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Sarcopenia as a risk factor for falls in patients undergoing maintenance hemodialysis: a cohort study
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS633–eS832
Ethics approval: This research was approved by the IRB of the University of Oklahoma Health Sciences Center (#2711), Oklahoma City, Oklahoma, USA. http://dx.doi.org/10.1016/j.physio.2015.03.3658 Research Report Platform Presentation Number: RR-PL-2129 Monday 4 May 2015 08:52 Room 328–329 THE WALK 2.0 STUDY: THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND HEALTH-RELATED QUALITY OF LIFE G.S. Kolt 1 , M.J. Duncan 2 , C. Vandelanotte 3 , C.M. Caperchione 4 , R.R. Rosenkranz 5 , A.J. Maeder 1 , T.N. Savage 1 , R. Tague 1 , A. Van Itallie 3 , E.S. George 1 , A. Rebar 3 , W.K. Mummery 6 1 University of Western Sydney, Sydney, Australia; 2 University of Newcastle, Newcastle, Australia; 3 Central Queensland University, Rockhampton, Australia; 4 University of British Columbia, Kelowna, Canada; 5 Kansas State University, Manhattan KA, USA; 6 University of Alberta, Edmonton, Canada
Background: Promotion of health and wellbeing through increased physical activity has increasingly focused on the use of the Internet to achieve maximum reach and effectiveness. To date, however, most Internet-based health promotion strategies have used more static Web 1.0 applications. Newer generation Web 2.0 Internet-based, interactive applications allow users to control the generation and sharing of information for collaboration, and it is thought that this creates better engagement with the website and intervention. The Walk 2.0 Study is investigating the potential of such applications in a 3-arm randomised controlled trial to better understand how these applications may influence health promotion variables including physical activity (PA) and health-related quality of life (HRQL). Purpose: The purpose of this presentation, in particular, is to examine the relationship between HRQL and PA in participants recruited for the substantive Walk 2.0 trial. Methods: The Walk 2.0 Study baseline data (N = 506 adults; mean age = 50.8 ± 13.0 years) was used to examine the relationship between PA and HRQL. The sample comprised 176 males and 330 females. At the time of recruitment, participants reported participating in less than 150 minutes of PA per week. Participants’ PA levels were assessed with the Active Australia Survey and the Short Form Health Survey (SF-36) was used to assess HRQL. Independent samples t-tests were used to identify differences in PA between participants reporting a more favourable health state (i.e., higher SF-36 scores) compared with those with a poorer health state (i.e., lower SF-36 scores).
Results: There were significant differences in PA between participants with higher and lower SF-36 scores for emotional wellbeing (301.8 ± 341.9 mins vs 228.6 ± 275.5 mins, t = 2.44, p < 0.05), energy/fatigue (317.3 ± 352.2 mins vs 208.4 ± 250.5 mins, t = 3.85, p < 0.001), and general health (299.7 ± 330.4 mins vs 223.8 ± 277.8 mins, t = 2.68, p < 0.05). No significant differences were identified in physical functioning between the two groups. Other SF-36 scales were not analysed because of moderate to strong ceiling effects. Conclusion(s): Those participants with lower levels of PA are likely to report lower HRQL. As such, interventions should consider this relationship and aim to engage participants in a way that enhances HRQL. Implications: Physiotherapists are increasingly engaging in ways to improve physical activity levels and quality of life of their clients. It is important that they consider web-based options given the reach that can be achieved. Keywords: Physical activity; Health-related quality of life; Internet Funding acknowledgements: National Health and Medical Research Council (Grant number 589903). Ethics approval: University of Western Sydney Human Research Ethics Committee. http://dx.doi.org/10.1016/j.physio.2015.03.3659 Research Report Poster Presentation Number: RR-PO-14-11-Mon Monday 4 May 2015 12:15 Exhibit halls 401–403 SARCOPENIA AS A RISK FACTOR FOR FALLS IN PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS: A COHORT STUDY K. Kono 1 , Y. Nishida 2 , H. Yabe 3 , Y. Moriyama 4 1 Aichi
