Publications by authors named "Christoforos D Giannaki"

52 Publications

A Systematic Review, Meta-Analysis and Meta-Regression on the Effects of Carbohydrates on Sleep.

Nutrients 2021 Apr 14;13(4). Epub 2021 Apr 14.

Department of Life and Health Sciences, University of Nicosia, 46 Makedonitisas Avenue, Nicosia CY1700, Cyprus.

This study aimed to assess the effects of quantity, quality and periodization of carbohydrates consumption on sleep. PubMed, SCOPUS and Cochrane Library were searched through October 2020. Data were pooled using random-effects meta-analysis. Eleven articles were included in the meta-analysis which consisted of 27 separate nutrition trials, resulting in 16 comparison data sets (sleep quantity = 11; sleep quality = 5). Compared to high carbohydrate (HCI), low carbohydrate intake (LCI) moderately increased duration and proportion of N3 sleep stage (ES = 0.37; 95% CI = 0.18, 0.56; < 0.001 and ES = 0.51; 95% CI = 0.33, 0.69; < 0.001, respectively). HCI prolonged rapid eye movement (REM) stage duration (ES = -0.38; 95% CI = 0.05, -8.05; < 0.001) and proportion (ES = -0.46; 95% CI = -0.83, -0.01; < 0.001), compared to LCI. The quality of carbohydrate intake did not affect sleep stages. Meta-regression showed that the effectiveness of carbohydrate quantity and quality in sleep onset latency was significantly explained by alterations of carbohydrate intake as a percentage of daily energy intake (R = 25.87, = 0.018) and alterations in the glycemic load (R = 50.8, = 0.048), respectively. Alterations in glycemic load partially explained the variance of the effectiveness of carbohydrate quality in sleep efficiency (R = 89.2, < 0.001) and wake after sleep onset (R = 64.9, = 0.018). Carbohydrate quantity was shown to affect sleep architecture, and especially N3 and REM sleep stages. Alterations in both quantity and quality of carbohydrate intake showed a significant effect on sleep initiation. Variations in carbohydrate quality significantly affected measures of sleep continuation. Further studies are needed to assess the effect of long-term carbohydrate interventions on sleep.
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http://dx.doi.org/10.3390/nu13041283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069918PMC
April 2021

The vicious circle between physical, psychological, and physiological characteristics of shift work in nurses: a multidimensional approach.

Sleep Breath 2021 Apr 17. Epub 2021 Apr 17.

Department of Physical Education and Sport Science, University of Thessaly, Karies, 42100, Trikala, Thessaly, Greece.

Purpose: To compare physical, psychological, and physiological adaptations between rotating and morning shift health workers using objective and subjective approaches.

Methods: Forty nurses [n = 20 morning shift (MS) group; n = 20 rotating shift (RS) group] were evaluated for anthropometry, body composition, and handgrip strength. Quality of life, depression, fatigue, daytime sleepiness, and sleep quality were assessed with SF-36, Zung Self-Rating Depression Scale (SDS), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI), respectively. Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ) and triaxial accelerometers. Sleep-related data were monitored with sleep actigraphy. Salivary melatonin levels were analyzed before/after sleep, and blood lipid profiles were measured the following morning.

Results: The RS group had higher mean BMI and total and abdominal fat and scored lower in the SF-36 (p < 0.01). All nurses showed reduced physical activity levels, which, in the RS group, were negatively correlated with FSS (p = 0.033) and SDS scores (p = 0.025). Poor sleep was revealed in 53% of nurses. The RS group had worse sleep quality by PSQI than the MS group (p = 0.045). PSQI scores were inversely related to SF-36 scores and positively correlated with FSS, BMI, waist circumference, and body fat (p < 0.05).

Conclusion: RS nurses showed increased body mass and total and abdominal fat along with decreased quality of life and sleep quality compared to MS counterparts. A strong relationship was found between physical, psychological, and physiological domains. Further studies should consider workplace interventions to prevent obesity, promote physical activity, and manage poor sleeping patterns in nurses.
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http://dx.doi.org/10.1007/s11325-021-02381-5DOI Listing
April 2021

Effects of Dehydration on Archery Performance, Subjective Feelings and Heart Rate during a Competition Simulation.

J Funct Morphol Kinesiol 2020 08 27;5(3). Epub 2020 Aug 27.

Department of Life and Health Sciences, University of Nicosia, 46 Makedonitisas Avenue, CY1700 Nicosia, Cyprus.

