilitation interventions after shunt surgery in iNPH. The objective of this study was to evaluate the effect of a physical exercise programme and goal attainment for patients with idiopathic normal pressure hydrocephalus (iNPH) after surgery compared to a control group. Methods This was a dual centre randomised controlled trial with assessor blinding, intention-to-treat (ITT) and per protocol (PP) analysis. Individuals diagnosed with iNPH scheduled to undergo shunt surgery at the Linköping University Hospital in Linköping and Sahlgrenska University Hospital in Gothenburg, Sweden were consecutively eligible for inclusion. Inclusion was conducted between January 2016 and June 2018. The patients were randomised 1:1 using sequentially numbered sealed envelopes to receive either written exercise information (control group) or written information and an additional supervised high-intensity, functional exercise programme (HIFE) executed twice weekly over 12 weeks (exercise group). Preoperatively, the patients set individual goals. The primary outcome was change from baseline in the total iNPH scale score at the post-intervention follow-up. Secondary outcomes were goal attainment, and change in the separate scores of gait, balance, neuropsychology and continence and in the total score after 6 months. Results In total, 127 participants were randomised to the exercise group (n = 62) and to the control group (n = 65). In the ITT population (exercise group, n = 50; control group, n = 59), there were no between-group differences in the primary outcome, but the attrition rate in the exercise group was high. The exercise group improved more than the control group in the balance domain scores after 6 months. Post-intervention, the PP exercise population achieved their set goals to a greater extent than the controls. Conclusions An additional effect of the 12-week HIFE-programme on the overall improvement according to the iNPH-scale after shunt surgery in iNPH was not shown. This could be due to high attrition rate. However, the long-term effect on balance and higher goal achievement indicate beneficial influences of supervised physical exercise. Trial registration clinicaltrials.gov, NCT02659111. Registered 20 January 2016, https://clinicaltrials.gov/ct2/show/NCT02659111

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The effectiveness of vestibular stimulation by rocking and vestibular exer-cises on postural stability, depression, anxiety and stress in elderly

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v10i2.423 ◽

2019 ◽

Vol 10 (2) ◽

pp. 1293-1297

Author(s):

Sahaya Rani ◽

Archana R ◽

Shyla Kamala Kumari

Keyword(s):

Postural Stability ◽

Demographic Data ◽

The Elderly ◽

Vestibular Stimulation ◽

Exercise Group ◽

Control Group ◽

Fetal Life ◽

Elderly Male

Using swings and rocking chair is a universal practice. Rocking was soothing as it offers relaxation through vestibular stimulation. Stimulation of vestibular receptors will begin during fetal life, and it was recommended to continue throughout life. The present study was undertaken to observe the effectiveness of vestibular stimulation by rocking on postural stability in the elderly. A total of 150 elderly male and females were part of the study after obtaining the written informed consent. After recruiting the participants, they were randomly grouped into three groups with 50 participants in each group. Neither exercise nor rocking was administered to the control group. Rocking was administered using a rocking chair once a day for 5 days in a week for 6 months for a rocking group. Rocking was administered using a rocking chair once a day for 5 days in a week + vestibular exercises were practiced two sessions per week for 6 months for rocking and vestibular exercise group. Demographic data were not significant between the groups. There was a significant decrease (P<0.001) in the stress score in both rocking the only group and rocking along with vestibular exercise group. The present study highlights the beneficial role of vestibular stimulation by rocking and by vestibular exercises in improving the postural stability and reducing the negative emotions like depression, anxiety and stress. Hence, the study recommends practicing vestibular stimulation either by rocking or by exercises in day to day life for better quality of life in general.

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Effects of Heparin on Early Patency of Arteriovenous Fistula in Angioaccess Surgery of Patients with End-Stage Renal Disease

Internal Medicine And Medical Investigation Journal ◽

10.24200/imminv.v2i4.108 ◽

2018 ◽

Vol 3 (1) ◽

pp. 36

Author(s):

Mohamamd Mozafar ◽

Fatemeh Hoseinzadegan ◽

Saran Lotfollahzadeh ◽

Maryam Baikpour ◽

Razie Amraei ◽

...

Keyword(s):

Renal Disease ◽

Arteriovenous Fistula ◽

Vascular Access ◽

End Stage Renal Disease ◽

Control Group ◽

Post Surgery ◽

Significant Difference ◽

Systemic Anticoagulation ◽

Stage Renal Disease ◽

End Stage

Background: Arteriovenous fistula (AVF) is now the optimal method of obtaining vascular access for dialysis. Measures such as systemic anticoagulation have been proposed as means of increasing patency rates but enough evidence does not exist to support their application. We aimed to evaluate the efficacy of preoperative heparin injection on patency of AVF during the first 24 hours after surgery and to determine whether such measure can be used to prevent early thrombosis of the vascular access.Methods: The study was carried out on 150 patients admitted to Shohada-e-Tajrish hospital for permanent vascular access placement during 2011-2012. 75 patients were randomly assigned to receive 100 units/kg of heparin intraoperatively and at 24 hours post-surgery AVF patency rate was assessed and compared to the control group. Results: All the 75 patients who had received heparin intraoperatively had a patent arteriovenous fistula 24 hours post-surgery which showed a statistically significant difference compared to the control group among which only 69 (92%) patients had a functioning AV fistula (p-value= 0.028).Conclusions: Our results show that systemic anticoagulation with heparin can be considered as an effective option in preventing vascular access failure. However, considering the contradictory data on the usefulness of heparin injection, larger trials are needed to evaluate efficacy and adverse effects of systemic intraoperative anticoagulation in End-Stage Renal Disease (ESRD) patients before qualifying it as a method of increasing AVF patency in these patients

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Effects of a structured exercise programme in sedentary dogs with chronic diarrhoea

Veterinary Record ◽

10.1136/vr.103902 ◽

2016 ◽

Vol 180 (9) ◽

pp. 224-224 ◽

Cited By ~ 1

Author(s):

H.-P. Huang ◽

Y.-H. Lien

Keyword(s):

Clinical Symptoms ◽

Activity Index ◽

Disease Activity Index ◽

Exercise Programme ◽

Exercise Group ◽

Moderate Intensity ◽

Control Group ◽

Chronic Diarrhoea ◽

Positive Effects ◽

Prednisolone Treatment

The aim of this investigation was to evaluate the effects of a structured exercise programme in sedentary dogs with chronic diarrhoea. Twenty-two dogs were enrolled in the study. All dogs received oral prednisolone (1 mg/kg/day for 14 days, followed by a tapering dosage) for 10 weeks. After four weeks of prednisolone treatment, dogs were assigned to either the exercise or control group (n=11 each). Owners of dogs in the exercise group were instructed to guide their dogs in structured exercise training (low-intensity to moderate-intensity aerobic and resistance exercise three to five days per week). After 10 weeks of prednisolone treatment with concomitant 6 weeks of complementary exercise, the Canine Inflammatory Bowel Disease Activity Index (CIBDAI) score had decreased significantly in the exercise group (from 8.8±1.5 at the start of the exercise programme to 2.4±1.5; P<0.001); no such change was observed in the control group (from 9.2±0.9 to 9.2±1.1). CIBDAI scores differed significantly between the groups at the end of the 10-week study period (P<0.001). The exercise programme affected all six CIBDAI parameters significantly; bodyweight (P<0.001, adjusted r2=0.722) was most affected. A structured exercise programme may have positive effects on clinical symptoms in sedentary dogs with chronic diarrhoea.

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