Medical College, Rehabilitaion, Kiyosu, Japan; 2 Seirei Christopher University, Rehabilitation, Hamamatsu, Japan; 3 Nagoya Kyoritsu Hospital, Rehabilitation, Nagoya, Japan; 4 Nagoya Kyoritsu Hospital, Wellness Center, Nagoya, Japan Background: Hemodialysis patients are more likely to develop mineral and bone disorders than patients not requiring hemodialysis. As a result, these patients have an elevated risk of bone fracture, when falls occur, as compared to other patients. Moreover, the incidence of sarcopenia among hemodialysis and elderly patients has been increasing, in Japan. Purpose: As a sarcopenia contributes to sever decrease in an individual’s muscle mass, strength, and physical performance, we hypothesized that there was a greater risk of falls among hemodialysis patients with sarcopenia than among
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS633–eS832
those without sarcopenia. We also investigated the fall-related factors among the subscales used to diagnose sarcopenia. Methods: We prospectively enrolled 139 Japanese outpatients who were undergoing maintenance hemodialysis three times/week. We assessed the demographic characteristics of these patients and evaluated them for the presence of sarcopenia, based on the results of baseline subscale measurements, including muscle mass (fat free mass index, FFMI), muscle strength (hand grip), and physical performance (short physical performance battery, SPPB). The primary outcome measure was the incidence of falls during a 1-year followup period. Cox proportional hazard regression was used to assess the contribution of sarcopenia subscale variables to the incidence of falls. Results: The 139 subjects had a median age of 69 years (25th and 75th percentiles, 63 and 75 years), 71 (51%) were women, 21 (15%) had more than three complications, and their median time on maintenance hemodialysis was 5.0 years (25th and 75th percentiles, 2.1 and 9.3 years), at baseline. Forty-seven patients (33.8%) with a median age of 71 years (25th and 75th percentiles, 64.5 and 75 years), fell at least once during the follow up period. In the multivariable analysis, the hazard ratio (HR) for falls in patients with sarcopenia was 1.42 (95% confidence interval [CI], 1.22–1.78; p = 0.007, Log rank; p = 0.012), and each of the sarcopenia subscale measure demonstrated an increase in the risk of falls: a 1-point increase in SPPB (HR, 0.89; 95% CI, 0.82–0.98; p = 0.015), a 1-kg increase in hand-grip strength (HR, 1.01; 95% CI, 0.96–1.07; p = 0.70), and a 1-kg/m2 increase in FFMI (HR, 0.89; 95% CI, 0.74–1.08; p = 0.26). Conclusion(s): The presence of sarcopenia, and the associated decline in physical performance, among outpatients undergoing maintenance hemodialysis was associated with an increased incidence of falls. To prevent falls, hemodialysis patients must be assessed for the presence of sarcopenia, and they should be encouraged to improve their physical function and performance. Implications: Sarcopenia, and its associated decline in physical performance among hemodialysis patients was related to physical activity, decreased protein intake, dialysis nutrition loss, immunologic changes, and other factors. Therefore, physiotherapy is necessary to provide comprehensive improvements in patient physical performance, including appropriate dialysis treatment and nutrition care, and reduce their risk of falling. Keywords: Sarcopenia; Falls; Physical activity Funding acknowledgements: There is no financial support in this study particularly. Ethics approval: We got approval the Aichi medical college ethical committee, approval number was 13022. http://dx.doi.org/10.1016/j.physio.2015.03.3660
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Research Report Poster Presentation Number: RR-PO-01-02-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 COMPARATIVE STUDY OF A CARDIOPULMONARY EXERCISE TEST ON LAND AND UNDERWATER IN PATIENTS WITH CHRONIC HEART FAILURE L. Rizzo Battistella 1 , P. Yazbek Junior 2 , M. Koprowski Garcia 3 1 University of Sao Paulo, Institute of Medicine and Rehabilitation, Physiatry, Sao Paulo, Brazil; 2 University of Sao Paulo, Institute of Medicine and Rehabilitation, Cardiac, Sao Paulo, Brazil; 3 University of Sao Paulo, Medicine and Rehabilitation Institute, Sao Paulo, Brazil
