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Taylor KA, Carroll MK, Short SA, Goode AP. Identifying characteristics and clinical conditions associated with hand grip strength in adults: the Project Baseline Health Study. Sci Rep 2024; 14:8937. [PMID: 38637523 PMCID: PMC11026445 DOI: 10.1038/s41598-024-55978-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/29/2024] [Indexed: 04/20/2024] Open
Abstract
Low hand grip strength (HGS) is associated with several conditions, but its value outside of the older adult population is unclear. We sought to identify the most salient factors associated with HGS from an extensive list of candidate variables while stratifying by age and sex. We used data from the initial visit from the Project Baseline Health Study (N = 2502) which captured detailed demographic, occupational, social, lifestyle, and clinical data. We applied MI-LASSO using group methods to determine variables most associated with HGS out of 175 candidate variables. We performed analyses separately for sex and age (< 65 vs. ≥ 65 years). Race was associated with HGS to varying degrees across groups. Osteoporosis and osteopenia were negatively associated with HGS in female study participants. Immune cell counts were negatively associated with HGS for male participants ≥ 65 (neutrophils) and female participants (≥ 65, monocytes; < 65, lymphocytes). Most findings were age and/or sex group-specific; few were common across all groups. Several of the variables associated with HGS in each group were novel, while others corroborate previous research. Our results support HGS as a useful indicator of a variety of clinical characteristics; however, its utility varies by age and sex.
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Affiliation(s)
- Kenneth A Taylor
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
| | | | | | - Adam P Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Medicine, Population Health Sciences, Durham, NC, USA
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Feasibility of an Intradialytic Combined Exercise Program Targeting Older Adults With End-Stage Renal Disease. J Aging Phys Act 2021; 29:905-914. [PMID: 34111843 DOI: 10.1123/japa.2020-0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022]
Abstract
Intradialytic exercise is feasible and yields substantial clinical benefits in middle-aged patients. However, evidence is scarce in older hemodialysis patients. OBJECTIVE To assess the feasibility and clinical benefits of supervised, intradialytic exercise in older patients. METHODS Multicenter one-arm feasibility study. The main outcome was feasibility (ease of recruitment, dropout rate, adherence, affective valence, and adverse events). The secondary outcomes were physical capacity (five-repetition sit-to-stand, 60-s sit-to-stand tests, and grip strength), quality of life (36-Item Short-Form Health Survey), quality of sleep (Pittsburgh Sleep Quality Index), depressive symptoms (Beck Depression Inventory), and dialysis efficacy (Kt/V and urea reduction ratio). RESULTS About 79% of the screened patients agreed to participate (n = 25, 73 [66-77] years). The dropout rate was high (32%), but adherence remained high among the participants who completed the study (94%). Improvements were found in the five-repetition sit-to-stand (p < .001), 60-s sit-to-stand tests (p = .028), 36-Item Short-Form Health Survey mental component score (p = .008), depressive symptoms (p = .006), and quality of sleep (p = .035). CONCLUSION Supervised intradialytic exercise seems safe and beneficial in older patients.
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Hand Grip Strength in Patients on Hemodialysis: An Observational Study. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1337:59-64. [DOI: 10.1007/978-3-030-78771-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bohannon RW. Grip Strength: An Indispensable Biomarker For Older Adults. Clin Interv Aging 2019; 14:1681-1691. [PMID: 31631989 PMCID: PMC6778477 DOI: 10.2147/cia.s194543] [Citation(s) in RCA: 356] [Impact Index Per Article: 71.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/13/2019] [Indexed: 12/20/2022] Open
Abstract
Grip strength has been proposed as a biomarker. Supporting this proposition, evidence is provided herein that shows grip strength is largely consistent as an explanator of concurrent overall strength, upper limb function, bone mineral density, fractures, falls, malnutrition, cognitive impairment, depression, sleep problems, diabetes, multimorbidity, and quality of life. Evidence is also provided for a predictive link between grip strength and all-cause and disease-specific mortality, future function, bone mineral density, fractures, cognition and depression, and problems associated with hospitalization. Consequently, the routine use of grip strength can be recommended as a stand-alone measurement or as a component of a small battery of measurements for identifying older adults at risk of poor health status.
