First Hour Of Recovery Research Articles

Sleep and cortical temperature in the Djungarian hamster under baseline conditions and after sleep deprivation.

The Djungarian hamster (Phodopus sungorus) is a markedly photoperiodic rodent which exhibits daily torpor under short photoperiod. Normative data were obtained on vigilance states, electroencephalogram (EEG) power spectra (0.25-25.0 Hz), and cortical temperature (TCRT) under a 16:8 h light-dark schedule, in 7 Djungarian hamsters for 2 baseline days, 4 h sleep deprivation (SD) and 20 h recovery. During the baseline days total sleep time amounted to 59% of recording time, 67% in the light period and 43% in the dark period. The 4 h SD induced a small increase in the amount of non-rapid eye movement (NREM) sleep and a marked increase in EEG slow-wave activity (SWA; mean power density 0.75-4.0 Hz) within NREM sleep in the first hours of recovery. TCRT was lower in the light period than in the dark period. It decreased at transitions from either waking or rapid eye movement (REM) sleep to NREM sleep, and increased at the transition from NREM sleep to waking or REM sleep. After SD, TCRT was lower in all vigilance states. In conclusion, the sleep-wake pattern, EEG spectrum, and time course of TCRT in the Djungarian hamster are similar to other nocturnal rodents. Also in the Djungarian hamster the time course of SWA seems to reflect a homeostatically regulated process as was formulated in the two-process model of sleep regulation.

Induction of translational thermotolerance in liver of thermally stressed rats

Heat-shock gene expression in cultures of single cell types has been well characterized but little is known about the heat-shock response of intact organs in vivo. In this study, the kinetics of hepatic heat-shock gene expression and the induction of thermotolerance were characterized in rats. Animals were subjected to a defined, reversible stress by increasing the core body temperature to 41 degrees C or 42 degrees C for 30 min. New synthesis of the inducible form of the heat shock-70 family of proteins (hsp-72) peaked simultaneously with the maximal level of hsp-72 transcripts at both temperatures. These data are consistent with previous observations in cultures of hepatoblastoma cells after thermal stress [De Maio, A., Beck, S. C. & Buchman, T. G. (1993) Circ. Shock 40, 177-186]. The incorporation of radioactive amino acids into polypeptides by the liver was blocked during the first hour of recovery after heat shock at 42 degrees C. This inhibition of protein synthesis by thermal stress could be prevented by prestressing rats at 42 degrees C for 30 min and allowing the rats to recover for 24 h at normal body temperature (37 degrees C). This phenomenon, previously defined as 'translational thermotolerance', correlates with the hepatic content of hsp-72; maximal protection occurs 24 h after a 42 degrees C thermal stress when hsp-72 (protein) is also maximum and decreases with the clearance of hsp-72 from the liver. These data suggest that the presence of hsp-72 within the liver may modulate the organ response to subsequent stresses and may be important to organ and animal survival after repeated insults.

Glucosidic pathways of glycogen breakdown and glucose production by muscle from postexercised frogs.

Muscle and body glucose in frogs increases markedly during the initial hour of recovery after strenuous exercise. The liver is not the major source responsible for this accumulation. This is indicated by the stability of liver glycogen levels after exercise and by the observation that hepatectomized and normal frogs accumulate similar amounts of glucose in their muscles and body during recovery. The renal contribution cannot account for this increase in body glucose. Most of the glucose that accumulates in the body after exercise has a muscular origin, as indicated by the facts that two-thirds of the body glucose is found in muscle and that the intracellular levels of muscle glucose are much higher than those of the plasma. The glucose that accumulates outside muscle may also have a muscular origin. The glucosidic pathways of glycogen breakdown are the only metabolic avenue with sufficient capacity to account for the amount of glucose accumulated in muscle during the first hour of recovery. These results indicate that the ability of an isolated preparation of frog muscle to liberate glucose during recovery from exercise (Fournier et al. J. Biol. Chem. 267: 8234-8238, 1992) is not an artifactual metabolic curiosity but rather a metabolic reality that takes place in vivo. Glucose accumulation during recovery is thought to facilitate the metabolic transition of frog carbohydrate metabolism from a catabolic state, characteristic of exercise, to an anabolic one.

Changes in heat shock protein synthesis and heat sensitivity during mouse thymocyte development.

