Background: Although patients receiving hemodialysis are more likely to develop metabolic disorders and muscle weakness at an earlier stage than healthy individuals, many older dialysis patients have difficulty establishing exercise habits to prevent these problems. Therefore, we evaluated the use of belt electrode-skeletal muscle electrical stimulation (B-SES), which can stimulate a wider area than conventional electrical muscle stimulation (EMS), to examine its application and safety in older hemodialysis patients as a means to improve lower extremity function without voluntary effort. Methods: This study was a randomized controlled trial (RCT) involving 20 older dialysis patients (>65 years old) with reduced physical activity. The control group received 12 weeks of routine care only and the intervention group received 12 weeks of B-SES during hemodialysis in addition to routine care. The primary endpoint was the 6 min walk test (6MWT) distance, while the Short Physical Performance Battery (SPPB), body composition, Functional Independence Measure (FIM), biochemistry test, and blood pressure/pulse measurements were used as secondary endpoints. Results: As a result of the 12-week B-SES intervention, no increase in creatine kinase or C-reactive protein levels was observed after the intervention in either group, and no adverse events attributed to the B-SES intervention were observed in the intervention group. Furthermore, the intervention group showed a significant improvement in the 6MWT and SPPB scores after the intervention. Conclusions: The results of this study suggest that a 12-week B-SES intervention during hemodialysis sessions safely improves 6MWT distance and SPPB scores in older patients with a reduced level of physical activity.

Decreased physical activity in hemodialysis (HD) patients causes various structural, metabolic, and functional abnormalities due to uremic changes in skeletal muscles. Electrical stimulation (ES) of the lower limbs was found to be effective in patients with cardiac insufficiency for exercise tolerance. This study compared the effects of ES and variable load ergometers on the lower limbs in HD patients. We performed a prospective, double-center, open-label, randomized controlled trial. Eligible patients were aged over 65 years, had end-stage renal disease, and underwent maintenance HD. The primary endpoint was muscle power, and the secondary endpoints included changes in dialysis efficiency, serum phosphorus, and inflammatory markers. Thirty HD outpatients were randomly assigned to the following groups: exercise (EX), ES, or control (SED). In EX and ES groups, patients were instructed to exercise twice a week for 12 weeks, depending on their physical capabilities. The safety and efficacy of aerobic training and ES during HD were confirmed when a sudden decrease in blood pressure or any other side effects did not occur. A repeated measures analysis of variance was performed as the principal method to evaluate time (baseline vs. 12 weeks) and group (EX vs. ES vs. SED) comparisons for the experimental outcomes. The efficiency of HD significantly increased in the ES and EX groups (p ≤ 0.02). Moreover, the ES group experienced a significant increase in muscle power (p = 0.01) and the weight bearing index (p = 0.04) and a significant decrease in serum phosphorus level (p = 0.04) and tumor necrosis factor-alpha (TNF-α) level (p = 0.04) from baseline to 12 weeks. Furthermore, there was a significant increase in serum TNF-α level (p ≤ 0.03) over time in both the EX and SED groups. The safety and efficacy of aerobic training and ES during HD were confirmed when a sudden decrease in blood pressure or any other side effects did not occur. Therefore, ES may improve the patient’s condition, similar to lower limb exercises, and ES should be considered as an option for rehabilitation programs in HD patients. UMIN Clinical Trials Registry ( UMIN-CTR R 000032202 ); retrospectively registered on April 11, 2018

Background: Elderly hemodialysis (HD) patients frequently experience reduced physical activity due to treatment-related immobility and fatigue, leading to accelerated functional decline. While exercise therapy is beneficial, adherence remains challenging among frail elderly patients. Belt-type electrical stimulation (B-SES) presents a potential alternative, though evidence for its safety and efficacy in this population is limited.Methods: In this 12-week prospective intervention study, eight frail maintenance HD patients (mean age 75.5 ± 0.9 years) received B-SES therapy during HD sessions. Outcomes were assessed through physical function measures, biochemical markers, quality of life indices, and body composition analysis using multiple imaging modalities (BIA, CT, ¹H-MRS).Results: Five participants completed the intervention, with three withdrawals unrelated to the treatment. Physical function measures showed a trend toward improvement without elevation in inflammatory markers. While BIA showed no significant changes in muscle mass, CT analysis revealed increased thigh muscle cross-sectional area, and ¹H-MRS indicated improvements in intramuscular fat composition. A significant correlation emerged between reduced intramyocellular lipids and improved physical performance measures (p < 0.05).Conclusion: B-SES demonstrated safety and potential efficacy in improving physical function and muscle quality among frail elderly HD patients. From a public health perspective, B-SES may serve as a feasible and accessible intervention for this population, particularly in resource-limited settings. However, further studies are needed to determine its cost-effectiveness in comparison with conventional exercise therapy.