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Affiliation(s)
- Richard W Bohannon
- Department of Physical Therapy, Campbell University, Lillington, NC, USA
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Hiraki K, Yasuda T, Hotta C, Izawa KP, Morio Y, Watanabe S, Sakurada T, Shibagaki Y, Kimura K. Decreased physical function in pre-dialysis patients with chronic kidney disease. Clin Exp Nephrol 2012; 17:225-31. [DOI: 10.1007/s10157-012-0681-8] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 08/03/2012] [Indexed: 11/30/2022]
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Jung TD, Park SH. Intradialytic exercise programs for hemodialysis patients. Chonnam Med J 2011; 47:61-5. [PMID: 22111062 PMCID: PMC3214879 DOI: 10.4068/cmj.2011.47.2.61] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Accepted: 08/12/2011] [Indexed: 11/06/2022] Open
Abstract
Although it is widely accepted that exercise is beneficial in patients with end-stage renal disease as in the general population, it is not easy to incorporate exercise programs into routine clinical practice. This review aimed to investigate the beneficial effects of exercise during hemodialysis and also to introduce various intradialytic exercise programs and their advantages as a first step in combining exercise programs into clinical practice. Aerobic and resistance exercise are beneficial not only in improving physical functioning, including maximal oxygen uptake and muscle strength, but also in improving anthropometrics, nutritional status, hematological indexes, inflammatory cytokines, depression, and health-related quality of life. However, it is not clear whether the beneficial effects of exercise are limited to only relatively healthy dialysis patients. Therefore, the effects of individualized exercise programs for elderly patients or patients with comorbid conditions need to be studied further.
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Affiliation(s)
- Tae-Du Jung
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
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Odden MC. Physical functioning in elderly persons with kidney disease. Adv Chronic Kidney Dis 2010; 17:348-57. [PMID: 20610362 DOI: 10.1053/j.ackd.2010.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 02/07/2010] [Accepted: 02/11/2010] [Indexed: 11/11/2022]
Abstract
Poor physical functioning in dialysis patients has been well documented. Several studies have reported an association of poor kidney function with adverse physical functioning outcomes, even in elderly persons with mild decrements in kidney function. These associations have been observed across multiple domains of physical function. This review summarizes the current research on physical functioning in kidney disease, with a special focus on elderly populations. Elderly persons with kidney disease may especially be at a high risk for disability and other adverse outcomes because of the dual effects of aging and kidney dysfunction on physical functioning. Both the correction of anemia and physical activity are effective for at least moderate improvements in physical function although these studies have been conducted primarily in younger persons with less comorbidity. The evidence that exists on exercise interventions in older adults with kidney disease is promising, although this population has been underrepresented in trials to date. More research on potential interventions to prevent or reduce poor physical functioning is needed in elderly persons with kidney disease.
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Hoffman JR, Kraemer WJ, Bhasin S, Storer T, Ratamess NA, Haff GG, Willoughby DS, Rogol AD. Position stand on androgen and human growth hormone use. J Strength Cond Res 2009; 23:S1-S59. [PMID: 19620932 DOI: 10.1519/jsc.0b013e31819df2e6] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hoffman, JR, Kraemer, WJ, Bhasin, S, Storer, T, Ratamess, NA, Haff, GG, Willoughby, DS, and Rogol, AD. Position stand on Androgen and human growth hormone use. J Strength Cond Res 23(5): S1-S59, 2009-Perceived yet often misunderstood demands of a sport, overt benefits of anabolic drugs, and the inability to be offered any effective alternatives has fueled anabolic drug abuse despite any consequences. Motivational interactions with many situational demands including the desire for improved body image, sport performance, physical function, and body size influence and fuel such negative decisions. Positive countermeasures to deter the abuse of anabolic drugs are complex and yet unclear. Furthermore, anabolic drugs work and the optimized training and nutritional programs needed to cut into the magnitude of improvement mediated by drug abuse require more work, dedication, and preparation on the part of both athletes and coaches alike. Few shortcuts are available to the athlete who desires to train naturally. Historically, the NSCA has placed an emphasis on education to help athletes, coaches, and strength and conditioning professionals become more knowledgeable, highly skilled, and technically trained in their approach to exercise program design and