Heat shock protein synthesis was examined in mouse thymocytes at three stages of development: early embryonic thymocytes, which are CD4-CD8-, adult thymocytes, which are primarily CD4+CD8+, and mature spleen T cells, which are CD4+CD8- or CD4-CD8+. After either a 41 degrees C or 42 degrees C heat shock, the synthesis of the major heat-inducible protein (hsp68) was elevated during the first hour of recovery but then decreased abruptly in thymocytes from adult mice. In contrast, the synthesis of hsp68 continued for up to 4 h after heating embryonic mouse thymocytes or mature spleen T cells. The more rapid termination of the heat shock response in the adult thymocytes was not the result of either less heat damage or more rapid repair since the recovery of general protein synthesis was more severely delayed in these cells. As well, the double positive CD4+CD8+ cells were more sensitive to hyperthermia than either the double negative CD4-CD8- or single positive CD4+CD8- or CD4-CD8+ cells. Exposure of fetal thymus organ cultures to elevated temperature revealed that the double negative thymocytes were able to survive and differentiate normally following a heat shock treatment that was lethal for the double positive thymocytes. Exposure of thymocytes from adult mice to elevated temperatures induced apoptotic cell death. This was evident by the cleavage of DNA into oligonucleosome-sized fragments. Quantitation of the extent of DNA fragmentation and the number of apoptotic cells by flow cytometry demonstrated that the extent of apoptotic cell death was related to the severity of the heat stress. Double positive (CD4+CD8+) thymocytes are selected on the basis of their T-cell antigen receptor (TCR). Most of these cells are negatively selected and die within the thymus by an active process of cell deletion known as apoptosis. Restricting hsp synthesis in response to stress might be essential during developmental processes in which cell maturation is likely to result in death rather than functional differentiation.

Variations in lactate apparent clearance during rest and exercise in normal man.

The purpose of this study is to present a simple kinetic model for the study of the lactate metabolism. This model based on pharmacokinetic theory, does not require labelled molecules and yields a finer approach to lactate metabolism than does a simple observation of blood lactate concentration. The variations in parameter values have been studied in six male subjects after intensive exercise (385 W, 110 rpm and 1 min) (IE) followed by three different recovery periods: passive recovery (RE), moderate exercise (ME) and heavy exercise (HE). Blood lactate concentration was measured prior to IE and during the first hour of recovery. After mathematical treatment, the results show that the apparent clearance increases 2.83 +/- 0.76 fold from RE to ME and 1.96 +/- 0.61 fold from RE to HE. The steady state blood lactate concentration induced by the intensity of recovery (La(ss)) increases slightly (1.53 +/- 0.37 fold) from RE (1.40 +/- 0.36 mmol.l-1) to ME (2.04 +/- 0.32 mmol.l-1). Then La(ss) increases markedly (3.78 +/- 0.91 mmol.l-1) during HE (2.81 +/- 0.78 fold the La(ss) value at RE). The ratio between the apparent rates of lactate production (F"K0) during RE, ME and HE was calculated. F"K0 increases in a linear way versus intensity of exercise recovery. It was concluded that in the human: 1) the blood lactate concentration is not an accurate indicator of lactate production, 2) in our experiment, the apparent lactate production is a linear function of exercise intensity and 3) the abruptly increasing blood lactate concentration at a high level of exercise intensity is due to a decrease in apparent clearance.

Protein synthesis in vaccinia virus-infected cells

Human Hep-2 cells were submitted to hypertonic shock (210 mM NaCl) to block host protein synthesis before infection with vaccinia virus. With the start of infection, the medium isotonicity (116 mM NaCl) was restored, and the effect of viral infection on the recovery of host polyribosomes and protein synthesis was studied. Although host translation blockage was released together with infection, vaccinia virus did not affect immediately host protein synthesis. During the first hour of recovery, infected cells could perfectly rebuild the polyribosome profile and recuperate the rate of protein synthesis. Also, during recovery, formation of the initiation complex for protein synthesis was not affected by viral infection. In this period, viral mRNA and proteins were detected by slot blot and SDS-polyacrylamide gel electrophoresis. The inhibitory effect of vaccinia virus on host translation was observed after the second hour of infection. These findings suggest that vaccinia virus-mediated shutoff occurs in a later period during infection, in parallel with viral mRNA accumulation in the polyribosomes and after the on-set of viral DNA replication.