This study aimed to investigate the effect of dehydration on archery performance, subjective feelings and heart rate response. Ten national level archers performed two archery competition simulations, once under euhydration (EUH) and once in a dehydrated state (DEH), induced by 24-h reduced fluid intake. Hydration status was verified prior to each trial by urine specific gravity (USG ≥ 1.025). Archery score was measured according to official archery regulations. Subjective feelings of thirst, fatigue and concentration were recorded on a visual analogue scale. Heart rate was continuously monitored during the trials. Archery performance was similar between trials ( = 0.155). During DEH trial (USG 1.032 ± 0.005), the athletes felt thirstier ( < 0.001), more fatigued ( = 0.041) and less able to concentrate ( = 0.016) compared with the EUH trial (USG 1.015 ± 0.004). Heart rate during DEH at baseline (85 ± 5 b∙min) was higher ( = 0.021) compared with EUH (78 ± 6 b∙min) and remained significantly higher during the latter stages of the DEH compared to EUH trial. In conclusion, archery performance over 72 arrows was not affected by dehydration, despite the induced psychological and physiological strain, revealed from decreased feeling of concentration, increased sensation of fatigue and increased heart rate during the DEH trial.
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http://dx.doi.org/10.3390/jfmk5030067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739258PMC
August 2020

Long-term intradialytic hybrid exercise training on fatigue symptoms in patients receiving hemodialysis therapy.

Int Urol Nephrol 2021 Apr 2;53(4):771-784. Epub 2021 Jan 2.

Live Lab, Department of PE and Sport Science, University of Thessaly, 42100, Trikala, Greece.

Purpose: Hemodialysis (HD) patients suffer from generalized weakness, exercise intolerance and muscle atrophy, all leading to generalized fatigue and lack of energy. HD patients spend at least 50% of their time in a functionally "switch off" mode with their fatigue sensations reaching a peak in the immediate hours after the dialysis session. The purpose of the current study was to assess the effectiveness of a nine-month hybrid intradialytic exercise program on fatigue symptoms occurring during and after hemodialysis session.

Methods: Twenty stable hemodialysis patients were included in the study (59 ± 13.7 years; 16 males). All patients completed a 9-month supervised exercise training program composed of both aerobic cycling and resistance training during HD. Aspects related to physical and generalized fatigue were assessed via validated questionnaires, while physical performance was assessed by a battery of tests, before and after the intervention period.

Results: Exercise capacity and physical performance were increased by an average of 65 and 40%, respectively. Patients reported feeling better during post-dialysis hours in question 1 (p = 0.000), question 3 (p = 0.009) and question 4 (p = 0.003) after the 9-month intervention. In addition, exercise training improved scores in cognitive function (p = 0.037), vitality (p = 0.05), depression (p = 0.000) and fatigue (p = 0.039).

Conclusion: The present study showed that a 9-month hybrid (aerobic + resistance) exercise training program improved symptoms of post-dialysis fatigue and overall general perception of fatigue. Hybrid exercise training is a safe and effective non-pharmacological approach to ameliorate fatigue symptoms in HD patients.

Trial Registration Number: Trial registration number The study is registered at ClinicalTrials.gov (NCT01721551, 2012) as a clinical trial.
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http://dx.doi.org/10.1007/s11255-020-02711-8DOI Listing
April 2021

Athletes' sleep assessment: from lifestyle to pharmacological interventions and vice versa.

Sleep Med 2021 Feb 10;78:49-50. Epub 2020 Dec 10.

Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus.

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http://dx.doi.org/10.1016/j.sleep.2020.12.007DOI Listing
February 2021

Separate and combined effects of cold dialysis and intradialytic exercise on the thermoregulatory responses of hemodialysis patients: a randomized-cross-over study.

BMC Nephrol 2020 12 2;21(1):524. Epub 2020 Dec 2.

School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, 42100, Greece.

Background: The separate and combined effects of intradialytic exercise training (IET) and cold dialysis (CD) on patient thermoregulation remain unknown. This study assessed the thermoregulatory responses of hemodialysis patients under four different hemodialysis protocols: a) one typical dialysis (TD) protocol (dialysate temperature at 37 °C), b) one cold dialysis (CD) protocol (dialysate temperature at 35 °C), c) one typical dialysis protocol which included a single exercise bout (TD + E), d) one cold dialysis protocol which included a single exercise bout (CD + E).

Methods: Ten hemodialysis patients (57.2 ± 14.9 years) participated in this randomized, cross-over study. Core and skin temperatures were measured using an ingestible telemetric pill and by four wireless iButtons attached on the skin, respectively. Body heat storage (S) calculated using the thermometric method proposed by Burton.