implementation. Optimizing nutritional strategies are a vital interface to help cope with exercise and sport demands (). In addition, research-based supplements will also have to be acknowledged as a strategic set of tools (e.g., protein supplements before and after resistance exercise workout) that can be used in conjunction with optimized nutrition to allow more effective adaptation and recovery from exercise. Resistance exercise is the most effective anabolic form of exercise, and over the past 20 years, the research base for resistance exercise has just started to develop to a significant volume of work to help in the decision-making process in program design (). The interface with nutritional strategies has been less studied, yet may yield even greater benefits to the individual athlete in their attempt to train naturally. Nevertheless, these are the 2 domains that require the most attention when trying to optimize the physical adaptations to exercise training without drug use.Recent surveys indicate that the prevalence of androgen use among adolescents has decreased over the past 10-15 years (). The decrease in androgen use among these students may be attributed to several factors related to education and viable alternatives (i.e., sport supplements) to substitute for illegal drug use. Although success has been achieved in using peer pressure to educate high school athletes on behaviors designed to reduce the intent to use androgens (), it has not had the far-reaching effect desired. It would appear that using the people who have the greatest influence on adolescents (coaches and teachers) be the primary focus of the educational program. It becomes imperative that coaches provide realistic training goals for their athletes and understand the difference between normal physiological adaptation to training or that is pharmaceutically enhanced. Only through a stringent coaching certification program will academic institutions be ensured that coaches that they hire will have the minimal knowledge to provide support to their athletes in helping them make the correct choices regarding sport supplements and performance-enhancing drugs.The NSCA rejects the use of androgens and hGH or any performance-enhancing drugs on the basis of ethics, the ideals of fair play in competition, and concerns for the athlete's health. The NSCA has based this position stand on a critical analysis of the scientific literature evaluating the effects of androgens and human growth hormone on human physiology and performance. The use of anabolic drugs to enhance athletic performance has become a major concern for professional sport organizations, sport governing bodies, and the federal government. It is the belief of the NSCA that through education and research we can mitigate the abuse of androgens and hGH by athletes. Due to the diversity of testosterone-related drugs and molecules, the term androgens is believed to be a more appropriate term for anabolic steroids.
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Affiliation(s)
- Jay R Hoffman
- Department of Health and Exercise Science, The College of New Jersey, Ewing, 08628, USA.
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Brodin E, Ljungman S, Stibrant Sunnerhagen K. Rising from a chair A simple screening test for physical function in predialysis patients. ACTA ACUST UNITED AC 2009; 42:293-300. [DOI: 10.1080/00365590701797556] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Elisabeth Brodin
- Department of Physiotherapy, Sahlgrenska University Hospital, Göteborg, Sweden
- Institute of Neuroscience and Physiology/Rehabilitation Medicine, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
| | - Susanne Ljungman
- Department of Nephrology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Katharina Stibrant Sunnerhagen
- Institute of Neuroscience and Physiology/Rehabilitation Medicine, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
- Sunnaas Rehabilitation Hospital and the Medical Faculty, Oslo University, Oslo, Norway
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Abstract
Many of the known benefits of exercise in the general population are of particular relevance to the ESRD population. In addition, the poor physical functioning that is experienced by patients who are on dialysis is potentially addressable through exercise interventions. The study of exercise in the ESRD population dates back almost 30 yr, and numerous interventions, including aerobic training, resistance exercise training, and combined training programs, have reported beneficial effects. Recently, interventions during hemodialysis sessions have become more popular and have been shown to be safe. The risks of exercise in this population have not been rigorously studied, but there have been no reports of serious injury as a result of participation in an exercise training program. It is time that we incorporate exercise into the routine care of patients who are on dialysis, but identification of an optimal training regimen or regimens, according to patient characteristics or needs, is still needed to facilitate implementation of exercise programs.
