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Background Most patients with minor stroke or transient ischemic attack (TIA) are discharged with little or no specialised follow-up. Nonetheless, these patients have a high prevalence of cognitive impairments and a considerable risk of recurrent stroke. Smoking cessation, physical activity, and adherence to antihypertensive and antithrombotic medication are highly recommended in patients with minor stroke and TIA. Evidence suggests that simple encouragement to change lifestyle is ineffective. Behavioural interventions might therefore be needed to support patients in managing their own health post-discharge. Objectives We aim to test the (1) feasibility of randomisation acceptance and an early initiated, client-centred lifestyle and behavioural intervention in a clinical setting, and (2) potential effect of the intervention on arterial blood pressure in patients with minor stroke or TIA and (3) explore the participants experience of barriers and facilitators for health behaviour after a stroke, including perceived needs and social support. Methods We will conduct a randomized controlled pilot trial: Eligible patients with acute minor stroke or TIA (n = 40) will be randomly allocated to either early initiated counselling with four weekly post-discharge follow-up sessions for 12 weeks or usual care. The primary outcome will be program feasibility and to discuss the relevance of arterial blood pressure as primary outcome after 12 weeks intervention. Selected participants will be invited to participate in semi-structured interviews, based on purposeful sampling, to evaluate the intervention and explore their experience of life after a stroke. The interviews will be analysed using a five-step thematic analysis approach. Discussion The study will provide evidence of the feasibility and potential effect of early initiated counselling on cardiovascular risk factors in patients with minor stroke and TIA. Qualitative interviews will contribute with a more nuanced understanding of the barriers and facilitators of health enhancing behaviour. Optimizing health behaviour counselling and providing formal support to the patients’ post-discharge may ease the transition and help more patients adhere to lifestyle and medication recommendations. Trial registration ClinicalTrial.gov, NCT03648957

Background: Intradialytic exercise is an effective intervention to reduce morbidity and mortality and increase quality of life among patients with chronic kidney disease undergoing dialysis. However, implementing and sustaining it in clinical practice has proved challenging. To identify how to best design an effective and sustainable intervention in clinical practice, we aimed to explore hemodialysis patients’ and nurses’ attitudes towards intradialytic exercise, including their motivation, anticipated barriers, and suggestions for the design of a proposed exercise program. Methods: Data were collected through qualitative semistructured interviews with patients and focus group interviews with nurses and analyzed inductively with content analysis. Results: Overall, patients’ and nurses’ attitudes towards intradialytic exercise were positive. Patients were motivated by their expectations about perceived benefits, such as improved quality of life and reduced musculoskeletal pain. Their main concern was triggering dialysis machine alarms and disturbing nurses. Nurses were more skeptical of intradialytic exercise and concerned about patient safety. Patients and nurses had several ideas on how to design a safe and motivating intradialytic exercise intervention. Conclusion: The analysis of patients’ and nurses’ experiences and attitudes generated recommendations for an intradialytic exercise program. Recommendations include individually tailored programs that are safe and that patients can do independently, continuous collaboration between patients, nurses, physicians, and physiotherapists, and educating nurses about the benefits and safety of intradialytic exercise.

Background Musculoskeletal pain has been reported as a clinical problem in patients with chronic kidney disease (CKD). The purpose of this study was to compare the frequency of musculoskeletal pain in patients with CKD and no mobility problems with a general population and to investigate the impact of pain on quality of life (QOL), physical activity and physical function. Methods Patients with CKD Stages 4 and 5 with or without a dialysis treatment and no mobility problems were included. Musculoskeletal pain in the shoulder/neck, back/low back and limbs and level of physical activity were measured using the Danish Health and Morbidity Survey and coded into dichotomous answers. QOL and physical function were measured using the kidney disease QOL questionnaire and the 30-s chair stand test, respectively. Data for the general population were collected in national registers and adjusted for age, gender and region. Results The patients (n = 539) had a mean age of 66 [95% confidence interval (CI) 65–67] years, 62% were men and they were treated with haemodialysis (HD) (n = 281), peritoneal dialysis (n = 62) or without dialysis (n = 196). The frequency of reported musculoskeletal pain in the patients did not exceed pain reported by the general population [e.g. pain in the limbs in patients undergoing HD versus a matched general population, 61% versus 63% (P = 0.533), respectively]. Pain in all measured body sites was associated with reduced QOL [e.g. pain in the limbs associated with a physical component scale β of −8.2 (95% CI −10.3 to −6.0), P Conclusions Musculoskeletal pain was not more frequently reported by patients with CKD and no mobility problems compared with the general population. However, as musculoskeletal pain was reported by up to two-thirds of the patient sample, healthcare professionals should remember to focus on this issue. The patients’ pain was associated with negative impacts on QOL, level of physical activity and physical function.

To investigate the effect of exercise training on musculoskeletal pain in patients with type 2 diabetes.The intervention was exercise twice weekly for 12 weeks. The primary outcome was musculoskeletal pain assessed using a 0-10 Numeric Rating Scale (NRS) in 11 body sites. Secondary outcomes were use of analgesics, glycaemic control and body weight.The participants (n = 69) were 66 ± 10 years old, 38 were men and 50 completed the intervention. Pain in the limbs was more frequently reported by the participants compared to a matched general population (80.9% vs 65.3%, p = 0.007). The participants who had any pain at baseline (NRS 0) and severe pain (NRS 3) reported significantly decreased pain in the feet, calf muscles, knees, thighs, hips, lower back and arms after the training period. Use of analgesics was unchanged, HbA1c (mmol/mol) decreased from 60 ± 15 to 54 ± 11, p 0.001 and body weight (kg) decreased from 100.5 ± 19.1 to 98.6 ± 17.7, p = 0.005.The participants with type 2 diabetes reported more frequent pain than a matched general population. The training intervention was associated with reduced musculoskeletal pain. Reduced pain may together with a positive impact on glycaemic control be an important motivational factor in patients with type 2 diabetes to perform exercise training.

