脑出血患者发生急性肾损伤的危险因素及预后分析

目的了解脑出血患者急性肾损伤(AKI)的发生情况、住院病死情况及其相关危险因素。方法回顾性分析2015年1月-2016年5月于武汉大学中南医院住院的354例脑出血患者的临床资料,以Logistic回归方程分析脑出血患者发生AKI及住院病死情况相关的独立危险因素,描绘ROC曲线,评价各独立危险因素对于脑出血患者AKI的发生及住院病死的预测价值。结果纳入354例脑出血患者AKI总发病率为35. 3%,AKI 1期、2期、3期发病率分别为22. 3%、5. 1%、7. 9%。脑出血患者总住院病死率为28. 3%,与非AKI组相比,AKI组患者的住院病死率显著增高(49. 6%vs. 7. 0%,P 0. 01),AKI 1期、2期、3期患者住院病死率分别为39. 2%,55. 6%,75. 0%。Logistic回归结果提示,使用利尿剂(OR=1. 796)、使用机械通气(OR=1. 728)、高急性生理与慢性健康状况评分(APACHEⅡ评分)(OR=1. 153)是脑出血患者发生AKI的独立危险因素。发生AKI(OR=5. 452)、贫血(OR=2. 786)、高龄(OR=1. 025)、高APACHEⅡ评分(OR=1. 198)是脑出血患者住院病死的独立危险因素。APACHEⅡ评分预测脑出血患者AKI的发生及住院病死均具有良好的准确性(AUC分别为0. 802,0. 864,均P 0. 01)。结论 AKI是脑出血患者常见的并发症,病死率高。重视AKI的早期筛查,尽早干预,是降低脑出血患者住院病死率有效措施。     

冠状动脉造影术后发生对比剂肾病的危险因素分析及防治措施探讨

目的探讨冠状动脉造影术后发生对比剂肾病(contrast induced nephropathy,CIN)的危险因素及其防治措施。方法选择2014年1月至2015年10月于新疆昌吉州人民医院行冠状动脉造影术的1 115例患者为研究对象,所有患者均按照标准法行冠状动脉造影术,术中使用对比剂为低渗非离子型对比剂碘佛醇,术前检测血肌酐(SCr),术后24~72 h复查SCr,根据患者手术前后SCr水平变化分为CIN组83例和非CIN组1 032例,2组患者使用相同方法进行水化、碱化。统计2组患者年龄、性别、吸烟、对比剂剂量以及糖尿病、慢性肾脏病、高血压、高脂血症、心功能不全方面的资料,数据采用SPSS 20.0统计软件进行分析,并进行多因素Logistic回归分析,指出发生CIN的危险因素,并提出防治措施。结果 1 115例接受冠状动脉造影术的患者中有83例发生CIN,CIN的发生率为7.44%。CIN组患者在年龄、糖尿病、慢性肾脏病、对比剂剂量方面与非CIN组比较,差异有统计学意义(P0.01);2组在性别、吸烟、高血压、高血脂、心功能不全方面差异无统计学意义(P0.01)。Logistic回归分析显示:高龄(OR=1.005,95%CI:1.005~1.048,P=0.002),慢性肾脏病(OR=5.977,95%CI:4.652~6.054,P=0.000),糖尿病(OR=2.077,95%CI:1.214~3.555,P=0.008),对比剂剂量(OR=2.020,95%CI:1.240~3.293,P=0.005),性别(OR=0.858,95%CI:0.599~1.229,P=0.403),吸烟(OR=0.858,95%CI:0.558~1.053,P=0.101),高血压(OR=1.141,95%CI:0.825~1.577,P=0.426),高脂血症(OR=1.066,95%CI:0.884~1.287,P=0.502),心功能不全(OR=0.789,95%CI:0.494~1.261,P=0.322)。结论高龄、慢性肾脏病、糖尿病、对比剂剂量是CIN发生的4个独立危险因素,其中慢性肾脏病是最强预测因子。加强冠状动脉造影术患者的术前评估,术前、术中、术后积极采取预防措施,尤其是水化、碱化疗法,是目前防治CIN的有效措施。     