Results: The TD and TD + E protocols were associated with increased S leading to moderate effect size increases in core body temperature (as high as 0.4 °C). The low temperature of the dialysate during the CD and the CD + E protocols prevented the rise in S and core temperature (p > 0.05), even during the period that IET took place.

Conclusions: TD and IET are accompanied by a moderate level of hyperthermia, which can be offset by CD. We recommended that CD or with IET can prevent the excessive rise of S.

Trial Registration: Clinical Trial Registry number: NCT03905551 ( clinicaltrials.gov ), DOR: 05/04/2019.
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http://dx.doi.org/10.1186/s12882-020-02167-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709248PMC
December 2020

Prevalence of hypohydration in adolescents during the school day in Cyprus: seasonal variations.

East Mediterr Health J 2020 Sep 24;26(9):1034-1041. Epub 2020 Sep 24.

Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus.

Background: Evidence on the hydration status of adolescents and seasonal and time variations is scarce.

Aims: This study aimed to assess variations in the hydration status and total water intake of adolescents in Cyprus between winter and summer and between the morning and end of the school day. Subjective feelings and cognitive function associated with hypohydration were also examined.

Methods: Fifty-three adolescents (39 boys) with a mean age (standard deviation, SD) of 15.1 (1.9) years were included in the study. Participants provided urine samples and completed a cognitive function test and a questionnaire on subjective feelings upon arrival at school and at the end of the school day. Data were collected in winter and summer in 2016-2017. Hydration level was determined by urine specific gravity and cognitive function was assessed with a symbol cancellation test. Total water intake was estimated from a food and fluid record kept by the participants.

Results: A high prevalence of hypohydration was found in both seasons ranging from 72% to 94%. Hypohydration was associated with perceptions of lower concentration and alertness (P = 0.008 and P = 0.047, respectively). Adolescents had significantly higher mean urine specific gravity in winter than in summer: 1.026 (SD 0.007) versus 1.023 (SD 0.007), respectively (P = 0.002). Hydration status was not associated with cognitive function or total water intake.

Conclusions: The high prevalence of hypohydration and the associated feelings of lower concentration and alertness in adolescents suggests that educational measures are needed to promote good drinking behaviour and improve hydration.
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http://dx.doi.org/10.26719/emhj.20.014DOI Listing
September 2020

A critical review on sleep assessment methodologies in athletic populations: factors to be considered.

Sleep Med 2020 10 4;74:211-223. Epub 2020 Aug 4.

Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus. Electronic address:

A growing body of research focus on athletes' sleep in order to investigate the effects of sleep in sports performance and recovery or the prevalence of sleep disorders in athletes. At the same time, several sleep monitoring tools have been developed and used in athletic populations for fulfilling these purposes. This review aimed to provide critical assessment to the most used by athletes' methodological approaches and compared them with the gold standard approach. Advantages and disadvantages of the various sleep monitoring tools were critically discussed. Literature related to aspects of athletes' sleep was reviewed. From the shortlisted studies, several factors that seem to affect sleep in athletes were identified using objective methods such as polysomnography/electroencephalography and actigraphy. These factors were associated to sleep (eg such as sleep environment, familiarization procedures and napping) and daily habits (eg nutrition, fluid consumption, alcohol and caffeine intake, tobacco use). The selected studies that evaluated sleep objectively were screened according the reporting rates of these variables. The majority of the screened studies were found to underreport these variables. Practical issues were addressed and recommendations about reporting sleep-related factors were made in order to improve studies' quality assessment and allow for more robust comparisons between studies.
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http://dx.doi.org/10.1016/j.sleep.2020.07.029DOI Listing
October 2020

The effect of evening cycling at different intensities on sleep in healthy young adults with intermediate chronobiological phenotype: A randomized, cross-over trial.

J Sports Sci 2021 Jan 26;39(2):192-199. Epub 2020 Aug 26.

Department of Life and Health Sciences, University of Nicosia , Nicosia, Cyprus.