ObjectiveEnd-stage kidney disease and hemodialysis (HD) treatment are associated with a high symptom burden in many patients. This study aimed at updating patient-reported outcomes concerning quality of life, fatigue, anxiety, and depression in HD patients treated in a single center in order to assess the need for palliative care provision.MethodA cross-sectional design, in which a sample of patients treated at a single HD department (Rigshospitalet, Denmark) between January and June 2019, was analyzed using the Kidney Disease Quality of Life Short Form, the Multidimensional Fatigue Inventory, and the Hospital Anxiety and Depression Scale. In addition, we compared the results with previously published data from the same department (2000) and with an age- and sex-matched sample from the Danish general population (1997/2014). Chi-square and t-tests were used for comparisons.ResultsScreened patients = 242, included = 141, analyzed = 131 (70.2% male, mean age = 61.3 years). HD patients reported low scores for quality of life, high scores for fatigue, and approximately 30% had anxiety/depression. Regarding quality of life, they had significantly lower scores on general health (P ≤ 0.000), vitality (P = 0.009), social functioning (P = 0.001), mental health (P = 0.007), and mental component (P = 0.005) compared with former data of HD patients. Moreover, they reported significantly poorer quality of life and worse fatigue compared with the general Danish population.Significance of resultsIn the patients undergoing HD, quality of life was poor and worsened when compared with former HD patients’ data. Additionally, fatigue, depression, and anxiety in HD patients were prevalent. A clear need for palliative care provision was observed.

(1) Background: The purpose of this article was to investigate the association between self-reported physical activity (PA) and all-cause mortality in ambulatory patients with chronic kidney disease (CKD), stage 4–5 including maintenance dialysis. (2) Methods: Ambulatory patients with CKD (eGFR &lt, 30 mL/min/1.73 m2) with conservative treatment or chronic dialysis were included. PA was assessed using the Saltin–Grimby Physical Activity Level Scale. A Cox proportional hazards regression model––adjusted for age, sex, plasma–albumin, body mass index, socioeconomic status, and treatment––was applied. (3) Results: Participants (n = 374) were followed 39 ± 15 months from entry to death or censoring. Throughout the study period of 39 months, 156 deaths (42%) were registered. Regarding physical activity, 128 (34%) of the participants were inactive, 212 (57%) were moderately active, and 34 (9%) were highly or vigorously active. Moderate PA was associated with a decreased mortality risk in women (n = 150) compared to inactivity (HR 0.27 (0.15, 0.51), p &lt, 0.001), whereas a high/vigorous level of PA was not significantly associated with mortality risk compared to inactivity. In men (n = 224), the associations between PA levels and mortality risk were not significant. (4) Conclusions: Moderate PA was associated with reduced all-cause mortality in ambulatory women with stage 4–5 CKD with or without maintenance dialysis treatment. Physical activity was not significantly associated with mortality in men.

IntroductionA physically active lifestyle during pregnancy improves maternal and offspring health but can be difficult to follow. In Denmark, less than 40% of pregnant women meet physical activity (PA) recommendations. The FitMum study aims to explore strategies to increase PA during pregnancy among women with low PA and assess the health effects of PA. This paper presents the FitMum protocol, which evaluates the effects of structured supervised exercise training or motivational counselling supported by health technology during pregnancy on PA level and health of mother and offspring.Methods and analysisA single-site three-arm randomised controlled trial that aims to recruit 220 healthy, pregnant women with gestational age (GA) no later than week 15 and whose PA level does not exceed one hour/week. Participants are randomised to one of three groups: structured supervised exercise training consisting of three weekly exercise sessions, motivational counselling supported by health technology or a control group receiving standard care. The interventions take place from randomisation until delivery. The primary outcome is min/week of moderate-to-vigorous intensity PA (MVPA) as determined by a commercial activity tracker, collected from randomisation until GA of 28 weeks and 0-6 days, and the secondary outcome is gestational weight gain (GWG). Additional outcomes are complementary measures of PA; clinical and psychological health parameters in participant, partner and offspring; analyses of blood, placenta and breastmilk samples; process evaluation of interventions; and personal understandings of PA.Ethics and disseminationThe study is approved by the Danish National Committee on Health Research Ethics (# H-18011067) and the Danish Data Protection Agency (# P-2019-512). Findings will be disseminated via peer-reviewed publications, at conferences, and to health professionals via science theatre performances.Trial registration numberNCT03679130.Protocol versionThis paper was written per the study protocol version 8 dated 28 August 2019.

Aims. The purpose was to assess the reproducibility of glucose changes during three sessions of standardized moderate intensity continuous training of cycling on an individual level in people with type 1 diabetes. Methods. Twelve adults (six females) with type 1 diabetes performed three test sessions on an ergometer bicycle (30 min, 67% of predicted heart rate) on three different days. The participants were 36.5 (26.6-45.5) (median, IQR) years old, and their HbA1c was 65 ± 15 mmol/mol ( mean ± SD ). Two hours before the tests, the participants had a standard meal. Interstitial glucose (IG) and capillary glucose (CG) were measured using an iPro2 Medtronic continuous glucose monitor and the Bayer Contour XT-device, respectively. Prior to the test sessions, resting heart rate was measured using a digital blood pressure monitor to estimate the desired intensity of the exercise. Results. The average within-participant relationship between the average slope in glucose during sessions 2 and 1 was in IG -0.29 (95% CI -1.11; 0.58) and in CG -0.04 (-0.68; 0.77). Between sessions 3 and 2, IG is 0.18 (-0.27; 0.64) and in CG 0.13 (-0.25; 0.55). Between sessions 3 and 1, IG was 0.06 (-0.57; 0.71) and in CG 0.06 (-0.39; 0.52). The results indicate low reproducibility at participant levels and remained unchanged after adjustment for baseline glucose values. Conclusion. On an individual level, the glucose declines during three standardized sessions of PA were not associated with identical responses of the measured IG and CG levels. An overall anticipated decline of glucose concentrations was found in the moderate intensity cycling sessions. This highlights the importance of regular CG measurements during and after physical activity and awareness towards potential exercise-induced hypoglycemia in persons with type 1 diabetes.

OBJECTIVE: Impairment in physical function and physical performance leads to decreased independence and health-related quality of life in people living with chronic kidney disease and end-stage kidney disease. Physical activity and exercise in kidney care are not priorities in policy development. We aimed to identify global policy-related enablers, barriers, and strategies to increase exercise participation and physical activity behavior for people living with kidney disease. DESIGN AND METHODS: Guided by the Behavior Change Wheel theoretical framework, 50 global renal exercise experts developed policy barriers and enablers to exercise program implementation and physical activity promotion in kidney care. The consensus process consisted of developing themes from renal experts from North America, South America, Continental Europe, United Kingdom, Asia, and Oceania. Strategies to address enablers and barriers were identified by the group, and consensus was achieved. RESULTS: We found that policies addressing funding, service provision, legislation, regulations, guidelines, the environment, communication, and marketing are required to support people with kidney disease to be physically active, participate in exercise, and improve health-related quality of life. We provide a global perspective and highlight Japanese, Canadian, and other regional examples where policies have been developed to increase renal physical activity and rehabilitation. We present recommendations targeting multiple stakeholders including nephrologists, nurses, allied health clinicians, organizations providing renal care and education, and renal program funders. CONCLUSIONS: We strongly recommend the nephrology community and people living with kidney disease take action to change policy now, rather than idly waiting for indisputable clinical trial evidence that increasing physical activity, strength, fitness, and function improves the lives of people living with kidney disease. ispartof: JOURNAL OF RENAL NUTRITION vol:32 issue:4 pages:441-449 ispartof: location:United States status: published