良性肛肠疾病患者术后急性尿潴留的预后因素分析

目的探讨良性肛肠疾病患者术后急性尿潴留的预后因素。方法回顾性分析2016年6月～2018年6月455例良性肛肠疾病的临床资料,31例(6. 8%)术后发生急性尿潴留,对患者年龄、性别、BMI、ASA分级、术前合并症、手术方式、手术范围、麻醉方法、手术时间、液体入量、出血量和术后镇痛补救情况等进行单因素分析,多因素logistic回归分析良性肛肠疾病患者术后急性尿潴留的预后因素。结果单因素分析显示年龄、性别、ASA分级、术前合并糖尿病、麻醉方法、手术范围、液体入量和术后镇痛补救有统计学差异(P 0. 05)。多因素logistic回归分析显示年龄≥76岁(OR=7. 002,95%CI:1. 181～41. 532,P=0. 032)、性别(OR=10. 322,95%CI:1. 633～65. 232,P=0. 013)、ASA分级(OR=4. 134,95%CI:1. 080～15. 823,P=0. 038)、糖尿病(OR=13. 715,95%CI:2. 032～92. 558,P=0. 007)、手术范围(OR=4. 546,95%CI:1. 681～12. 296,P=0. 003)、麻醉方法(OR=3. 241,95%CI:1. 558～6. 741,P=0. 002)和术后镇痛补救(OR=7. 289,95%CI:1. 479～35. 914,P=0. 015)是良性肛肠疾病患者术后发生急性尿潴留的独立预后因素。结论年龄、性别、糖尿病、手术范围、麻醉方法和术后镇痛补救是良性肛肠疾病患者术后发生急性尿潴留的预后因素,针对预后因素进行干预可能减少术后急性尿潴留的发生。     

慢性肾脏病4～5期患者睡眠质量的随访研究

目的探讨慢性肾脏病(chronic kidney diseases,CKD)4期、维持性血液透析(maintenance hemodialysis,MHD)和持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者睡眠质量的动态变化及其影响因素。方法选择我科住院并接受随访的128例患者,其中CKD4期(CKD 4期组)患者43例、MHD患者(MHD组)41例、CAPD患者(CAPD组)44例,随访1年,每6个月用匹兹堡睡眠指数量表评估睡眠质量,并记录实验室指标。单因素及多因素Logistic分析睡眠质量的影响因素。结果 3组患者间年龄、性别、社会经济因素、吸烟、体质量指数、Charlson合并症指数、原发肾脏病无统计学差异(P0.05)。基线和第6个月时,MHD组和CAPD组的睡眠质量总分均显著高于CKD 4期组(P0.05)。随访第12个月时,3组间睡眠质量总分无统计学差异(P0.05)。同基线值相比,随访第6个月时3组睡眠质量总分均显著升高(P0.05)。同随访第6个月时相比,随访第12个月时CKD 4期组睡眠质量总分显著升高(P0.05),透析组无显著改变(P0.05)。随着患者PSQI总分的动态变化,3组患者血红蛋白、钙磷乘积、全段甲状旁腺素和超敏C反应蛋白也发生改变。年龄(OR=1.83,P=0.01)、血红蛋白(OR=1.46,P=0.01)、钙磷乘积(OR=1.25,P=0.02)、全段甲状旁腺素(OR=1.17,P=0.03)、超敏C反应蛋白(OR=1.32,P=0.04)与睡眠质量差显著相关。结论 CKD 4期以上患者睡眠质量随着时间的推移逐渐恶化,老年、贫血、钙磷代谢紊乱及微炎症反应是影响睡眠质量差的独立危险因素。     

获得性肾囊肿危险因素的配对病例对照研究

目的 :探讨影响获得性肾囊肿 (ARC)发病的危险因素。方法 :回顾性分析 5 3例ARC患者临床资料 ,进行 1∶1配对病例对照研究 ,并建立回归模型分析其危险因素 ,在α =0 .0 5水平确定其危险因素。结果 :经过单因素条件回归、多因素条件Logistic回归、逐步条件回归分析 ,结果显示肌酐清除率 (Ccr)水平 (OR =0 .4 98,P =0 .0 112 ,β =- 0 .6 976 2 )和年龄 (OR =2 .0 93,P =0 .0 2 71,β =0 .7385 2 )与ARC有显著性 (P <0 .0 5 )关联。结论 :Ccr水平和年龄是ARC的危险因素 ,慢性肾脏疾病患者随着Ccr下降和 (或 )年龄增加 ,ARC发病率呈上升趋势。     