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Affiliation(s)
- Kirsten L Johansen
- Nephrology Section, 111J, San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
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Johansen KL, Painter PL, Sakkas GK, Gordon P, Doyle J, Shubert T. Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis: A randomized, controlled trial. J Am Soc Nephrol 2006; 17:2307-14. [PMID: 16825332 DOI: 10.1681/asn.2006010034] [Citation(s) in RCA: 282] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Patients who are on hemodialysis commonly experience muscle wasting and weakness, which have a negative effect on physical functioning and quality of life. The objective of this study was to determine whether anabolic steroid administration and resistance exercise training induce anabolic effects among patients who receive maintenance hemodialysis. A randomized 2 x 2 factorial trial of anabolic steroid administration and resistance exercise training was conducted in 79 patients who were receiving maintenance hemodialysis at University of California, San Francisco-affiliated dialysis units. Interventions included double-blinded weekly nandrolone decanoate (100 mg for women; 200 mg for men) or placebo injections and lower extremity resistance exercise training for 12 wk during hemodialysis sessions three times per week using ankle weights. Primary outcomes included change in lean body mass (LBM) measured by dual-energy x-ray absorptiometry, quadriceps muscle cross-sectional area measured by magnetic resonance imaging, and knee extensor muscle strength. Secondary outcomes included changes in physical performance, self-reported physical functioning, and physical activity. Sixty-eight patients completed the study. Patients who received nandrolone decanoate increased their LBM by 3.1 +/- 2.2 kg (P < 0.0001). Exercise did not result in a significant increase in LBM. Quadriceps muscle cross-sectional area increased in patients who were assigned to exercise (P = 0.01) and to nandrolone (P < 0.0001) in an additive manner. Patients who exercised increased their strength in a training-specific fashion, and exercise was associated with an improvement in self-reported physical functioning (P = 0.04 compared with nonexercising groups). Nandrolone decanoate and resistance exercise produced anabolic effects among patients who were on hemodialysis. Further studies are needed to determine whether these interventions improve survival.
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Affiliation(s)
- Kirsten L Johansen
- Nephrology Section, 111J, San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
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Kiefer DE, Emery LJ. Functional performance and grip strength after total hip replacement. Occup Ther Health Care 2005; 18:41-56. [PMID: 23927652 DOI: 10.1080/j003v18n04_04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Objective. The progress of adults after total hip replacement (THR) was measured baseline to discharge using the Functional Independence Measure (FIM). Measures of effectiveness and efficiency were investigated. Additionally, although grip strength is frequently evaluated, its relationship to impact on functional gains after THR is unknown and was explored in this study. Method. A retrospective chart review was conducted on 41 patients' progress in acute rehabilitation following THR. Baseline and discharge FIM subscales of self-care, mobility, and locomotion were compared using paired t-tests with post hoc correction for type I error. Effectiveness and efficiency indicators on FIM subscale improvement were calculated. Grip strength was compared to expected values by age and gender using one-sample t-tests. Then, grip strength and FIM subscale scores were correlated using Pearson correlation. Results. FIM subscale scores each improved 2.1 points on average. Statistically significant improvement was made in 10 subscales of self-care, mobility, and locomotion. Grip strength was significantly less than expected norms in six of 14 subgroups after surgery; four of eight were female subgroups. There were no significant correlations between grip strength and any FIM subscale. Conclusion. Improvement in functional performance, as measured by FIM, was made on all FIM subscales. Grip strength after THR was moderately decreased from the norm. Results suggest that loss of grip strength alone may not adversely affect functional performance.
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Johansen KL, Shubert T, Doyle J, Soher B, Sakkas GK, Kent-Braun JA. Muscle atrophy in patients receiving hemodialysis: effects on muscle strength, muscle quality, and physical function. Kidney Int 2003; 63:291-7. [PMID: 12472795 DOI: 10.1046/j.1523-1755.2003.00704.x] [Citation(s) in RCA: 259] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Dialysis patients are less active and have reduced functional capacity compared to individuals with normal renal function. Muscle atrophy and weakness may contribute to these problems. This investigation was undertaken to quantify the extent of atrophy in the lower extremity muscles, to determine whether defects in muscle specific strength (force per unit mass) or central nervous system (CNS) activation are present, and to assess the relationship between muscle size and physical performance in a group of patients on hemodialysis. METHODS Thirty-eight dialysis subjects (aged 55 +/- 15 years) and nineteen healthy sedentary controls (aged 55 +/- 13 years) were enrolled. Magnetic resonance imaging of the lower leg was used to determine the total cross-sectional area (CSA) and the area of contractile and non-contractile tissue of the ankle dorsiflexor muscles. Isometric dorsiflexor strength was measured during a maximal voluntary contraction with and without superimposed tetanic stimulation (N = 22 for dialysis subjects, N = 12 for controls). Physical activity was measured by accelerometry, and gait speed was recorded as a measure of physical performance. RESULTS Dialysis subjects were weaker, less active, and walked more slowly than controls. Total muscle compartment CSA was not significantly different between dialysis subjects and controls, but the contractile CSA was smaller in the dialysis patients even after adjustment for age, gender, and physical activity. Central activation and specific strength were normal. Gait speed was correlated with contractile CSA. CONCLUSIONS Significant atrophy and increased non-contractile tissue are present in the muscle of patients on hemodialysis. The relationship between contractile area and strength is intact in this population. Muscle atrophy is associated with poor physical performance. Thus, interventions to increase physical activity or otherwise address atrophy may improve performance and quality of life.