Quality of life (QOL) and physical activity (PA) is reduced in patients with chronic kidney disease (CKD). The aim was to investigate the impact of marital status and educational level on QOL and PA in patients with CKD including dialysis treatment. This cross-sectional study included ambulatory adult patients undergoing dialysis or CKD stage 4–5. Data for marital status, educational level and PA were obtained using the Danish health and Morbidity Survey. QOL was assessed using the Physical Component Scale and the Mental Component Scale scores from the Kidney Disease Quality of Life Instrument. Five hundred twelve participants were included: 316 (62%) were married/had a permanent partner, 119 (23%) had a low level of education, 327 (67%) were physically active. After confounder adjustments (age, sex, treatment), having a permanent partner was associated with greater scores in Mental Component Scale, β 2.88 [CI 95% 0.99; 4.77], p = 0.003, and being physically active in women OR 2.237 [1.231; 4.066], p = 0.008. A high vs low educational level was associated with greater scores in Physical Component Scale (3.79 [1.01; 6.58], p = 0.008) and in Mental Component Scale (3.55 [0.82; 6.28], p = 0.011). In ambulatory patients with CKD stage 4–5, being married or having a permanent partner and a high educational level had positive impacts on mental QOL. Higher educational level was also associated with better physical QOL. The presented inequality in QOL should be considered in communications, care and treatments in clinical practice.

Introduction: Pain is a clinical complication in COPD that interferes with physical activity level (PAL), quality of life (QoL) and pulmonary interventions. Yet, research on the magnitude of and the differences in pain characteristics including prevalence, localization and intensity in people with COPD are sparsely researched. Aim: To investigate pain prevalence, -localization and -intensity in people with and without COPD, and to investigate the association between pain intensity and PAL. Methods: Data were derived from the recent 2017 Danish Health and Morbidity Survey. Data included pain intensity on a numeric rating scale (NRS) and localization, PAL, QoL, sleep-disturbance, comorbidities, demographic and behavioral factors. Results: 528 people with COPD and 8184 people without COPD (51% females, mean±SD age 67±11 years) were analysed. Pain prevalence was significantly higher in people with COPD vs those without (72% vs. 58%, p Conclusion: The findings emphasizes the importance of incorporating routine assessment of pain at the physician consultation and subsequent management in e.g. rehabilitation programs.

Jeanette Hansen, 1 Stig Molsted, 2 Ola Ekholm, 3 Henrik Hansen 4 1Department of Public Health, University of Copenhagen, Copenhagen, Denmark; 2Department of Clinical Research, North Zealand Hospital, Hillerød, Denmark; 3National Institute of Public Health, University of Southern Denmark, Odense, Denmark; 4Respiratory Research Unit, Department of Respiratory Medicine, University Hospital Hvidovre, Hvidovre, DenmarkCorrespondence: Henrik HansenRespiratory Research Unit, Department of Respiratory Medicine, University Hospital Hvidovre, Kettegård alle 30, Hvidovre 2650, DenmarkTel +45 28946780Email henrikhanseninfo@gmail.comIntroduction: Pain is a clinical complication to chronic obstructive pulmonary disease (COPD) that interferes negatively with physical activity level (PAL), quality of life (QOL) and pulmonary interventions. Yet, research in pain characteristics including prevalence, localization, and intensity in people with COPD are sparsely researched.Aim: To investigate self-reported pain prevalence, localization and intensity of pain in people with and without COPD, and to investigate the association between pain intensity and PAL among participants with COPD.Methods: Data were derived from the Danish Health and Morbidity Survey in 2017. The study population was restricted to individuals aged ≥ 35 years. Data included pain intensity assessed on the Numeric Rating Scale (NRS) and localization, PAL, QoL, sleep disturbance, comorbidities, sociodemographic and behavioral factors.Results: In all, 528 participants with COPD and 8184 participants without COPD (51% females, mean ±SD age 67.1± 11.4 years) were analyzed. Pain prevalence within the past 14 days was significantly higher in participants with COPD vs nonCOPD (72.7% vs 57.7%, p< 0.001) and mainly located in the limbs, thorax, and lower back. COPD was associated with the prevalence of chronic pain (≥ 6 months) (OR: 2.78, 95%CI: 2.32; 3.34, p< 0.001). Participants with COPD reported a higher pain intensity compared to those with nonCOPD with a mean difference of 1.04 points (95%CI: 0.75; 1.32, p< 0.001) on the NRS. In the adjusted multiple logistic regression analysis, pain intensity was negatively associated with odds of being physical active (OR: 0.72, 95%CI: 0.61; 0.85, p< 0.001).Conclusion: Pain is more prevalent in people with self-reported COPD. After adjustment for age and gender, COPD was associated with an elevated pain intensity. Sleep disturbance and multimorbidity had the most pronounced impacts on pain intensity in the multiple linear regression model. In participants with COPD, increased pain intensity was negatively associated with being physically active.Keywords: COPD, pain, cross-sectional, physical activity, quality of life

Aim was to investigate the association between quality of life (QoL), bowel anatomy, and the need for home parenteral support (HPS) volume in patients with nonmalignant short-bowel syndrome (SBS) and intestinal failure (IF).The SBS-QoL scale was used in a cross-sectional study of 95 nonmalignant SBS-IF patients. Sum QoL scores (0: best, 170: worst) were calculated. Patients were defined as having a small bowel (≤200 cm), and patients with jejunostomy or ileostomy were subclassified based on functional small-bowel length (cm) into 4 anatomy subgroups: 1a-1d (0-49, 50-99, 100-149, 150-200 cm, respectively). Multiple linear regression analyses explored associations between QoL, patient groups, and HPS volume, adjusting for age, sex, body mass index, and education.Complete data were obtained from 60 patients. HPS volume was associated with a worse SBS-QoL score (L/d, β = 7.91; SE = 3.90; P = .048), but male sex associated with improvement (β = -26.28; SE = 11.06; P = .021). No differences in sum QoL were seen between the benign SBS-IF subgroups 1a-d (P = .210). Multivariate regression analyses showed that patients with a small-bowel stoma, a small-bowel length50 cm was associated with a significantly worse/higher SBS-QoL score compared with a length50 cm.In patients with benign SBS-IF, high HPS volume was associated with poor QoL. Also, jejunostomy or ileostomy with small-bowel length50 cm was associated with impaired QoL. These findings support rehabilitation strategies that reduce fecal losses and decrease HPS needs.