Atrial natriuretic peptide in patients with acute myocardial infarction without functional heart failure

The purpose of the present study was to measure plasma levels of atrial natriuretic peptide (ANP) in patients with acute myocardial infarction without heart failure, and also to assess the temporal sequence of changes of plasma ANP during the first hours of recovery from myocardial infarction. The study was performed in 22 patients who were admitted to the Intensive Care Unit with the diagnosis of acute myocardial ischaemia that had an evolution of less than 6 h. Blood samples were drawn on admission and at 1, 8, and 24 h, and plasma concentrations of ANP, renin, aldosterone, epinephrine, norepinephrine and vasopressin were measured. Compared with control subjects, on admission patients showed increased plasma levels of ANP, as well as increased plasma renin activity (PRA), aldosterone, norepinephrine, epinephrine, dopamine, and antidiuretic hormone (ADH). ANP, but not renin or aldosterone plasma values, decreased with time, and there was a significant correlation between ANP and time after onset of pain. No increase in plasma creatinine was observed during the hospital stay, and the patients showed a negative fluid balance. No relationship was found between the location or extension of the infarction, or morphine treatment and ANP plasma levels. The high levels of ANP seem to counteract the haemodynamic and fluid-retention effects of the vasoconstrictive factors released after myocardial infarction.

Comparison of Induction with and First Hour of Recovery From Brief Propofol and Methohexital Anesthesia

BOYSEN, K.; SANCHEZ, R.; RAVN, J.; PEDERSEN, E.; KRINTEL, J. J.; DYRBERG, V Author Information

Delayed Temporary Threshold Shift Induced by Impulse Noises (Weapon Noises) in Men

Most of the available information on the effects of impulse noise on hearing is derived from temporary threshold shift (TTS2) measurements performed 2 min after a single exposure to small-weapon noises. TTS is known to recover as a linear function of the logarithm of time when it is induced by a continuous noise of moderate intensity. Following the exposure to impulse noise, several investigators have reported individual exceptions to the log-time relation, e.g. increases in TTS during the first hour of recovery. These authors observed a 'rebound recovery function' for most of the exposed men, and they conclude that this phenomenon '... has implications for the use of TTS in the construction of damage risk criteria for hazardous noise exposure ..., a single measure, such as the widely used TTS2 may not be an adequate index of the magnitude of the TTS'. In order to thoroughly investigate in man the existence of 'delayed' TTS following the exposure to actual weapon noises, the 'French Committee on Weapon Noises' carried out the following study. Three groups of soldiers (28 subjects) wearing no hearing protection were exposed in the free field over 2 days to impulse noises produced by a rifle. Békésy audiograms were obtained from each subject just before the exposure, and at 5 min, 1 h and 4 h after exposure. All audiometric tests were carried out even when no TTS was observable in the first postexposure audiogram. A significant number of subjects showed a 'delayed TTS' and/or 'rebound recovery'. The maximum TTS was observed at 1 h after exposure, but the observation of a delayed recovery and a rebound recovery indicate that audiometric tests should be performed in all cases at least up to 4 h after the exposure. More detailed work is necessary to establish what changes may be necessary in the present damage risk criteria for impulse noises of a very high level.

Posthypoxic glucose supplement reduces hypoxic‐ischemic brain damage in the neonatal rat

We evaluated the effect of posthypoxic glucose supplement in a neonatal hypoxic-ischemic animal model. Seven-day-old rats underwent bilateral ligation of the carotid arteries, followed by exposure to an 8% oxygen atmosphere for 1 hour. The extent of hypoxic-ischemic brain damage was assessed histologically 72 hours later. Glucose load immediately after the end of the hypoxic exposure reduced the volume of neocortical infarction to 37% of the unsupplemented value, and attenuated ischemic damage in the striatum and the dentate gyrus. At the end of the hypoxic exposure, the brain level of glucose was 0.3 mmol/kg and the level of lactate 9 mmol/kg. Glucose supplement produced a rapid rise in brain glucose level to 3 to 5 mmol/kg over the next 2 hours. Lactate in both brain and plasma gradually fell toward the baseline level during the first hour of recovery. Posthypoxic glucose supplement slightly retarded lactate restitution. At any period of this neonatal model, brain lactate levels did not exceed the toxic level, which is postulated to be responsible for cerebral infarction in adult ischemic models. These results illustrate the important role of glucose in the development of neonatal hypoxic-ischemic encephalopathy and the fact that full cortical infarction can develop even if brain lactate levels are low.