Individuals with visual and hearing impairments often experience reduced physical activity and limited participation in daily activities, which may affect autonomic regulation and cardiovascular risk. However, impairment-specific physiological characteristics in young adults remain poorly understood. This exploratory and hypothesis-generating cross-sectional pilot study investigated autonomic modulation during an acute orthostatic stress test in 35 university students divided into three groups: healthy controls, individuals with visual impairments, and individuals with hearing impairments. Indicators of arteriosclerosis, physical function, autonomic nervous system activity assessed by heart rate variability (HRV), physical activity level, and quality of life were evaluated and compared among groups. The primary outcomes of this study were vascular and autonomic responses during the acute orthostatic stress test, specifically the Arterial Velocity Pulse Index (AVI), Arterial Pressure-volume Index (API), and heart rate variability (HRV) indices. Secondary outcomes included baseline body composition, motor performance, daily physical activity levels, and quality of life (QOL) scores. Although no significant group × time interactions were observed for HRV parameters during the acute orthostatic stress test, a significant main effect of group was observed for HF, whereas no significant group effects were observed for the other HRV parameters. Significant group differences were observed for both API and AVI, with post hoc comparisons indicating higher values in the hearing impairment group than in healthy controls. These preliminary findings may suggest potential impairment-specific cardiovascular profiles that warrant further investigation in larger studies. No significant differences were observed in physical function or quality of life among the groups. Overall, the findings should be interpreted cautiously because of the exploratory design and small sample size. These exploratory findings may suggest possible differences in vascular characteristics in young adults with sensory impairments, with exploratory observations regarding autonomic modulation. However, these observations require confirmation in larger adequately powered studies.

Background/Objectives: Chronic kidney disease (CKD) is characterized by accelerated aging and functional decline. Serum α-Klotho levels, an anti-aging biomarker predominantly associated with renal function, have emerged as potential indicators of biological aging and cardiovascular risk. To investigate the association between serum α-Klotho levels and habitual physical activity in hemodialysis patients. Methods: This study combined (1) a prospective case analysis of high-intensity interval training (HIIT) in a hemodialysis patient and (2) a cross-sectional analysis of 24 hemodialysis patients and 18 healthy controls. Serum α-Klotho levels were measured using ELISA, and their association with habitual physical activity was evaluated. Results: Serum α-Klotho levels were significantly lower in hemodialysis patients than in healthy controls (p < 0.001). In hemodialysis patients, physical activity was moderately correlated with serum α-Klotho levels (r = 0.52, p = 0.02), whereas no significant association was observed in healthy controls. The case analysis demonstrated marked improvement in physical function following HIIT. These findings suggest that serum α-Klotho levels may be associated with physical activity status in hemodialysis patients. Conclusions: Serum α-Klotho levels were associated with habitual physical activity in hemodialysis patients and may represent a potential molecular indicator related to physical function and rehabilitation status. These findings support further investigation of biomarker-informed approaches in renal rehabilitation.

Objective To investigate nailfold capillary parameters in community-dwelling individuals aged over 60 years who have hypertension and do not exercise regularly. Furthermore, the study examined the correlations between capillary function and other health-related indicators. Design A single- center pilot trial Setting Faculty of Health, Tsukuba University of Technology, Japan Participants hypertensive community-dwelling elderly people Intervention Microcirculation was observed before and 1 min after arm-curl exercise by means microscopy of capillary with non-exercised limb. Additionally, we examined other health-related indicators. Outcome measures: Acute effects of reperfusion on nailfold density, flow, and diameters. Secondary outcomes included the correlations between microvascular parameters and other health-related indicators. We hypothesized that brief exercise could enhance microcirculation reperfusion and correlate with other health-related parameters. Results: There were 20 participants with a mean (SD) age of 67.1 (5.8) years. The capillary flow rate changed from 2.3±6.7 to 2.7±0.2 log µm/s (P