Background: During neck-level immersion, the water pressure causes significant displacement of blood from the lower limbs to intrathoracic circulation, triggering adaptive physiological responses due to the increase in central blood volume and consequent cardiovascular burden. Some authors caution against aquatic exercises in patients with heart failure once these responses overload adaptive cardiovascular mechanisms. However, in controlled situations, immersion in warm water breaks down homeostasis, stimulates regulatory mechanisms and organ and system responses that are beneficial to healthy individuals and those suffering from some degree of heart failure. Finding out the cardio-respiratory reactions during immersion will aid the Cardiologists to better understand, if there is a risk for this group of patients. Purpose: To compare responses to a Cardiopulmonary Exercise Test (CPX) performed in water versus ones on land, investigate and understand patient’s cardio respiratory performance while immersed in warm water. Methods: Forty subjects, twenty patients 63.7 ± 8.89 years of age with chronic heart failure, Classification I-II according to NYHA and twenty healthy subjects 64.7 ± 7.09 years of age performed two CPX tests in a facility equipped with a gas analyser and electrocardiogram (ECG). The first one was conducted on land, and the second was performed one week later on an underwater treadmill. The patients were submerged to the sternal notch in a temperature-controlled swimming pool (33–34 ◦ C). Data was collected in five cardiorespiratory periods: 1. 2. 3. 4. 5.
rest, anaerobic threshold (AT), respiratory compensation point (RCP), maximal effort (ME) and recovery (R).
Results: Statistically significant differences were found in the pool test when compared to the land at the following test moments: Total test time (p < 0.001), patients are able to do more exercicer in pool than on land. Perceived
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS633–eS832
Ethics approval: This research was approved by the IRB of the University of Oklahoma Health Sciences Center (#2711), Oklahoma City, Oklahoma, USA. http://dx.doi.org/10.1016/j.physio.2015.03.3658 Research Report Platform Presentation Number: RR-PL-2129 Monday 4 May 2015 08:52 Room 328–329 THE WALK 2.0 STUDY: THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND HEALTH-RELATED QUALITY OF LIFE G.S. Kolt 1 , M.J. Duncan 2 , C. Vandelanotte 3 , C.M. Caperchione 4 , R.R. Rosenkranz 5 , A.J. Maeder 1 , T.N. Savage 1 , R. Tague 1 , A. Van Itallie 3 , E.S. George 1 , A. Rebar 3 , W.K. Mummery 6 1 University of Western Sydney, Sydney, Australia; 2 University of Newcastle, Newcastle, Australia; 3 Central Queensland University, Rockhampton, Australia; 4 University of British Columbia, Kelowna, Canada; 5 Kansas State University, Manhattan KA, USA; 6 University of Alberta, Edmonton, Canada
Background: Promotion of health and wellbeing through increased physical activity has increasingly focused on the use of the Internet to achieve maximum reach and effectiveness. To date, however, most Internet-based health promotion strategies have used more static Web 1.0 applications. Newer generation Web 2.0 Internet-based, interactive applications allow users to control the generation and sharing of information for collaboration, and it is thought that this creates better engagement with the website and intervention. The Walk 2.0 Study is investigating the potential of such applications in a 3-arm randomised controlled trial to better understand how these applications may influence health promotion variables including physical activity (PA) and health-related quality of life (HRQL). Purpose: The purpose of this presentation, in particular, is to examine the relationship between HRQL and PA in participants recruited for the substantive Walk 2.0 trial. Methods: The Walk 2.0 Study baseline data (N = 506 adults; mean age = 50.8 ± 13.0 years) was used to examine the relationship between PA and HRQL. The sample comprised 176 males and 330 females. At the time of recruitment, participants reported participating in less than 150 minutes of PA per week. Participants’ PA levels were assessed with the Active Australia Survey and the Short Form Health Survey (SF-36) was used to assess HRQL. Independent samples t-tests were used to identify differences in PA between participants reporting a more favourable health state (i.e., higher SF-36 scores) compared with those with a poorer health state (i.e., lower SF-36 scores).