INTRODUCTION: The incidence of acute readmissions is higher among elderly medical patients than in the general population. Risk factor identification is needed in order to prevent readmissions.OBJECTIVE: To estimate the incidence of acute readmissions among medical patients ≥65years discharged from departments of internal medicine and to identify risk factors associated with readmissions.MATERIAL AND METHODS: We included patients discharged between 1st of January 2011 and 1st of December 2014 and collected data regarding primary diagnosis and comorbidities. The primary outcome was acute readmission within 30days of discharge. We determined risk factors using a multivariable Cox proportional hazards model.RESULTS: Out of 21,634 discharged patients, 3432 (15.9%) patients had an acute readmission. Risk factors were: age per decade (HR: 1.06, 95%CI: 1.02-1.11), male sex (HR: 1.07, 95%CI: 1.00-1.15), receiving home care service (personal care) (HR: 1.33, 95%CI: 1.15-1.55), nursing home residency (HR: 1.30, 95%CI: 1.14-1.48), a previous admission within six months (HR: 1.59, 95%CI: 1.48-1.72), increased length of index admission (HR: 1.14, 95%CI: 1.11-1.17), and moderate or high level of comorbidities (HR: 1.22, 95%CI: 1.13-1.32, HR: 1.52, 95%CI: 1.38-1.67, respectively).CONCLUSION: Around one in six patients had an acute readmission and we identified several risk factors. The risk factors a previous hospital admission within six months, a long or very long length of index admission and a high level of comorbidities were strong risk factors for an acute readmission.

Purpose: It has been suggested that patients with inspiratory muscle weakness could benefit from specific inspiratory muscle training (IMT). We aimed to examine the frequency of patients with inspiratory muscle weakness in a Danish hospital-based outpatient pulmonary rehabilitation program, and to evaluate the association between inspiratory muscle strength and peripheral muscle strength and walking capacity. Methods: Maximal Inspiratory Pressure (MIP) was assessed in 97 patients with COPD (39 men, 58 women, mean age years 70 ± 9, forced expiratory volume in 1 s ((FEV1) = 35 ± 10% pred.). The impact of MIP on knee-extension strength, walking distance, and symptom burden was evaluated using multiple linear regression analyses. Results: The MIP of the patients with COPD was 63 (95% CI 59; 67) cmH2O and it was significantly reduced compared to gender and age-matched reference values 76 (95% CI 73; 79) cmH2O (p < 0.001). Seven patients (7.2%) were under the lower limit of normal. MIP was negatively correlated with increasing age, female gender, decreasing knee-extension strength and lower FEV1% pred. Walking distance was associated with knee-extension strength and it was not associated with MIP. Conclusion: Maximal inspiratory pressure was reduced in patients with COPD but only a few patients had a weak MIP. Whilst MIP was associated with leg muscle strength, it was not associated with walking distance or symptoms.

Introduction Improvements in health behaviour are often recommended as part of secondary prevention in patients with stroke and transient ischaemic attack. However, there is a lack of knowledge as to how this is applied in clinical practice. Aim In this systematic review and meta-analysis, we examined the effect of counselling or educational intervention directed at individual or multiple behavioural risk factors on blood pressure and other reported outcomes. Methods PubMed, Embase, PsycInfo, CINAHL, Scopus and Web of Science were systematically searched. Meta-analyses were conducted on all outcome measures if appropriate. A qualitative analysis of the content of the interventions was conducted to review which elements the interventions consisted of. Results Twenty-nine randomized controlled trials were identified. Fourteen reported effects on systolic blood pressure, and pooled results showed a significant beneficial effect (n = 2,222; -3.85 mmHg [95%CI -6.43; -1.28]). The effect was greatest in the four interventions which included supervised training (n = 174; -9.83 mmHg [95%CI -16.56; -3.09]). Conclusion Modifying health behaviour in stroke survivors might have a moderate beneficial effect on blood pressure, especially if the intervention includes supervised physical training.

Objective Self-efficacy has been shown to influence initiating and maintaining physical activity. Pregnancy often leads to a decline in physical activity and exercise self-efficacy assessments could be a tool to help women stay active during pregnancy. The Pregnancy Exercise Self-Efficacy Scale (P-ESES) is an English questionnaire assessing the self-efficacy in pregnant women to perform physical activity. The aim of this study was to translate the P-ESES questionnaire into a valid and reliable Danish version, P-ESES-DK. Study design The study included a qualitative design for the validation of the questionnaire and a prospective longitudinal observational study for the reliability testing. Main outcome measures The questionnaire was translated into Danish in a four-stage process with translation, back-translation and synthesis. The pre-final version was tested by eight women and changes were made to complete the final version of P-ESES-DK. The reliability testing was performed using a test-retest analysis of P-ESES-DK with 75 Danish pregnant women. Reliability was assessed using Intraclass Correlation Coefficient (ICC), Cronbach’s alpha and agreement was visualized using a Bland-Altman plot. Results The questionnaire was found to have a good content validity. The assessment of the test re-test reliability showed an ICC of 0.809 and a Cronbach’s alpha of the test and re-test were 0.839 and 0.869, respectively. The Bland-Altman plot showed that 93.9% of the answers were within the 95% limits of agreement. Conclusions The Danish version of P-ESES was found to be both reliable and valid. Thus, it can be used as a helpful tool to measure self-efficacy related to physical activity during pregnancy.