Comparison of induction with and first hour of recovery from brief propofol and methohexital anesthesia

Anesthesia and recovery during the first hour after propofol and methohexital anesthesia for termination of pregnancy, lasting about 12 min, were compared, the latter in a double-blind manner by means of psychomotor tests (coin counting and continuous auditory reaction time). Muscle movements and hiccups were seen significantly more frequently during methohexital inductions. No differences were seen regarding pain at the site of injection or apnea between the groups. At 15 min after the last dose of anesthetic, recovery after methohexital was ahead of that after propofol, but after 1 h, psychomotor performance was better in the propofol group. Side-effects during recovery were few, and incidences did not differ significantly. Although the difference in reaction time test was significant, it was hardly large enough to be of any clinical importance. Both drugs are useful for brief outpatient anesthesia, but smoother induction gives propofol an edge over methohexital.

Carbohydrate and Energy Metabolism during the Evolution of Hypoxic-Ischemic Brain Damage in the Immature Rat

The brain damage that evolves from perinatal cerebral hypoxia-ischemia may involve lingering disturbances in metabolic activity that proceed into the recovery period. To clarify this issue, we determined the carbohydrate and energy status of cerebral tissue using enzymatic, fluorometric techniques in an experimental model of perinatal hypoxic-ischemic brain damage. Seven-day postnatal rats were subjected to unilateral common carotid artery ligation followed by 3 h of hypoxia with 8% oxygen at 37 degrees C. This insult is known to produce tissue injury (selective neuronal necrosis or infarction) predominantly in the cerebral hemisphere ipsilateral to the carotid artery occlusion in 92% of the animals. Rat pups were quick-frozen in liquid nitrogen at 0, 1, 4, 12, 24, or 72 h of recovery; littermate controls underwent neither ligation nor hypoxia. Glucose in both cerebral hemispheres was nearly completely exhausted during hypoxia-ischemia, with concurrent increases in lactate to 10 mmol/kg. During recovery, glucose promptly increased above control values, suggesting an inhibition of glycolytic flux, as documented in the ipsilateral cerebral hemisphere by measurement of glucose utilization (CMRglc) at 24 h. Tissue lactate declined rapidly during recovery but remained slightly elevated in the ipsilateral hemisphere for 12 h. Phosphocreatine (P approximately Cr) and ATP in the ipsilateral cerebral hemisphere were 14 and 26% of control (p less than 0.001) at the end of hypoxia-ischemia; total adenine nucleotides (ATP + ADP + AMP) also were partially depleted (-46%).(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in Ventilation, Oxygen Uptake, and Carbon Dioxide Output during Recovery from Isoflurane Anesthesia

Recovery from inhalation anesthesia is often marked by the occurrence of postoperative tremor that resembles shivering, which is known to be associated with an increase in oxygen uptake (VO2), CO2 output (VCO2), and minute ventilation (VE). This study determined the time course of the ventilatory changes observed during the first hour of recovery from isoflurane anesthesia. Ten patients (ASA PS 1) scheduled for minor orthopedic surgery (knee arthroscopy) were included in this study. Anesthesia was induced with thiopental (5 mg/kg) and maintained with 70% N2O and isoflurane (1-2%) in oxygen, allowing spontaneous ventilation. In the recovery room, after N2O had been discontinued, patients were connected to a Beckman Metabolic measurement cart, which allowed a continuous monitoring of VE, VO2, VCO2, and PETCO2. Postoperative tremor was observed in all patients within 7.1 +/- 1.2 min (mean +/- SEM) after isoflurane discontinuation and was associated with a marked increase in the following: VO2, from 173 +/- 26 ml/min at the end of anesthesia to 457 +/- 88 ml/min; VCO2, from 149 +/- 18 ml/min at the end of anesthesia to 573 +/- 98 ml/min; and VE, from 6.8 +/- 0.7 l/min at the end of anesthesia to 16.6 +/- 2.8 l/min (values obtained 20 min after isoflurane discontinuation). In three patients during intense shivering, VO2, VCO2, and VE reached peak values higher than 800 ml/min, 1,300 ml/min and 30 l/min, respectively. This study shows that postoperative tremor following isoflurane anesthesia may be associated with prolonged and large increases in oxygen uptake, CO2 output, and minute ventilation.