开颅夹闭手术和血管栓塞介入术治疗颅内动脉瘤破裂疗效的Meta分析

目的分析比较开颅手术夹闭与血管栓塞介入术治疗脑动脉瘤破裂的效果。方法检索Pub Med、Cochrane图书馆、CNKI和万方数据库,收集2013-01—2018-04间发表的关于手术夹闭(夹闭组)与血管栓塞介入术(栓塞组)治疗脑动脉瘤疗效对比的文献,按纳入标准筛选文献、提取资料,然后利用Rev Man 5. 3软件进行Meta分析。结果 22篇文献纳入分析,共5 454例患者,其中夹闭组患者3 150例、栓塞组患者2 304例。Meta分析结果显示:2组术后患者的预后效果(OR=0. 73,95%CI:0. 52～1. 02,P=0. 07)、病死率(OR=0. 68,95%CI:0. 41～1. 13,P=0. 14)及致残率(OR=1. 41,95%CI:0. 90～2. 21,P=0. 13)无显著差异。栓塞组患者的术后并发症发生率低于夹闭组(OR=0. 48,95%CI:0. 39～0. 59,P 0. 000 01),但术后复发率高于夹闭组(OR=8. 33,95%CI:4. 73～14. 69,P 0. 000 01)。同时2组术后患者的血管痉挛发生率(OR=1. 21,95%CI:0. 73～1. 99,P=0. 46)、脑积水发生率(OR=0. 69,95%CI:0. 41～1. 17,P=0. 17)差异无统计学意义。而栓塞组患者术后再次出血率(OR=2. 7,95%CI:1. 56～4. 65,P=0. 000 4)及脑梗死发生率(OR=2. 39,95%CI:1. 78～3. 21,P 0. 000 01)均高于夹闭组;术后颅内感染发生率低于手术夹闭组(OR=0. 25,95%CI:0. 11～0. 58,P=0. 001)。结论手术夹闭与血管栓塞介入术治疗颅内动脉瘤各有利弊,临床医师应根据患者的具体情况合理选择治疗方案。     

CSTM1基因多态性和膀胱癌遗传易感性的关系

目的　探讨GSTM1基因多态性与膀胱癌遗传易感性的关系。　方法　采用PCR技术 ,以病例 对照研究方法 ,对 6 9例膀胱癌患者和 88例健康对照者的GSTM 1基因型进行检测。　结果　膀胱癌患者GSTM1空白基因型频率为 5 8% ,对照组为 4 1% ,两组比较差别有显著性意义 (χ2 =4 .5 1,P <0 .0 5 ) ,OR值为 2 .0 (95 %CI =1.0 5～ 3.79)。吸烟者中 ,患者组GSTM1空白基因型频率为71% ,对照组为 2 4 % ,两组比较差别有显著性意义 (χ2 =2 2 .6 ,P <0 .0 1) ,OR值为 8.3(95 %CI =3.34～ 2 0 .6 5 )。以GSTM1非空白型 /不吸烟者为参照 ,GSTM1空白型 /吸烟者的OR值为 4 .6 4 (95 %CI=1.86～ 11.37,χ2 =11.6 3,P <0 .0 1) ,差别有显著性意义。　结论　GSTM 1基因多态性与膀胱癌易感性有关 ,在膀胱癌的发生发展中与吸烟协同起作用     

cN0期甲状腺乳头状微小癌大容量中央区淋巴结转移的危险因素

目的:探讨c N0期甲状腺乳头状微小癌(PTMC)中央区淋巴结转移(CLNM),尤其是大容量淋巴结转移(LV-LNM,转移数目5枚)的危险因素。方法:回顾性分析512例行甲状腺全切或腺叶及峡部切除加中央区淋巴结清扫术的c N0期PTMC患者的临床资料,并根据CLNM转移情况将患者分为LV-LNM组和非LV-LNM组,分析c N0期PTMC患者CLNM及LV-LNM的危险因素。结果:512例患者中女415例(81.1%),男97例(18.9%),CLNM阳性者178例(34.8%),LV-LNM者21例(4.1%)。单因素分析显示,性别、年龄、癌灶直径、多灶性肿瘤、腺外侵犯及BRAF~(V600E)基因突变与CLNM有关(均P0.05);性别、年龄、多灶性肿瘤及腺外侵犯与LV-LNM有关(均P0.05)。多因素分析显示,男性(OR=1.451,95%CI=1.030～2.044,P=0.033)、年龄40岁(OR=1.720,95%CI=1.289～2.295,P=0.000)、癌灶直径0.5 cm(OR=1.677,95%CI=1.218～2.309,P=0.002)和多灶性肿瘤(OR=1.872,95%CI=1.384～2.532,P=0.000)是CLNM的独立危险因素;男性(OR=2.852,95%CI=1.773～4.588,P=0.000)、年龄40岁(OR=1.913,95%CI=1.434～2.552,P=0.000)及多灶性肿瘤(OR=1.579,95%CI=1.161～2.148,P=0.004)是LV-LNM的独立危险因素。结论:性别、年龄、癌灶直径和多灶性肿瘤是PTMC患者发生CLNM的高危因素,而男性、年龄40岁的多灶性c N0期PTMC患者更容易发生LV-LNM,应积极行预防性中央区淋巴结清扫术。     

