Search PubMed⌕ Search

Biomedical subjects

P Painter

Publications and source records attributed to P Painter.

At least 19 recordsLinked to original sources
PubMed2000

Physical functioning and health-related quality-of-life changes with exercise training in hemodialysis patients.

The Renal Exercise Demonstration Project was designed to test the effects of two different approaches to exercise programming on the levels of physical activity, physical functioning, and self-reported health status in hemodialysis patients. Two hundred eighty-six patients were recruited for participation. Intervention patients were given individually prescribed exercise for 8 weeks of independent home exercise, followed by 8 weeks of incenter cycling during dialysis. Physical performance testing was performed at baseline and after each intervention using gait speed, sit-to-stand test, and 6-minute walk. The Medical Outcomes Study Short Form 36-item (SF-36) questionnaire was used to assess self-reported health status. The intervention group showed increased participation in physical activity. There were significant differences between the intervention and nonintervention groups in change over time in normal and fast gait speed, sit-to-stand test scores, and the physical scales on the SF-36, including the physical component scale. The intervention group improved in these test results, whereas the nonintervention group either did not change or declined over the duration of the study. It is clear that improvements in physical functioning result from exercise counseling and encouragement in hemodialysis patients. Because self-reported physical functioning is highly predictive of outcomes in hemodialysis patients, more attention to patients' levels of physical activity is warranted.

Activities of Daily Living↗
PubMed2000

Low-functioning hemodialysis patients improve with exercise training.

The Renal Exercise Demonstration Project provided two different approaches to exercise programming to a group of hemodialysis patients. Physical functioning and self-reported health-related quality of life were measured at baseline, after 2 months of independent exercise, and again after 2 months of in-center cycling. This study compares the responses to intervention of patients who initially scored low (<34) on the Physical Component Scale (PCS) on the Medical Outcomes Study Short-Form 36 questionnaire to those who initially scored higher (>34) on the same scale. The high-PCS group scored higher on all physical function tests (normal gait speed, fast gait speed, and sit-to-stand test) at each testing time than the low-PCS group. The high-PCS group improved only on the sit-to-stand test, whereas the low-PCS group improved in all three physical function tests. There were significant differences between the groups in change over time in all the physical scales and the PCS over time, with the low-PCS group showing improvements in response to the intervention and the high-PCS group showing no change over time. No differences in change over time were noted between the groups on the mental scales in either group. We conclude that low-functioning hemodialysis patients can benefit from exercise counseling in both objective measures of physical functioning and self-reported physical functioning. The impact of such interventions seems to be more profound in the lowest functioning patients.

Analysis of Variance↗
PubMed2000

Physical activity for the chronically ill and disabled.

Exercise prescription principles for persons without chronic disease and/or disability are based on well developed scientific information. While there are varied objectives for being physically active, including enhancing physical fitness, promoting health by reducing the risk for chronic disease and ensuring safety during exercise participation, the essence of the exercise prescription is based on individual interests, health needs and clinical status, and therefore the aforementioned goals do not always carry equal weight. In the same manner, the principles of exercise prescription for persons with chronic disease and/or disability should place more emphasis on the patient's clinical status and, as a result, the exercise mode, intensity, frequency and duration are usually modified according to their clinical condition. Presently, these exercise prescription principles have been scientifically defined for clients with coronary heart disease. However, other diseases and/or disabilities have been studied less (e.g. renal failure, cancer, chronic fatigue syndrome, cerebral palsy). This article reviews these issues with specific reference to persons with chronic diseases and disabilities.

Adolescent↗
PubMed1999

Physical functioning: definitions, measurement, and expectations.

The nephrology community has begun to recognize the importance of physical functioning in the overall treatment of their patients. Physical functioning is highly associated with such outcomes as hospitalization, nursing home admission, falling, level of dependency, and death in older individuals. Because there are many terms used to refer to physical functioning, this report classifies physical functioning into basic actions and complex activities; activities considered essential for maintaining independence, and those considered discretionary that are not required for independent living, but may have an impact on quality of life. We also present a model of the determinants of physical functioning, which goes beyond the presence or absence of disease and considers physical, sensory, environmental, and behavioral factors. Measurement of physical functioning can be complicated and ranges from self-report questionnaires to performance measures of specific tasks to vigorous laboratory measures. There are limitations to each of the measurement methods; however, some level of assessment provides information about the patient that is not otherwise available. Valid and reliable tests of physical performance are available that are easily administered and provide valuable information about the patient. Just as the patient's nutrition, medications, and adequacy of dialysis are monitored, baseline and subsequent physical functioning assessments allow us to monitor the patient's clinical course as it relates to their physical ability. Such measurement also allows for the identification of patients with lower functioning who would benefit from physical therapy or other exercise intervention.

Exercise↗
PubMed1999

The physiological consequences of bed rest and inactivity.

Most dialysis patients experience prolonged periods of physical inactivity and often bedrest. The physiological consequences of bed rest and inactivity are many and detrimentally affect the functioning of many bodily systems, several of which affect physical functioning. Reductions in plasma volume reduce cardiac filling, stroke volume, and cardiac output. Skeletal muscle fiber size, diameter, and capillarity are reduced, as is bone density. These changes result in profound reductions in physical work capacity. The effects of bed rest and inactivity in patients with chronic renal failure may have more serious consequences, in that they may exacerbate the pathophysiology of renal failure such as cardiac dysfunction, anemia, muscle wasting, muscle weakness, neuropathy, glucose intolerance, and reduced bone density.

Bed Rest↗
PubMed1999

Exercise after renal transplantation.

Renal transplant recipients experience troublesome side effects of the immunosuppression medication, many of which may be attenuated or ameliorated with regular physical activity. Preliminary data show that exercise training after transplantation increases exercise capacity and muscle strength and may contribute to higher quality of life after transplantation.