Amphetamine and α-methyl- p-tyrosine affect the exercise-induced imbalance between the availability of tryptophan and synthesis of serotonin in the brain of the rat

This study was performed to investigate the effects of exercise on the synthesis of dopamine (DA) and 5-hydroxytryptamine (5-HT) in the brain of the trained rat. The consequences on the relationships between these two systems were also examined. The sum of the levels of free 3,4-dihydroxyphenyl acetic acid (DOPAC plus homovanillic acid (HVA) was increased by running and remained elevated throughout the first hour of recovery. Regional studies indicated that the levels of DA were increased in the midbrain, hypothalamus and hippocampus. In these areas, DOPAC showed little variation whereas HVA was largely increased. Administration of pargyline confirmed this increase in the metabolism of DA in hypothalamus and midbrain during running. Food deprivation and administration of tryptophan clearly revealed that running, despite increasing levels of tryptophan and 5-hydroxyindoleacetic acid in brain, reduced the central control of synthesis of 5-HT by tryptophan, probably by inhibiting tryptophan hydroxylase. To examine if such an alteration was caused by the running-induced activation of metabolism of DA in brain, compounds known to affect the activity of DA were used. Administration of amphetamine potentiated the relative inhibition of synthesis of 5-HT induced by running, while α-methyl- p-tyrosine prevented this effect of exercise. Haloperidol did not produce any significant change. It is concluded that the control of the synthesis of 5-HT in brain by the availability of tryptophan is altered during exercise and that the increased central catecholaminergic activity participates in such an alteration.

A Rotating Respirometer to Monitor Voluntary Activity and Associated Exchange of Respiratory Gases in the Land Hermit Crab (Coenobita Compressus)

ABSTRACT A rotating respirometer was designed which enabled respiratory gas exchange in the land hermit crab Coenobita compressas to be correlated with voluntary submaximal sustained pedestrian activity. In the laboratory, crabs remained spontaneously active for up to 150 min, maintaining velocities of 0·6 cm s−1. Comparable activity patterns were observed in the field. Quiescent O2 uptake increased logarithmically as a function of load rating of the adopted molluscan shell. Steady-state and were measured after 30 min of spontaneous activity and both increased linearly with velocity. There was good correspondence between Y-intercept values and those measured in inactive crabs. At the mean locomotory speed, and were increased 3·4-fold and 2·6-fold respectively above settled rates. Minimum and gross energetic cost of transport were estimated and compared with values in the literature. and returned to settled levels within the first hour of recovery. The activity profile and concomitant changes in gas exchange are discussed in the context of acquisition of the shell-dwelling habit.

Effects of exogenous catecholamines and exercise on plasma magnesium concentrations.

Catecholamines and physical exercise are known to influence the metabolism of several minerals in man, but the effects on magnesium (Mg) have been scarcely investigated. In the present study, infusion of adrenaline (5 micrograms/min for 30 min followed by 10 micrograms/min for 30 minutes) significantly reduced the plasma Mg levels in healthy males. This effect was abolished by simultaneous infusion of propranolol. Noradrenaline had no such effect. In order to stimulate endogenous catecholamine release healthy males carried out physical exercise in four different ways: ergometer bicycling at maximum load until exhaustion with and without oral beta-blockade, ergometer bicycling with stepwise increasing load until exhaustion, isokinetic maximal exercise with one leg, with blood sampling both from the venous effluent of the exercising leg and the opposite resting arm and long-term (60 min) steady state ergometer bicycling at approximately 65% of estimated maximum capacity. During short-term (less than 20 min) intense exercise (i.e. experiments 1-3) the plasma Mg concentrations were increased. This was probably due to a reduction of plasma volume and to an influx of Mg to the vascular pool. During long-term steady state exercise (experiment 4) the Mg levels were not significantly affected but decreased during the first hour of recovery. These results suggest that both the beta-adrenergic system and muscular activity by itself affect Mg homeostasis.