This study investigated the effect of various cycling intensities on sleep-related parameters in healthy young adults with intermediate chronobiological phenotype. Ten recreationally trained male volunteers underwent an evening i) moderate-intensity continuous training (MICT; 45 min at 70% W), ii) high-intensity interval training (HIIT; 10 × 1 min at 90% W), iii) sprint interval training (SIT; 6 × 20 sec at 140% W) or iv) a non-exercise (CON) trial in randomized, counter-balanced and crossover order. At baseline, somatometric data, maximum oxygen uptake and chronotype were evaluated. Sleep-related indices and daily activity were recorded by a multi-sensor activity monitor. Total sleep time was longer after SIT compared to CON and MICT ( < 0.05). Sleep efficiency was higher in SIT than in CON ( < 0.05). Sleep onset latency did not differ among trials. Wake after sleep onset was decreased after SIT compared to CON (= 0.049). No differences were found for bedtime among trials. Wake time was earlier in the MICT trial compared to CON ( = 0.026). Evening cycling exercise -independently of intensity- did not impair sleep of individuals with intermediate chronobiological phenotype. Furthermore, a single SIT session improved sleep quantity and continuation of individuals with this specific chronotype.
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http://dx.doi.org/10.1080/02640414.2020.1812194DOI Listing
January 2021

Effects of 12 months of detraining on health-related quality of life in patients receiving hemodialysis therapy.

Int Urol Nephrol 2020 Sep 14;52(9):1771-1778. Epub 2020 Aug 14.

Department of PE and Sport Science, University of Thessaly, Trikala, Greece.

Purpose: Limited data exist regarding the effects of detraining on functional capacity and quality of life (QoL) in the hemodialysis population. The aim of the current study was to assess whether the discontinuation from a systematic intradialytic exercise training program will affect aspects of health-related QoL and functional capacity in hemodialysis patients.

Methods: Seventeen hemodialysis patients (12 Males/5 Females, age 60.8 ± 13.6 year) participated in this study. Patients were assessed for functional capacity using various functional capacity tests while QoL, daily sleepiness, sleep quality, depression and fatigue were assessed using validated questionnaires at the end of a 12-month aerobic exercise program and after 12 months of detraining.

Results: The detraining significantly reduced patients' QoL score by 20% (P = 0.01). More affected were aspects related to the physical component summary of the QoL (P < 0.001) rather than those related to the mental one (P = 0.096). In addition, the performance in the functional capacity tests was reduced (P < 0.05), while sleep quality (P = 0.020) and daily sleepiness scores (P = 0.006) were significantly worse after the detraining period. Depressive symptoms (P = 0.214) and the level of fatigue (P = 0.163) did not change significantly.

Conclusions: Detraining has a detrimental effect in patients' QoL, functional capacity and sleep quality. The affected physical health contributed significantly to the lower QoL score. It is crucial for the chronic disease patients, even during emergencies such as lockdowns and restrictions in activities to maintain a minimum level of activity to preserve some of the acquired benefits and maintain their health status.
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http://dx.doi.org/10.1007/s11255-020-02560-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426199PMC
September 2020

Deconstructing athletes' sleep: A systematic review of the influence of age, sex, athletic expertise, sport type, and season on sleep characteristics.

J Sport Health Sci 2020 Mar 19. Epub 2020 Mar 19.

Department of Life and Health Sciences, University of Nicosia, Nicosia 1700, Cyprus. Electronic address:

Purpose: This systematic review aims to describe objective sleep parameters for athletes under different conditions and address potential sleep issues in this specific population.

Methods: PubMed and Scopus were searched from inception to April 2019. Included studies measured sleep only via objective evaluation tools such as polysomnography or actigraphy. The modified version of the Newcastle-Ottawa Scale was used for the quality assessment of the studies.

Results: Eighty-one studies were included, of which 56 were classified as medium quality, 5 as low quality, and 20 as high quality. A total of 1830 athletes were monitored over 18,958 nights. Average values for sleep-related parameters were calculated for all athletes according to sex, age, athletic expertise level, training season, and type of sport. Athletes slept on average 7.2 ± 1.1 h/night (mean ± SD)?, with 86.3% ± 6.8% sleep efficiency (SE). In all datasets, the athletes' mean total sleep time was <8 h. SE was low for young athletes (80.3% ± 8.8%). Reduced SE was attributed to high wake after sleep onset rather than sleep onset latency. During heavy training periods, sleep duration and SE were on average 36 min and 0.8% less compared to pre-season and 42 min and 3.0% less compared to in-season training periods, respectively.

Conclusion: Athletes' sleep duration was found to be short with low SE, in comparison to the general consensus for non-athlete healthy adults. Notable sleep issues were revealed in young athletes. Sleep quality and architecture tend to change across different training periods.
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http://dx.doi.org/10.1016/j.jshs.2020.03.006DOI Listing
March 2020

High-Intensity Functional Training Improves Cardiorespiratory Fitness and Neuromuscular Performance Without Inflammation or Muscle Damage.

J Strength Cond Res 2020 Feb 27. Epub 2020 Feb 27.