慢性肾脏病患者幽门螺旋杆菌感染率分析

目的:研究慢性肾脏病各期幽门螺旋杆菌(Hp)感染率及分布特征。方法:调查2010年01月~2016年06月在我科门诊及住院的慢性肾脏病(CKD)患者360例及同时期于我院健康体检者100例,测定患者血清幽门螺旋杆菌抗体Ig G及Ig M,利用改良的MDRD公式估算肾小球滤过率(e GFR),比较各组患者Hp现症感染(Hp Ig M阳性+Hp Ig G阳性)率及既往感染(Hp Ig M阴性+Hp Ig G阳性)率,并分析其差异。结果:(1)所有CKD患者血清幽门螺杆菌(Hp)现症感染率57.8%(208/360),既往感染率30%(108/360),二者均与健康成人组(现症感染率43%,既往感染率21%)差异无统计学意义(P0.05)。(2)与健康成人组相比,CKD1期、CKD5期Hp现症感染率差异无统计学意义(P0.05),CKD2期~CKD4期现症感染率显著升高(P0.05),CKD5期既往感染率显著增加(P0.01)。(3)CKD5期患者Hp现症感染率较CKD3期(χ2=3.873,P=0.049)、CKD4期(χ2=11.534,P0.01)降低,但既往感染率(43%)较其他CKD组显著增加(P0.05)。结论:(1)慢性肾脏病患者幽门螺杆菌现症感染随肾功能进展而增加,至尿毒症期,Hp既往感染率增加,现症感染有所降低。(2)建议慢性肾脏病患者及时筛查幽门螺杆菌感染,并积极治疗,提高患者生活质量及改善预后。     

非大量蛋白尿狼疮肾炎患者肾脏病理严重程度的危险因素分析

目的研究影响非大量蛋白尿(24h蛋白尿3. 5 g)狼疮肾炎(LN)患者肾脏病理严重程度的危险因素以及预后情况。方法纳入2004年1月1日至2018年3月31日于华中科技大学同济医学院附属同济医院行肾脏穿刺活检确诊为LN并且起始24h蛋白尿3. 5 g的患者作为研究对象,记录患者肾活检时相关临床信息,并行规律随访。对所有患者肾活检时的病理切片进行重新阅片,采用统一标准进行评分,根据患者肾脏病理严重程度分为病理轻组和病理重组。采用Log-rank检验比较两组的缓解率差异。采用Logistic回归方程分析影响非大量蛋白尿LN患者肾脏病理严重程度的危险因素。结果共纳入95例非大量蛋白尿LN患者,以女性为主,平均年龄(32. 4±1. 1)岁,其中有随访者共79人。肾脏病理轻组43例,肾脏病理重组52例,病理轻组患者血红蛋白、血清IgA水平均高于病理重组(P 0. 05),而血氯水平显著低于病理重组(P 0. 05)。随访结果显示,病理轻组患者的远期(大于6个月)累积完全缓解率大于病理重组(P 0. 05)。多因素Logistic回归结果提示,年龄(OR=1. 219,95%CI:1. 043～1. 425,P 0. 05)、SLEDAI-2K评分(OR=1. 202,95%CI:1. 025～1. 411,P 0. 05)、起始蛋白尿定量(OR=3. 793,95%CI:1. 058～13. 595,P 0. 05)、血清IgA水平(OR=0. 222,95%CI:0. 063～0. 781,P 0. 05)是肾脏病理重的独立危险因素。结论老龄、高SLEDAI-2K评分、高起始蛋白尿定量和低血清IgA水平可能与非大量蛋白尿LN患者的肾脏病理较重相关。     

A self‐determination approach to the understanding of the impact of physical activity on depressive symptoms