Results: There were significant differences in PA between participants with higher and lower SF-36 scores for emotional wellbeing (301.8 ± 341.9 mins vs 228.6 ± 275.5 mins, t = 2.44, p < 0.05), energy/fatigue (317.3 ± 352.2 mins vs 208.4 ± 250.5 mins, t = 3.85, p < 0.001), and general health (299.7 ± 330.4 mins vs 223.8 ± 277.8 mins, t = 2.68, p < 0.05). No significant differences were identified in physical functioning between the two groups. Other SF-36 scales were not analysed because of moderate to strong ceiling effects. Conclusion(s): Those participants with lower levels of PA are likely to report lower HRQL. As such, interventions should consider this relationship and aim to engage participants in a way that enhances HRQL. Implications: Physiotherapists are increasingly engaging in ways to improve physical activity levels and quality of life of their clients. It is important that they consider web-based options given the reach that can be achieved. Keywords: Physical activity; Health-related quality of life; Internet Funding acknowledgements: National Health and Medical Research Council (Grant number 589903). Ethics approval: University of Western Sydney Human Research Ethics Committee. http://dx.doi.org/10.1016/j.physio.2015.03.3659 Research Report Poster Presentation Number: RR-PO-14-11-Mon Monday 4 May 2015 12:15 Exhibit halls 401–403 SARCOPENIA AS A RISK FACTOR FOR FALLS IN PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS: A COHORT STUDY K. Kono 1 , Y. Nishida 2 , H. Yabe 3 , Y. Moriyama 4 1 Aichi
Medical College, Rehabilitaion, Kiyosu, Japan; 2 Seirei Christopher University, Rehabilitation, Hamamatsu, Japan; 3 Nagoya Kyoritsu Hospital, Rehabilitation, Nagoya, Japan; 4 Nagoya Kyoritsu Hospital, Wellness Center, Nagoya, Japan Background: Hemodialysis patients are more likely to develop mineral and bone disorders than patients not requiring hemodialysis. As a result, these patients have an elevated risk of bone fracture, when falls occur, as compared to other patients. Moreover, the incidence of sarcopenia among hemodialysis and elderly patients has been increasing, in Japan. Purpose: As a sarcopenia contributes to sever decrease in an individual’s muscle mass, strength, and physical performance, we hypothesized that there was a greater risk of falls among hemodialysis patients with sarcopenia than among
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS633–eS832
those without sarcopenia. We also investigated the fall-related factors among the subscales used to diagnose sarcopenia. Methods: We prospectively enrolled 139 Japanese outpatients who were undergoing maintenance hemodialysis three times/week. We assessed the demographic characteristics of these patients and evaluated them for the presence of sarcopenia, based on the results of baseline subscale measurements, including muscle mass (fat free mass index, FFMI), muscle strength (hand grip), and physical performance (short physical performance battery, SPPB). The primary outcome measure was the incidence of falls during a 1-year followup period. Cox proportional hazard regression was used to assess the contribution of sarcopenia subscale variables to the incidence of falls. Results: The 139 subjects had a median age of 69 years (25th and 75th percentiles, 63 and 75 years), 71 (51%) were women, 21 (15%) had more than three complications, and their median time on maintenance hemodialysis was 5.0 years (25th and 75th percentiles, 2.1 and 9.3 years), at baseline. Forty-seven patients (33.8%) with a median age of 71 years (25th and 75th percentiles, 64.5 and 75 years), fell at least once during the follow up period. In the multivariable analysis, the hazard ratio (HR) for falls in patients with sarcopenia was 1.42 (95% confidence interval [CI], 1.22–1.78; p = 0.007, Log rank; p = 0.012), and each of the sarcopenia subscale measure demonstrated an increase