Aim. To investigate the associations between diabetes and musculoskeletal pain, osteoarthritis, osteoporosis, and rheumatoid arthritis. Methods. Self-reported data were provided by the nationwide Danish National Health Survey 2013. Inclusion criteria were age≥40 years and known diabetes status. The exposure variable was diabetes, and the outcome variables included musculoskeletal pain during the last 14 days in three body sites (back/lower back, limbs, and shoulder/neck), osteoarthritis, osteoporosis, and rheumatoid arthritis. Logistic regression analyses adjusted for age, gender, BMI, education, marital status, and physical activity were performed. Results. 9,238 participants with diabetes were 65.6±11.0 (mean±SD) years old; 55.6% were males. 99,980 participants without diabetes were 59.2±11.8 years old; 46.7% were males. Diabetes was associated with back/lower back pain (OR 1.2 (CI 95% 1.1-1.2), p<0.001), pain in the limbs (1.4 (1.3-1.4), p<0.001), shoulder/neck pain (1.2 (1.1-1.3), p<0.001), osteoarthritis (1.3 (1.2-1.4), p<0.001), osteoporosis (1.2 (1.1-1.4), p=0.010), and rheumatoid arthritis (1.6 (1.4-1.7), p<0.001). In participants with diabetes, physical activity was associated with reduced pain (e.g., back/lower back pain (0.7 (0.6-0.7), p<0.001)). Conclusion. Diabetes was associated with elevated odds of having musculoskeletal pain. Diabetes was also associated with elevated odds of having osteoarthritis, osteoporosis, and rheumatoid arthritis. The most frequent disease in individuals with diabetes was osteoarthritis. The reported pain may have negative impacts on the level of physical activity. Health-care professionals should remember to inform patients with diabetes that musculoskeletal pain, osteoarthritis, osteoporosis, and rheumatoid arthritis are not contraindications to exercise training.

To assess distal blood pressures (BPs) in ankle and toe, walking capacity, intermittent claudication symptoms, physical activity and self-rated health after intermittent vacuum treatment (IVT) for peripheral artery disease (PAD). Forty-eight patients with PAD were randomised to either a control (C)-group with lifestyle changes or lifestyle changes in combination with VacuMed® treatment thrice weekly for 6 weeks. Ankle and toe BPs were measured before, after 6 weeks of intervention and after 6 weeks follow-up. Walking capacity, intermittent claudication symptoms, physical activity and self-rated health (Likert scale) were also assessed. The ankle to brachial index (ABI) and BPs in the ankle and toe decreased after 6 and 12 weeks in both groups with no difference between the groups. In the legs with the lowest ABI at baseline in each patient, there were no differences regarding ABI, BPs and toe-systolic BP index between the groups after either the intervention or the follow-up period. The BPs decreased in both groups. The walking distance and the time to pain were unchanged in the IVT-group and increased in the C-group after the follow-up period, but without any significant differences between the groups. The level of objectively tested physical activity and self-rated health remained unchanged throughout the study in both the IVT- and the C-group. There were no differences between the changes of the self-rated health data during the study period between the IVT- and the C-group. VacuMed® had no effect per se on distal blood pressures, walking capacity, intermittent claudication symptoms, physical activity and self-rated health.

Introduction: The aim of this study was to assess the effect of high-intensity resistance training on satellite cell (SC) and myonuclear number in the muscle of patients undergoing dialysis. Methods: Patients (n = 21) underwent a 16-week control period, followed by 16 weeks of resistance training 3 times weekly. SC and myonuclear number were determined by immunohistochemistry of vastus lateralis muscle biopsy cross-sections. Knee extension torque was tested in a dynamometer. Results: During training, SCs/type I fibers increased by 15%, whereas SCs/type II fibers remained unchanged. Myonuclear content of type II, but not type I, fibers increased with training. Before the control period, the SC content of type II fibers was lower than that of type I fibers, whereas contents were comparable when normalized to fiber area. Torque increased after training. Conclusions: Increased myonuclear content of type II muscle fibers of dialysis patients who perform resistance training suggests that SC dysfunction is not the limiting factor for muscle growth. Muscle Nerve 52: 736–745, 2015

Background. Obstructive sleep apnoea (OSA) is related to type 2 diabetes (T2DM), and it may be associated with reduced inspiratory muscle strength (IMS). The aim of this study was to investigate the IMS in patients with T2DM, with or without OSA. Methods. Patients with T2DM with OSA (n=33) and without OSA (n=28) were included. The maximum IMS was tested using the POWERbreathe KH2 device. Reference IMS values were data calculated using an algorithm based on general populations and adjusted for age and gender. Results. There was no difference in IMS between the OSA group (median (range) 77 (35–124) cmH2O) and the non-OSA group (84 (33–122) cmH2O) (p=0.97). The IMS values were reduced in the OSA group compared with the reference values (92.9 (62.3–100.0) cmH2O) (p=0.030), whereas the non-OSA group did not have reduced IMS. When the IMS values of all T2DM patients were compared with reference values, the IMS values were 79 (33–124) cmH2O and 93.8 (62.3–102.4) cmH2O, respectively (p=0.017). Conclusion. No difference in IMS between patients with T2DM with or without OSA was found. However, patients with T2DM and OSA had reduced IMS compared with age- and gender-matched references whereas the non-OSA group did not have reduced IMS.

Background. The aim of this study was to investigate IL-6 and 25-hydroxyvitamin D (25-OH D) associations with muscle size and muscle function in dialysis patients.Methods. Patients were included in a 16-week control period followed by 16 weeks of high-intensity resistance training thrice weekly. IL-6 and 25-OH D were analysed after an over-night fast. Muscle fibre size was analysed in biopsies fromm. vastus lateralis. Muscle power was tested using a Leg Extensor Power Rig.Results. Patients (n=36) with IL-6 ≥ 6.49 pg/ml (median) were older and had decreased muscle power and a reduced protein intake (P<0.05) compared with patients with IL-6 < 6.49 pg/ml. IL-6 was not associated with muscle fibre size. Vitamin D deficiency (25-OH D < 50 nmol/l) was present in 51% of the patients and not associated with muscle power. IL-6 remained unchanged during the training period, whilst muscle power increased by 20–23% (P<0.001).Conclusion. Elevated IL-6 values were associated with decreased muscle power but not with decreased muscle fibre size. Half of the patients were suffering from vitamin D deficiency, which was not associated with muscle power. IL-6 was unchanged by high-intensity resistance training in dialysis patients in this study.