The purpose was to test a new motivational sequence. It was hypothesized that more autonomous forms of motivation would predict the intensity of physical activity (PA), which in turn, would predict depressive symptoms. In order to evaluate self‐determined motivation, the Self‐Determination Index (SDI) was used. Because the reasons that can lead a person to engage in walking, moderate PA, or vigorous PA may be different, 3 independent self‐determination indexes were measured (SDIWalking, SDIModerate, and SDIVigorous). It was also measured the metabolic equivalent of task values (METs) for walking, moderate, and vigorous PA, as well as the depressive symptoms. The sample consisted of 357 college students whose ages ranged from 18 to 29 years. Structural equation modeling was used to test the hypothesized model. The indices of fit showed that the revised model fits the data reasonably well: S‐Bχ²₍₁₁₎ = 14.83, p = .190; χ²/df = 1.35; *comparative fit index = .99; *root mean square error of approximation = .03, 90% CI [.000, .068]; standardised root mean square residual = .03. It was found that vigorous PA is the only intensity that predicts depressive symptoms. In other words, SDIV‐predicted vigorous PA (measured as MET_SV), which subsequently predicted less depressive symptoms (SDIV → MET_SV → Depressive symptoms). Further research should investigate the effects of vigorous PA on depressive symptoms.     

Exercise in individuals with CKD

There are few studies evaluating exercise in the nondialysis chronic kidney disease (CKD) population. This review covers the rationale for exercise in patients with CKD not requiring dialysis and the effects of exercise training on physical functioning, progression of kidney disease, and cardiovascular risk factors. In addition, we address the issue of the risk of exercise and make recommendations for implementation of exercise in this population. Evidence from uncontrolled studies and small randomized controlled trials shows that exercise training results in improved physical performance and functioning in patients with CKD. In addition, although there are no studies examining cardiovascular outcomes, several studies suggest that cardiovascular risk factors such as hypertension, inflammation, and oxidative stress may be improved with exercise training in this population. Although the current literature does not allow for definitive conclusions about whether exercise training slows the progression of kidney disease, no study has reported worsening of kidney function as a result of exercise training. In the absence of guidelines specific to the CKD population, recent guidelines developed for older individuals and patients with chronic disease should be applied to the CKD population. In sum, exercise appears to be safe in this patient population if begun at moderate intensity and increased gradually. The evidence suggests that the risk of remaining inactive is higher. Patients should be advised to increase their physical activity when possible and be referred to physical therapy or cardiac rehabilitation programs when appropriate.     

Daily physical activity and type 2 diabetes: A review

Physical activity improves glycemic control and reduces the risk of cardiovascular disease (CVD) and mortality in patients with type 2 diabetes (T2D). Moderate to vigorous physical activity is recommended to manage T2D; however, patients with T2D can be physically weak, making it difficult to engage in the recommended levels of physical activity. Daily physical activity includes various activities performed during both occupational and leisure time such as walking, gardening, and housework that type 2 diabetic patients should be able to perform without considerable physical burden. This review focuses on the association between daily physical activity and T2D. Walking was the most common form of daily physical activity, with numerous studies demonstrating its beneficial effects on reducing the risk of T2D, CVD, and mortality. Walking for at least 30 min per day was shown to reduce the risk of T2D by approximately 50%. Additionally, walking was associated with a reduction in mortality. In contrast, evidence was extremely limited regarding other daily physical activities such as gardening and housework in patients with T2D. Recent studies have suggested daily physical activity, including non-exercise activity thermogenesis, to be favorably associated with metabolic risks and mortality. However, well-designed longitudinal studies are warranted to elucidate its effects on overall health.     

Does Activity-Based Rehabilitation With Goal Attainment Scaling Increase Physical Activity Among Younger Knee Arthroplasty Patients? Results From the Randomized Controlled ACTION Trial

BackgroundEspecially in younger knee osteoarthritis patients, the ability to perform physical activity (PA) after knee arthroplasty (KA) is of paramount importance, given many patients’ wish to return to work and perform demanding leisure time activities. Goal Attainment Scaling (GAS) rehabilitation after KA may improve PA because it uses individualized activity goals. Therefore, our aim was to objectively quantify PA changes after KA and to compare GAS-based rehabilitation to standard rehabilitation.MethodsData were obtained from the randomized controlled ACTION trial, which compares standard rehabilitation with GAS-based rehabilitation after total and unicompartmental KA in patients <65 years of age. At 2 time points, preoperatively and 6 months postoperatively, 120 KA patients wore a validated 3-dimensional accelerometer for 1 consecutive week. Data were classified as sedentary (lying, sitting), standing, and active (walking, cycling, running). Repeated measures analysis of variance was used to compare PA changes over time.ResultsComplete data were obtained for 97 patients (58% female), with a mean age of 58 years (±4.8). For the total group, we observed a significant increase in PA of 9 minutes (±37) per day (P = .01) and significant decrease in sedentary time of 20 minutes (±79) per day (P = .02). There was no difference in standing time (P = .11). There was no difference between the control group and the intervention group regarding changes in PA, nor between the total KA group and the unicompartmental KA group.ConclusionWe found a small but significant increase in overall PA after KA, but no difference between GAS-based rehabilitation and standard rehabilitation. Likely, enhanced multidisciplinary perioperative strategies are needed to further improve PA after KA.     

