Nephrologists' view on exercise training in chronic kidney disease (results of the questionnaire at the WCN 2003)

During the WCN 2003 in Berlin a questionnaire on the opinion of nephrologists about physical activity was provided. A total of 47 participants completed the questionnaire (Germany 6, other European countries 15, non-European countries 15, unknown country 12). 37% of the individuals stated that they exercise on a regular basis, whereas 41% exercise infrequently. 95% agreed on the fact that the sedentary lifestyle is an important risk factor in CKD patients; 78% thought that it is the responsibility of the nephrologist to advice the patients about physical activity. 33% offer in-centre training programs. 15% of the patients participate in out-centre groups. This occurs most frequently in Germany where the health care system provides the largest financial support. 74% were in need of written material about exercising. Thus, it is an important goal to include instructions concerning training instruction and infrastructure into the routine treatment regimen of CKD patients, dialysis patients and kidney transplant recipients.     

Exercise testing in asymptomatic adults: a statement for professionals from the American Heart Association Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention

Along with coronary artery calcium scanning, ankle-brachial index measurement, and carotid artery ultrasound, exercise electrocardiography has been proposed as a screening tool for asymptomatic subjects thought to be at intermediate risk for developing clinical coronary disease. A wealth of data indicate that exercise testing can be used to assess and refine prognosis, particularly when emphasis is placed on nonelectrocardiographic measures such as exercise capacity, chronotropic response, heart rate recovery, and ventricular ectopy. Nevertheless, randomized trial data on the clinical value of screening exercise testing are absent; that is, it is not known whether a strategy of routine screening exercise testing in selected subjects reduces the risk for premature mortality or major cardiac morbidity. The writing group believes that a large-scale randomized trial of such a strategy should be performed.     

Supervised exercise training counterbalances the adverse effects of insulin therapy in overweight/obese subjects with type 2 diabetes

OBJECTIVE

To examine the effect of supervised exercise on traditional and nontraditional cardiovascular risk factors in sedentary, overweight/obese insulin-treated subjects with type 2 diabetes from the Italian Diabetes Exercise Study (IDES).

RESEARCH DESIGN AND METHODS

The study randomized 73 insulin-treated patients to twice weekly supervised aerobic and resistance training plus structured exercise counseling (EXE) or to counseling alone (CON) for 12 months. Clinical and laboratory parameters were assessed at baseline and at the end of the study.

RESULTS

The volume of physical activity was significantly higher in the EXE versus the CON group. Values for hemoglobin A_1c, BMI, waist circumference, high-sensitivity C-reactive protein, blood pressure, LDL cholesterol, and the coronary heart disease risk score were significantly reduced only in the EXE group. No major adverse events were observed.

CONCLUSIONS

In insulin-treated subjects with type 2 diabetes, supervised exercise is safe and effective in improving glycemic control and markers of adiposity and inflammation, thus counterbalancing the adverse effects of insulin on these parameters.Atherosclerosis has been increasingly recognized as an inflammatory disease characterized by systemic, central fat-driven and local low-grade inflammation, which is involved in all stages of its natural history (1). Several proinflammatory mediators have been associated with cardiovascular disease (CVD), independent of traditional CVD risk factors (2). In particular, high-sensitivity C-reactive protein (hs-CRP) has been shown to be a strong independent predictor of CVD in patients with type 2 diabetes (3). More recently, clinical trial data have demonstrated that reduction of hs-CRP is associated with marked improvements in CVD outcomes (4) and that high-intensity, preferably mixed (aerobic and resistance) exercise training, in addition to daytime physical activity (PA), is required for achieving a significant anti-inflammatory effect in subjects with type 2 diabetes (5).When patients with type 2 diabetes in secondary failure to oral hypoglycemic agents (OHAs) are shifted to insulin treatment, alone or combined with OHAs, glycemic control improves, but there is generally an undesirable adverse effect of increased body weight (6,7) accompanied by lower or no improvement or even worsening of the chronic inflammatory state (7–9). This adverse effect, which might counteract the positive effect of the insulin-mediated decrease in plasma glucose levels on CVD risk, could be minimized by exercise training, although there is no evidence in the literature supporting this concept.As a subanalysis of the Italian Diabetes Exercise Study (IDES), we examined the effect of supervised exercise training in addition to structured exercise counseling, compared with counseling alone, on traditional and nontraditional CVD risk factors in sedentary, insulin-treated, overweight/obese subjects with type 2 diabetes.     

A novel computerised notation and analysis system for assessment of injury and injury risk in football

Notation analysis has now gained wide use in the assessment of competitive football play. Computer-aided methods have largely replaced the use of hand-notation systems. Whilst a hand-notation approach has been adopted previously in assessing injury-risk in football, the recording and analysing of events with injury potential are time-consuming. In this report, a computerised system of notating incidents in the game is described. Key incidents are monitored with respect to degree of injury potential, location and other factors. The use of the system is illustrated by comparing home and away performances in Premier League matches between Manchester United and Liverpool F.C. The system has advantages in speed and accuracy of handling data related to injury and injury risk.