in the risk of falls: a 1-point increase in SPPB (HR, 0.89; 95% CI, 0.82–0.98; p = 0.015), a 1-kg increase in hand-grip strength (HR, 1.01; 95% CI, 0.96–1.07; p = 0.70), and a 1-kg/m2 increase in FFMI (HR, 0.89; 95% CI, 0.74–1.08; p = 0.26). Conclusion(s): The presence of sarcopenia, and the associated decline in physical performance, among outpatients undergoing maintenance hemodialysis was associated with an increased incidence of falls. To prevent falls, hemodialysis patients must be assessed for the presence of sarcopenia, and they should be encouraged to improve their physical function and performance. Implications: Sarcopenia, and its associated decline in physical performance among hemodialysis patients was related to physical activity, decreased protein intake, dialysis nutrition loss, immunologic changes, and other factors. Therefore, physiotherapy is necessary to provide comprehensive improvements in patient physical performance, including appropriate dialysis treatment and nutrition care, and reduce their risk of falling. Keywords: Sarcopenia; Falls; Physical activity Funding acknowledgements: There is no financial support in this study particularly. Ethics approval: We got approval the Aichi medical college ethical committee, approval number was 13022. http://dx.doi.org/10.1016/j.physio.2015.03.3660
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Research Report Poster Presentation Number: RR-PO-01-02-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 COMPARATIVE STUDY OF A CARDIOPULMONARY EXERCISE TEST ON LAND AND UNDERWATER IN PATIENTS WITH CHRONIC HEART FAILURE L. Rizzo Battistella 1 , P. Yazbek Junior 2 , M. Koprowski Garcia 3 1 University of Sao Paulo, Institute of Medicine and Rehabilitation, Physiatry, Sao Paulo, Brazil; 2 University of Sao Paulo, Institute of Medicine and Rehabilitation, Cardiac, Sao Paulo, Brazil; 3 University of Sao Paulo, Medicine and Rehabilitation Institute, Sao Paulo, Brazil
Background: During neck-level immersion, the water pressure causes significant displacement of blood from the lower limbs to intrathoracic circulation, triggering adaptive physiological responses due to the increase in central blood volume and consequent cardiovascular burden. Some authors caution against aquatic exercises in patients with heart failure once these responses overload adaptive cardiovascular mechanisms. However, in controlled situations, immersion in warm water breaks down homeostasis, stimulates regulatory mechanisms and organ and system responses that are beneficial to healthy individuals and those suffering from some degree of heart failure. Finding out the cardio-respiratory reactions during immersion will aid the Cardiologists to better understand, if there is a risk for this group of patients. Purpose: To compare responses to a Cardiopulmonary Exercise Test (CPX) performed in water versus ones on land, investigate and understand patient’s cardio respiratory performance while immersed in warm water. Methods: Forty subjects, twenty patients 63.7 ± 8.89 years of age with chronic heart failure, Classification I-II according to NYHA and twenty healthy subjects 64.7 ± 7.09 years of age performed two CPX tests in a facility equipped with a gas analyser and electrocardiogram (ECG). The first one was conducted on land, and the second was performed one week later on an underwater treadmill. The patients were submerged to the sternal notch in a temperature-controlled swimming pool (33–34 ◦ C). Data was collected in five cardiorespiratory periods: 1. 2. 3. 4. 5.
rest, anaerobic threshold (AT), respiratory compensation point (RCP), maximal effort (ME) and recovery (R).
Results: Statistically significant differences were found in the pool test when compared to the land at the following test moments: Total test time (p < 0.001), patients are able to do more exercicer in pool than on land. Perceived