Aim The aim of this study was to investigate the effects of high-load resistance training on the rate of force development and neuromuscular function in patients undergoing dialysis. Methods Twenty-nine patients were tested before and after 16 weeks of resistance training. The rate of force development was tested using the Good Strength dynamometer chair. Muscle strength and neuromuscular function in the m. Vastus lateralis was estimated using electromyography in a one repetition maximum test during dynamic knee extension and during a 20 s isometric knee extension with 50% of the one repetition maximum load. Muscle biopsies from the m. Vastus lateralis were analysed for morphologic characteristics. Results One repetition maximum in knee extension increased by 46% (P

Background/Aims: The aim of this controlled study was to investigate the effect of high-load strength training on glucose tolerance in patients undergoing dialysis. Methods: 23 patients treated by dialysis underwent a 16-week control period followed by 16 weeks of strength training three times a week. Muscle fiber size, composition and capillary density were analyzed in biopsies obtained in the vastus lateralis muscle. Glucose tolerance and the insulin response were measured by a 2-hour oral glucose tolerance test. Results: All outcome measures remained unchanged during the control period. After strength training the relative area of type 2X fibers was decreased. Muscle fiber size and capillary density remained unchanged. After the strength training, insulin concentrations were significantly lower in patients with impaired glucose tolerance or type 2 diabetes (n = 14) (fasting insulin from 68 ± 12 (46-96) to 54 ± 10 (37-77) pmol/l, p < 0.05, 2-hour insulin from 533 ± 104 (356-776) to 344 ± 68 (226-510) pmol/l, p < 0.05, total insulin area under the curve from 1,868 ± 334 (1,268-2,536) to 1,465 ± 222 (1,094-1,913), p < 0.05). Insulin concentrations were unchanged in patients with normal glucose tolerance (n = 9). Conclusion: The conducted strength training was associated with a significant improvement in glucose tolerance in patients with impaired glucose tolerance or type 2 diabetes undergoing dialysis. The effect was apparently not associated with muscle hypertrophy, whereas the muscle fiber type composition was changed.

The aims were to investigate the prevalence of musculoskeletal pain in patients with type 2 diabetes and demonstrate possible associated factors.Nine hundred fifty-one patients completed a validated questionnaire used in The Danish Health and Morbidity Survey and results were compared to data for 2923 matched subjects from the Danish population. Musculoskeletal pain was self-reported Pain in the shoulder and neck; Low-back pain; and Pain in the arm, hand, knee and/or hip.Compared to the age, gender and region matched controls patients reported musculoskeletal pain 1.7-2.1 times as frequent (p0.001). Pain was more frequently reported in women (p0.001). Low-back pain and Pain in the arm, hand, knee and/or hip was associated with body mass index (p0.005). Low-back pain was associated with a sedentary life style, impaired quality of life and reduced physical function (p0.05).The prevalence of musculoskeletal pain was seriously increased in patients with type 2 diabetes. It was associated with body mass index, reduced quality of life, low physical function and the ability to be physical active. Focus on musculoskeletal pain in clinical practice is therefore of major importance in lifestyle interventions in type 2 diabetes.

Objective Patients on dialysis have low physical activity levels. The aim of the study was to examine the validity of action planning and coping planning within the theory of planned behaviour framework, for predicting physical activity behaviour of patients on haemodialysis. Design This is a prospective study design. Methods One hundred and forty-four patients who were undergoing haemodialysis were selected from dialysis centres. The mean age of the patients was 56.61 (SD = 11.38) years. The patients completed a questionnaire including variables from the theory of planned behaviour, action planning and coping planning. Physical activity was prospectively assessed at 4-weeks with the validated International Physical Activity Questionnaire self-report measure. A hierarchical regression analysis was performed to examine the effects of action planning and coping planning on physical activity behaviour. Results There was a main effect for coping planning but not for action planning. Moreover, the analyses resulted in a significant amount of incremental variance accounted for by the interaction of coping planning and intention. Conclusion Results suggest the combination of high levels of coping planning and intention is associated with increases in physical activity.

Aim: The aims of the study were to translate the Kidney Disease Quality of Life – Short Form version 1.3 (KDQOL-SF ver. 1.3) questionnaire into Iranian (Farsi), and to then assess it in terms of validity and reliability on Iranian patients. Methods: The questionnaire was first translated into Farsi by two independent translators, and then subsequently translated back into English. After translation disparities had been reconciled, the final Iranian questionnaire was tested. An initial test–retest reliability evaluation was performed over a 10 day period on a sample of 20 patients recruited from a larger group (212 patients with end-stage renal disease on haemodialysis). Afterwards, reliability was estimated by internal consistency, and validity was assessed using known group comparisons and constructs for the patient group as a whole. Finally, the factor structure of the questionnaire was extracted by performing exploratory factor analysis. Results: All of the scales in the questionnaire showed good test–retest reliability (i.e. intraclass correlations between test and retest scores were >0.7). All of the scales met the minimal criteria (0.7) for internal consistency and Cronbach's-α ranged 0.71–0.93. Furthermore, results from a discriminate validity evaluation showed that the questionnaire could be used to discriminate between subgroups of the patients. Finally, a principal component analysis of the disease-specific scales indicated that this part of the questionnaire could be summarized into an 11 factor structure that jointly accounted for 79.81% of the variance. Conclusion: The Iranian version of the KDQOL-SF questionnaire is both highly reliable and valid for use with Iranian patients on haemodialysis.

Health related quality of life (HRQOL) has become a recognized outcome in studies of the treatment of patients undergoing hemodialysis (HD). The aim of this study was to assess changes in HRQOL reported by two different samples of patients undergoing HD in the same dialysis center in 2002 and 2015. Two samples of patients from the same Danish dialysis center completed the HRQOL questionnaire Kidney Disease Quality of Life version 1.3 in 2002 (n = 71) and 2015 (n = 81), respectively. The associations between KDQOL summery scores and the time frame were analyzed in multivariable regression analyses. The 2015 sample of patients were older compared to the 2002 sample (66 ± 13 vs. 59 ± 16 years, p = 0.003, respectively), they comprised more obese patients (20.6 vs. 3.2%, p = 0.002) and more patients with hypoalbuminemia (66.7 vs. 42.9%, p = 0.006). After confounder adjustment the time period 2015 versus 2002 was not associated with changes in the generic summery scales Physical Component Scale (β 3.9, 95% CI-0.1; 7.9, p = 0.051) and Mental Component Scale (β -2.5, 95% CI -7.6; 2.5, p = 0.322) or the disease specific summery scale Kidney Disease Component Scale (β 1.0, 95% CI -5.1; 7.1, p = 0.746). This study indicated an unchanged HRQOL when recent data were compared with data collected 13 years earlier in patients undergoing HD from a Danish dialysis center. We suggest that the included dialysis center monitor HRQOL and pay attention on interventions that may be associated with improvements of HRQOL and reduce the elevated frequency of patients with obesity or hypoalbuminemia.