Blood Gas Tensions and Acid-Base Regulation in the Salt-Water Crocodile, Crocodylus Porosus, at Rest and After Exhaustive Exercise

ABSTRACT Salt-water crocodiles, Crocodylus porosus Schneider, were catheterized and , pH and lactate concentration ([lactate]) were measured in arterial blood during rest and after forced exhaustive activity at 30° C. Gas exchange ratio (R), calculated from blood and , decreased from about 1·0 to 0·3 during resting voluntary breath-holding and indicated CO2 sequestration in the body fluids. The mean value for R in undisturbed animals was 0·6, which substantiates the hypothesis that some CO2 excretion is extrapulmonary. In vitro buffer value of true plasma was – 23·5 +1·9mmol HCO2−I−1 pH−1. In vivo buffer value, determined by short-term self titration with metabolic CO2, was – 12·2 + 4·7mmolHCOs− I−1 pH−1. Exhaustive activity for 5 min in laboratory animals resulted in pronounced metabolic lactacidosis: pH decreased approximately from 7·43 to 7·11 while lactate concentration increased from 1·2 to 20–30 mmol I−1. The acidosis was reduced by respiratory compensation during the first hour of recovery and by metabolic adjustments that were practically complete after the third hour. Greater acidosis (pH down to 6·4) in larger field-captured animals was resolved over a longer period. During recovery, lactate and proton fluxes between the blood and other tissue were uncoupled. The virtual absence of the fixed-acid Bohr effect in C. porosus blood is adaptive in large individuals because it facilitates continued O2 uptake from the lung into blood which may be acidified by as much as 1 pH unit as a result of physical activity.

Qualité du réveil après anesthésie générale à l'isoflurane ou à l'halothane

The quality of recovery and the time required for it were compared in two groups of 20 patients after general anaesthesia with isoflurane or halothane for elective head and neck surgery. The groups were comparable with regard to age, sex ratio, ASA physical status, type of surgery and duration of anaesthesia. After premedication with diazepam and atropine, a standard induction technique was used (thiopentone, succinylcholine), avoiding opiates and sedatives. Maintenance was assured with a mixture of 30% oxygen, 70% nitrous oxide and isoflurane or halothane. The time between the end of administration of anaesthetic drugs and eye opening was 7.15±2.9 min in the isoflurane group, and 11.0±4.7 min in the halothane group (p<0.01). The differences between the times for the return of spatial and temporal orientation and of mental arithmetic were not significant, though they were clinically clearly perceptible. The patients were less sleepy, livelier and less agitated in the isoflurane group in the first hour of recovery. Recovery was more rapid after general anaesthesia with isoflurane, and of better clinical quality.

Delayed recovery of behavior after anesthesia in rats

Early, complete recovery from general anesthesia is of importance for out-patients, in resuscitation research and in behavior testing of neonates. A model was designed to study behavior during the first week of recovery from anesthesia in rats, using two methods: spontaneous and unrestrained locomotor activity was tested and passive avoidance of electroshock was studied in a two session, one trial model. Neurologic deficit and ease of handling were also tested After anesthesia with halothane 1 2% in N 2O/O 2 for 30 min, spontaneous activity was reduced, compared with unanesthetized rats, for up to at least 48 h. On day 6 post-anesthesia, locomotor activity was recovered, and, on days 4 and 5, passive avoidance was unchanged. Neurologic deficits were absent after the first hour of recovery and ease of handling was unchanged. Conclusion: Halothane and nitrous oxide have prolonged effects on locomotor behavior beyond the immediate post-anesthesia recovery period, at a time when neurologic deficit testing does not reveal any abnormalities. The model is suitable for the comparison of recovery from different anesthesia techniques in rats.

Mild Steady-State Exercise During Hemodialysis Treatment

In brief: The purpose of this study was to determine the feasibility and physiological effects of mild steady-state exercise during hemodialysis treatment. Three men and three women pedaled a Monark bicycle ergometer at 150 kgm min1 for five minutes during the first hour of hemodialysis treatment. Heart rate, blood pressure, pH, Hco3, and respiratory and blood gases were analyzed before hemodialysis treatment, at rest just before exercise, during exercise, and at selected times during the first hour of recovery. The authors concluded that all the physiological responses during hemodialysis treatment were typical of a deconditioned person responding to low-level exercise. The rise in blood pressure and arterial oxygen tension may have positive implications for hemodialysis treatment. Further investigation is warranted into the value of using exercise during hemodialysis treatment as a means of training.