Total Hip Arthroplasty Improves Pain and Function but Not Physical Activity

BackgroundPeople with hip osteoarthritis are likely to limit physical activity (PA) engagement due to pain and lack of function. Total hip arthroplasty (THA) reduces pain and improves function, potentially allowing increased PA. PA of THA patients was quantified to 12 months postoperation. The hypothesis was that postoperatively levels of PA would increase.MethodsPA of 30 THA patients (67 ± 7 years) was objectively measured preoperatively and 3 and 12 months postoperation. Harris Hip Score (HHS), Oxford Hip Score (OHS), and 6-minute walk test (6MWT) were recorded. Mixed linear modelling was used to examine relationships of outcomes with time, baseline body mass index (BMI), age, gender, and baseline HHS.ResultsTime was not a significant factor in predicting volume measures of PA, including sit-to-stand transitions, upright time, and steps. Notably, baseline BMI was a significant predictor of upright time, steps, largest number of steps in an upright bout, HHS, and 6MWT. Baseline HHS helped predict longest upright bout, cadence of walking bouts longer than 60 seconds, and OHS. The significant effect of participant as a random intercept in the model for PA outcomes suggested habituation from presurgery to postsurgery.ConclusionVolume measures of PA did not change from presurgery to 12 months postsurgery despite improvement in HHS, OHS, and 6MWT. Baseline BMI was a more important predictor of upright activity and stepping than time. Preoperative and postoperative PA promotion could be used to modify apparently habitual low levels of PA to enable full health benefits of THA to be gained.     

A meta-analysis of the association of physical activity with reduced risk of colorectal cancer

BACKGROUND: Physical activity may be associated with reduced risk of colorectal cancer. The main aim of this paper is to review the available evidence for a link between exercise and large bowel cancer. METHODS: A Cochrane-type methodology was performed. Data extracted included, type of study, type of physical activity measured and the numerical results. The risk ratios (RR) of the studies have been pooled according to the type of study, type of exercise, type of cancer and sex. Pooling was undertaken using fixed effect meta-analysis. A random effect meta-analysis was used where substantial heterogeneity existed. RESULT: Data from 19 cohort studies showed a statistically significant reduction in the risk of colon cancer in physically active males, RR being 0.79 (95% CI 0.72-0.87) and 0.78 (95% CI 0.68-0.91) for occupational and recreational activities, respectively. In women only recreational activities are protective against colon cancer (RR = 0.71, 95%CI 0.57-0.88). Case-control studies showed significantly reduced risks of colon cancer in both sexes irrespective of the type of activity. No protection against rectal cancer is seen in either sex. CONCLUSION: There is considerable evidence that physical activity is associated with reduced risk of colon cancer in both males and females.     

Depression and disease severity as correlates of everyday physical activity in heart transplant candidates

It is unclear to what extent patients awaiting heart transplantation (HTx) engage in physical activities. We examined the everyday physical activity and its associations with depressive symptoms and disease severity in 318 patients newly registered for HTx in the multi‐site study ‘Waiting for a New Heart’ (aged 53.5 ± 11.4 years, 18% female patients). Participants completed questionnaires assessing depressive symptomatology and physical activity (number of physical activities, caloric expenditure associated with each activity), and estimated the distance they were able to walk without a break. Medical parameters at the time of listing [e.g. peak oxygen consumption (peakVO₂); the German Transplant Society Score (GTSS)] were provided by Eurotransplant. Almost 50% of patients engaged in activities of daily living (housework, walking), but <10% engaged in regular exercise. All physical activity measures correlated significantly with peakVO₂ (Ps < 0.01). Elevated depression scores were present in 39% of patients. Controlling for confounding variables (e.g. peakVO₂, diastolic blood pressure, GTSS, age), depressive symptomatology accounted for additional variance in all physical activity measures (Ps < 0.05). The association of depressive symptoms with reduced physical activity suggests two important perspectives: attempts to increase physical activity (especially in the area of daily living) might benefit from targeting depression, and increased physical activity might also help to reduce depressive symptoms.