Background/Aims: It is relevant to investigate health-related quality of life (HRQOL) in dialysis and chronic kidney disease (CKD) patients in order to optimise treatment. The aim of this study was to investigate HRQOL in dialysis and CKD patients, to compare results from patients treated with hemodialysis (HD) and peritoneal dialysis (PD) and to investigate the prediction of dialysis quality control parameters (blood hemoglobin, plasma albumin, and Kt/V) and tobacco smoking in disease-specific HRQOL. Methods: Seventy-one HD, 59 PD, and 63 CKD patients participated in the study. Dialysis quality control parameters were measured and the patients completed the questionnaire Kidney Disease Quality Of Life. Results: PD patients rated Dialysis Staff Encouragement and Patient Satisfaction better than HD patients (p≤ 0.05). Dialysis patients scored significant lower than the general population in all generic HRQOL scales (p ≤ 0.01), whereas CKD patients scored lower than the general population in 5 of 8 scales (p ≤ 0.05). The dialysis quality parameters did not predict dialysis patients’ disease specific HRQOL, but tobacco consumption was independently associated with low scores on a number of HRQOL scales. Conclusion: Based on the results, it is suggested to include elements of HRQOL as a supplement to standard quality control parameters. It is also suggested routinely to include information of the beneficial effects of physical activity already in the predialysis program, and to focus on smoking as a very important risk factor.

Background.We investigated serum testosterone and insulin-like growth factor 1 (IGF-1) levels’ associations with muscle fibre size and resistance training in male dialysis patients.Methods.Male patients were included in a 16-week control period followed by 16 weeks of resistance training thrice weekly. Blood samples were obtained to analyse testosterone, luteinizing hormone (LH), IGF-1, and IGF-binding protein 3. Muscle fibres’ size was analysed in biopsies fromm. vastus lateralis.Results.The patients’ testosterone levels were within the normal range at baseline (n=20) (19.5 (8.2–52.1) nmol/L versus 17.6 (16.1–18.0), resp.) whereas LH levels were higher (13.0 (5.5–82.8) U/L versus 4.3 (3.3–4.6),P<0.001, resp.). IGF-1 and IGF-binding protein 3 levels were higher in the patients compared with reference values (203 (59–590) ng/mL versus 151 (128–276),P=0.014, and 5045 (3370–9370) ng/mL versus 3244 (3020–3983),P<0.001, resp.). All hormone levels and muscle fibre size (n=12) remained stable throughout the study. Age-adjusted IGF-1 was associated with type 1 and 2 fibre sizes (P<0.05).Conclusion.Patients’ total testosterone values were normal due to markedly increased LH values, which suggest a compensated primary insufficiency of the testosterone producing Leydig cell. Even though testosterone values were normal, resistance training was not associated with muscle hypertrophy. This trial is registered withISRCTN72099857.

This study aimed to compare sexual dysfunction in Danish female predialysis patients with chronic kidney disease (CKD) stage 4–5 with age-matched healthy women in Denmark. Twenty-seven adult female predialysis patients (CKD stage 4–5 ~ creatinine clearance ≤ 30 ml/min) without diagnosed depression and 54 randomly assigned healthy female controls completed the questionnaires Female Sexual Function Index, Female Sexual Distress Scale, and the Major Depression Inventory. Predialysis patients reported lower Female Sexual Function Index scores compared to the controls (14.2 ± 2.1 vs. 20.1 ± 1.7, respectively, p = 0.048), more frequent sexual distress (44 vs. 22 %, respectively, p = 0.044), and more frequent sexual dysfunction (41 vs. 17 %, respectively, p = 0.041). There was no difference between the patients’ and the controls’ depression scores (12.2 ± 2.2 vs. 8.6 ± 1.1, respectively, p = 0.180). Sexual dysfunction was found to be more than two times as frequent in Danish female predialysis patients with CKD stage 4–5 compared to age- and gender-matched healthy controls, and this result emphasizes the need for attention towards sexual function in the treatment for CKD.

Objective The aim of this study was to investigate the effects of high-load strength training and protein intake in patients undergoing dialysis with a focus on muscle strength, physical performance, and muscle morphology. Design This was a randomized controlled study conducted in three dialysis centers. Subjects Subjects for the study included 29 patients undergoing dialysis. Intervention The participants went through a control period of 16 weeks before completing 16 weeks of strength training. Before the training period, the participants were randomly assigned to receive a protein or a nonprotein drink after every training session. Main Outcome Measure Muscle strength and power were tested using the good strength equipment and the leg extensor power rig. Physical performance and function were assessed using a chair stand test and the Short Form 36 questionnaire. Muscle fiber type size and composition were analyzed in biopsies obtained from the m. vastus lateralis. Results All variables remained unchanged during the control period. After training, muscle strength and power, physical performance, and physical function increased significantly. Muscle fiber composition was changed by a relative decrease in type 2x muscle fiber number whereas muscle size at the fiber level was unchanged. There were no effects of combining the training with protein intake. Conclusions High-load strength training is associated with improvements in muscle strength and power, physical performance, and quality of life. The effects were surprisingly not associated with muscle hypertrophy, and the results did not reveal any additional benefit of combining the training with protein intake. The positive results in muscle strength and physical performance have clinically relevant implications in the treatment of patients undergoing dialysis.

The worldwide epidemic of Type 2 diabetes necessitates evidence-based self-management education programmes. The purpose of this study was to investigate the effects and costs of an empowerment-based structured diabetes self-management education programme in an unselected group of patients with Type 2 diabetes. Seven hundred and two patients undergoing treatment by general practitioners (GPs) were included. The education comprised three modules over a 12-month period. It was based on the empowerment philosophy. The education followed a written curriculum, and the educators were given special training in its use. Glycemic control (HbA1c) was found to improve from 7.34 ± 1.34 to 6.88 ± 1.09%, P < 0.001 and body weight decreased from 90.9 ± 19.3 to 87.1 ± 18.1 kg, P < 0.001, following the education programme. Moreover, significant improvements were found in terms of fasting blood glucose, blood pressure, female waist circumference, lipid profile, quality of life, physical activity and the patients' knowledge of diabetes whilst the number of visits to GPs declined. This study supports the use of an empowerment vision as a basis for an interdisciplinary group-based education programme with individuals with Type 2 diabetes. Moreover, the costs of implementing this education programme were found to be minimal.

Background: Muscle function is impaired in uraemic patients and several causes have been proposed. Deficiency of 25-hydroxyvitamin D (25-OHD), which affects muscle function in non-uraemic patients, may very well also be associated with the myopathy found in these patients. The aim of this study was to investigate the association between 25-OHD and muscle function as well as physical function in chronic kidney disease (CKD) and peritoneal dialysis (PD) patients. Methods: In this cross-sectional study, 21 adult patients with CKD stage 3–5 and 21 patients treated with PD were included. Standard biochemistry parameters were measured including 25-OHD, 1,25-dihydroxycholecalciferol (1,25-OHD) and parathyroid hormone analysis. Muscle function was determined by 30-second surface electromyography (sEMG) recordings of a right thigh muscle (vastus lateralis) and a second left finger muscle (second dorsal interosseous) under voluntary contractions. Physical function was determined using a 30-second Chair Stand Test and the Short Form 36 quality of life questionnaire. Clinical characteristics were collected from the patient records. Results: Moderate vitamin 25-OHD deficiency (Conclusions: 25-OHD deficiency was prevalent in uraemic patients in the present study. Muscle function as determined using sEMG and the Chair Stand Test was not associated with 25-OHD. The results may be biased by the limited variation in 25-OHD and masked by effects of several other variables in this very sick population.