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Affiliation(s)
- Kirsten L Johansen
- Department of Medicine, San Francisco VA Medical Center, University of California, San Francisco 94121, USA.
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Sadler JH. Health promotion for end-stage renal disease patients. ADVANCES IN RENAL REPLACEMENT THERAPY 1998; 5:275-85. [PMID: 9792082 DOI: 10.1016/s1073-4449(98)70019-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Health promotion is the desired objective of dialysis treatment. Achieving the highest level of functioning not only improves the life of the patient but rewards the staff through the positive feedback that improvement produces. The facility is rewarded by a stable population producing a more secure stream of income. The therapeutic environment is improved through better communication, positive attitudes, and more active participation of patients in their care. When maximum health is the focus of care, activities to achieve health are part of routine clinical contact, not additional effort requiring more staff. Fundamental to achieving health is adequate dialysis, control of anemia, good nutrition, and attention to comorbid conditions. The "Five Es" Life Options model of rehabilitation is a pattern for pursuing health and life enhancement. Encouragement is the positive attitude and expectations for each patient. Evaluation is individualized planning and periodic assessment of progress. Education prepares the patient for participation and responsibility. Exercise (on dialysis and off) improves physical capacity and well being. Employment is sought for those of working age and capability. A number of facilities have shown the effectiveness and benefits of these practices. In addition, using health status/quality of life measures to obtain patient-reported assessment of condition allows objective scoring. Comparisons and compilations can be made to evaluate the effect of interventions or illness on status. This can be accomplished for groups or individuals to document the effect of health promotion.
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Affiliation(s)
- J H Sadler
- University of Maryland, Independent Dialysis Foundation, Baltimore 21201, USA
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Bohannon RW, Smith J, Barnhard R. Balance Deficits Accompanying Renal Disease are Related to Diabetic Status. Percept Mot Skills 1995; 81:528-30. [PMID: 8570352 DOI: 10.1177/003151259508100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Balance deficits were examined in a sample of kidney-transplant candidates (60 men, 30 women) using an ordinal scale. Normal performance was defined as unilateral standing for more than 20 sec. Only 52% of the subjects balanced normally. A significant relationship between balance performance and diabetic status was found. Diabetic patients were more likely to show impaired balance. This finding is consistent with prior reports of gait and strength deficits among kidney-transplant candidates.
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Affiliation(s)
- R W Bohannon
- School of Allied Health Professions, University of Connecticut, Storrs 06269-2101, USA
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Bohannon RW, Smith J, Barnhard R. Balance deficits accompanying renal disease are related to diabetic status. Percept Mot Skills 1995. [PMID: 8570352 DOI: 10.2466/pms.1995.81.2.528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Balance deficits were examined in a sample of kidney-transplant candidates (60 men, 30 women) using an ordinal scale. Normal performance was defined as unilateral standing for more than 20 sec. Only 52% of the subjects balanced normally. A significant relationship between balance performance and diabetic status was found. Diabetic patients were more likely to show impaired balance. This finding is consistent with prior reports of gait and strength deficits among kidney-transplant candidates.
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Affiliation(s)
- R W Bohannon
- School of Allied Health Professions, University of Connecticut, Storrs 06269-2101, USA
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