Exercise↗
PubMed1999

Research on physical activity and health among people with disabilities: a consensus statement.

Research is required to advance the understanding of issues related to the effect of physical activity on health and disease prevention among people with disabilities. This report is the result of a consensus process using selected experts in health and exercise. The purpose of the consensus conference was to identify research priorities for physical activity and health among people with disabilities. Priorities were established by 30 participants, who were selected by the principal investigators to achieve balance in the areas of engineering, epidemiology, medicine, nutrition, exercise physiology, and psychology. Experts summarized relevant data from their research and from comprehensive review of the scientific literature on the topic areas chosen for the conference. Public commentary was provided by participants in the 1996 Paralympic Congress. Panel members discussed openly all material presented to them in executive session. Commentary from open discussion periods were recorded and transcribed. Selected panelists prepared first drafts of the consensus statements for each research priority question. All of these drafts were distributed to the panelists and pertinent experts. The documents were edited by the drafting committee to obtain consensus. This research priority setting process revealed that greater emphasis must be placed on determining the risks and benefits of exercise among people with disabilities. Exercise must be studied from the perspective of disease prevention while mitigating risk for injury. Five areas were identified as focal points for future work: epidemiological studies; effects of nutrition on health and ability to exercise; cardiovascular and pulmonary health; children with disabilities; and accessibility and safety of exercise programs. As people with disabilities live longer, the need for addressing long-term health issues and risk for secondary disability must receive greater attention. As a consequence of the consensus process, specific recommendations for future research regarding the impact of exercise on the health and quality of life of persons with disabilities were defined.

Cardiovascular Diseases↗
PubMed1994

The impact of recombinant human erythropoietin on exercise capacity in hemodialysis patients.

Peak oxygen uptake (VO2peak) of patients with end-stage renal failure treated with hemodialysis is very low. The improvement of anemia with recombinant human erythropoietin (rHuEPO) results in a very small change in VO2peak. This change is minimal compared with the magnitude of change in hematocrit, suggesting that other factors continue to limit exercise tolerance. This article reviews the physiology of oxygen transport and the determinants of VO2peak. Anemic hemodialysis patients are limited by a reduced cardiac output response to exercise and an inability to widen the arterio-venous oxygen difference. The lack of change in cardiac output and a remaining low arterio-venous oxygen difference following improvement of anemia with rHuEPO therapy suggest an underlying muscle limitation to exercise. Evidence for this muscle limitation is presented. Exercise training may improve the ability of muscle to use oxygen, thus optimizing the effect of the increased hematocrit resulting from rHuEPO therapy.

Anemia↗
PubMed1994

Case study of the anemic patient: epoetin alfa--focus on exercise.

Physical functioning of patients with chronic renal failure is often low. An exercise program can enhance their capacity for physical activity and thus improve their quality of life. Dialysis staff can use a four-step approach to develop strategies to encourage exercise. In addition, staff support can help motivate patients to take part in exercise programs.

Activities of Daily Living↗
PubMed1994

The importance of exercise training in rehabilitation of patients with end-stage renal disease.

Exercise capacity in patients with kidney failure undergoing dialysis is low compared with age-predicted values. The level of exercise tolerance in these patients is such that the energy requirements for activities of daily living and occupational tasks impinge on their capacity to perform these tasks. Therefore, it is not surprising that many patients do not seek or are unable to work because they are physically unable to sustain the energy required for such activity. There are several ways to increase exercise tolerance in these patients--transplant, exercise training, and recombinant human erythropoietin (epoetin) therapy. Successful kidney transplant increases exercise capacity to near normal values for sedentary healthy individuals. Exercise training after transplant further increases exercise capacity and counteracts some of the negative side effects of glucocorticoid therapy, such as muscle wasting and excessive weight gain. Exercise training in patients on dialysis increases exercise tolerance approximately 25% (in studies performed before epoetin administration). Similar increases are observed after correction of the anemia of kidney failure with epoetin. However, the increase in exercise capacity is small compared with the magnitude of change in hematocrit level. It is possible that epoetin therapy unmasks a muscle limitation to exercise that may be improved by exercise training. Anecdotal evidence suggests that exercise training in patients on epoetin therapy may result in an exercise capacity similar to that of transplant recipients. However, epoetin therapy to improve hematocrit levels does not automatically make patients exercise. Active counseling and encouragement are necessary to improve physical functioning.(ABSTRACT TRUNCATED AT 250 WORDS)

Exercise↗
PubMed1989

Chromium carcinogenicity: California strategies.

Hexavalent chromium was identified by California as a toxic air contaminant (TAC) in January 1986. The California Department of Health Services (CDHS) concurred with the findings of the International Agency for Research on Cancer that there is sufficient evidence to demonstrate the carcinogenicity of chromium in both animals and humans. CDHS did not find any compelling evidence demonstrating the existence of a threshold with respect to chromium carcinogenesis. Experimental data was judged inadequate to assess potential human reproductive risks from ambient exposures. Other health effects were not expected to occur at ambient levels. The theoretically increased lifetime carcinogenic risk from a continuous lifetime exposure to hexavalent chromium fell within the range 12-146 cancer cases per nanogram hexavalent chromium per cubic meter of air per million people exposed, depending on the potency estimate used. The primary sources found to contribute significantly to the risk of exposure were chrome platers, chromic acid anodizing facilities and cooling towers utilizing hexavalent chromium as a corrosion inhibitor. Evaluation of genotoxicity data, animal studies and epidemiological studies indicates that further consideration should be given to the potential carcinogenicity of hexavalent chromium via the oral route.

Air Pollutants↗