Chronic uraemia is associated with abnormalities in skeletal muscles, which can affect their working capacity. It is also well known that the fibre-type composition of skeletal muscles influences endurance, muscle strength and power. In this study we therefore determined the size and distribution of muscle fibres and the myosin heavy-chain (MHC) isoform composition in patients on haemodialysis (HD) in order to establish any differences with values for untrained control subjects.Muscle biopsies were obtained from the vastus lateralis muscle of 14 non-diabetic patients on HD. The size and distribution of muscle fibres were evaluated using adenosine triphosphate synthase (ATPase) histochemistry, whilst MHC isoform composition was determined in muscle homogenates using sodium dodecyl sulphate-polyacrylamide gel electrophoresis. Values were compared to those for a group of age-, gender- and BMI-matched untrained control subjects. The aerobic work capacity of the patients was also determined.The MHC composition for I, IIA and IIX isoforms was found to be 35.3% +/- 18.2%, 35.9% +/- 7.1% and 28.9% +/- 15.6%, respectively, findings supported by the ATPase histochemically determined fibre-type composition of the vastus lateralis muscle. The mean fibre area of type 1 and 2 fibres was 3283 +/- 873 and 3594 +/- 1483 MICROm2, respectively. The MHC composition and the size of the type 1 fibres of the patients on HD were significantly different from those of the control subjects.The data demonstrate relatively fewer type 1 and consequently more type 2x fibres, with a corresponding change in MHC isoforms (MHC I and MHC IIX) in the skeletal muscle of patients on HD. Several patients on HD were found to have15% type 1 (or relative percentage of MHC I) fibres. Such a low percentage of type 1 fibres is very rarely observed in normal untrained subjects. Chronic uraemia more severely affects the composition than the size of fibres.

The questionnaire Kidney Disease Quality of Life Short Form version 1.3 (KDQOL-SF) is valuable for assessing the health-related quality of life in patients treated with chronic dialysis. The aim of this study was to translate and test the reliability of the KDQOL-SF for use in Denmark.Translation into Danish and back-translation into English were performed. Pilot, field and internal consistency reliability tests were performed.Cronbach's alpha coefficients for the internal reliability test ranged from 0.77 to 0.93 for the eight generic scales. In a test involving all patients, two of the disease-specific scales had Cronbach's alpha coefficients of0.70 ("social support" = 0.67; and "quality of social interaction" = 0.43). After removing one item from the scale "quality of social interaction", Cronbach's alpha reached 0.63. A test of the scores of peritoneal dialysis (PD) patients discovered low reliability for three disease-specific scales. The KDQOL-SF manual and the Danish manual for the Short Form 36 (SF36) differed in the scoring of four generic scales: "role limitation-physical", "bodily pain", "general health" and "social function".With the exception of the scale "quality of social interaction" the Danish translation of the KDQOL-SF achieved values in the internal consistency reliability test of the same level as the original U.S. version. When data were stratified according to dialysis treatment, the reliability of PD patients scores was lower. Generic data from the questionnaire SF36 should be scored according to the Danish SF36 manual.

Along with survival and other types of clinical outcome, physical, mental and social well-being are important indicators of the effectiveness of the medical care that haemodialysis (HD) patients receive. The present cross-sectional study was designed to assess self-rated health in HD patients from a large Danish HD centre compared to a Danish general population sample with similar sex and age distributions. Furthermore, employment status and associations between self-rated health and clinical, social and demographic factors were investigated.A total of 150 patients were included. They were asked to complete the Short Form 36 (SF-36) questionnaire and additional questions concerning education and employment status. The SF-36 consists of eight scales representing physical, social, mental and general health. Clinical, biochemical and dialysis adequacy data were obtained from hospital records.A total of 112 patients completed the questionnaire, giving a response rate of 75%. Compared to the general population sample, HD patients scored significantly lower on all eight SF-36 scales (p0.01), with the greatest difference being observed for items concerning physical functioning. No correlation was found between any of the eight scales and estimates of dialysis adequacy. Of patients aged 18-60 years, 22% were in employment.In a large group of Danish HD patients, self-rated health (and especially physical function) was found to be substantially impaired compared to the general population and only a small proportion of patients were employed. We believe that results obtained using the SF-36 questionnaire represent an independent marker of health status in HD patients and should be considered, together with common clinical outcome measures, when monitoring patients. Furthermore, we believe that self-rated health questionnaires are a useful tool for evaluating the need for and the effects of physical activity programmes in a dialysis unit.

Background: The number of chronic renal failure patients treated by hemodialysis (HD) is continuously increasing. Most patients have reduced physical capacity and have a high risk of cardiac and vascular diseases. The aim of this study was to determine the effects of 5 months physical exercise of HD patients’ physical capacity, self-rated health and risk factors for cardiovascular disease. Methods: 33 HD patients were included in the study. Inclusion criteria: HD for more than 3 months, age >18 years. Exclusion criteria: Diabetes mellitus, symptomatic cardiovascular disease, musculoskeletal limitations, severe peripheral polyneuropathy, inability to speak Danish or English, dementia or other mental disorders. The patients were randomly assigned to an exercise group (EG, n = 22) or a control group (CG, n = 11). Prior to randomization, baseline testing was performed. The effects were measured by aerobic capacity, ‘2-min stair climbing’, ‘squat test’, self-rated health (SF36), blood pressure and lipids. All tests were carried out by blinded testers. The intervention consisted of 1 h of physical exercise twice a week for 5 months. Results: 20 patients completed the intervention. Attendance was 74% of all sessions. There were no dropouts caused by complications related to the intervention. The EG had a significant increase in aerobic capacity, ‘squat test’ and Physical Function and Physical Component Scale (SF36). No significant changes were observed in any of the parameters in the CG. Conclusion: Physical exercise twice a week for 5 months increases physical function and aerobic capacity in HD patients. An exercise program with only two exercise sessions per week seems easy to implement in clinical practice with high attendance among participants. Further investigation is needed to determine the effects on blood pressure and lipids. There were no medical complications related to the exercise program.