School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece.

Posnakidis, G, Aphamis, G, Giannaki, CD, Mougios, V, Aristotelous, P, Samoutis, G, and Bogdanis, GC. High-intensity functional training improves cardiorespiratory fitness and neuromuscular performance without inflammation or muscle damage. J Strength Cond Res XX(X): 000-000, 2020-We examined the effects of high-intensity functional training (HIFT) on cardiorespiratory and neuromuscular performance, as well as on inflammatory and muscle damage markers. Thirteen physically active healthy volunteers (aged 28.3 ± 3.8 years, 5 men and 8 women) underwent 8 weeks of a group HIFT program performed 3 times per week. Each session consisted of 4 rounds of a 9-exercise circuit (30-second exercise and 15-second recovery). During the first and last weeks of training, venous blood was sampled daily to monitor changes in serum C-reactive protein (CRP) and creatine kinase (CK). After 8 weeks of HIFT, body fat decreased by 0.64 ± 1.01 kg (p = 0.041), maximal oxygen uptake improved by 1.9 ± 2.2 ml·kg·min (p = 0.009), countermovement jump by 2.6 ± 1.5 cm (p = 0.001), bench press 1-repetition maximum (1RM) by 4.5 ± 3.8 kg (p = 0.001), maximum number of bench press repetitions at 65% 1RM by 4 ± 5 repetitions (p = 0.03), and abdominal muscle endurance by 6 ± 4 repetitions (p < 0.001). In both week 1 and week 8 of training, CK increased mildly in the morning after the first session of the week (main effect for day, p = 0.008), whereas no significant changes were observed in CRP (p = 0.31). During week 8, CK on all days was ∼32% lower compared with week 1 (160 vs. 235 U·L; main effect of week 1 vs. week 8, p = 0.027), whereas CRP remained unchanged (p = 0.225). This HIFT program was effective in improving cardiorespiratory and neuromuscular physical fitness without causing significant inflammation or muscle damage in physically active subjects.
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http://dx.doi.org/10.1519/JSC.0000000000003516DOI Listing
February 2020

The Effects of a 6-Month High Dose Omega-3 and Omega-6 Polyunsaturated Fatty Acids and Antioxidant Vitamins Supplementation on Cognitive Function and Functional Capacity in Older Adults with Mild Cognitive Impairment.

Nutrients 2020 Jan 26;12(2). Epub 2020 Jan 26.

Department of Life and Health Sciences, University of Nicosia, Nicosia 2417, Cyprus.

The aim of the present study was to examine the effects of a high-dose omega-3 and omega-6 fatty acids supplementation, in combination with antioxidant vitamins, on cognitive function and functional capacity of older adults with mild cognitive impairment (MCI), over a 6-month period in a randomized, double-blind, placebo-controlled trial. Forty-six older adults with MCI (age: 78.8 ± 7.3 years) were randomized 1:1 to receive either a 20 mL dose of a formula containing a mixture of omega-3 (810 mg Eicosapentaenoic acid and 4140 mg Docosahexaenoic acid) and omega-6 fatty acids (1800 mg gamma-Linolenic acid and 3150 mg Linoleic acid) (1:1 w/w), with 0.6 mg vitamin A, vitamin E (22 mg) plus pure γ-tocopherol (760 mg), or 20mL placebo containing olive oil. Participants completed assessments of cognitive function, functional capacity, body composition and various aspects of quality of life at baseline and following three and six months of supplementation. Thirty-six participants completed the study (eighteen from each group). A significant interaction between supplementation and time was found on cognitive function (Addenbrooke's Cognitive Examination -Revised (ACE-R), Mini-Mental State Examination (MMSE) and Stroop Color and Word Test (STROOP) color test; < 0.001, = 0.011 and = 0.037, respectively), functional capacity (6-min walk test and sit-to-stand-60; = 0.028 and = 0.032, respectively), fatigue ( < 0.001), physical health ( = 0.007), and daily sleepiness ( = 0.007)-showing a favorable improvement for the participants receiving the supplement. The results indicate that this nutritional modality could be promising for reducing cognitive and functional decline in the elderly with MCI.
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http://dx.doi.org/10.3390/nu12020325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071310PMC
January 2020

Cardiac autonomic function during intradialytic exercise training.

Postgrad Med 2019 Sep 15;131(7):539-545. Epub 2019 Sep 15.

Department of Physical Education & Sport Science, University of Thessaly , Trikala , Greece.

: Cardiac autonomic nervous system (ANS) dysfunction is a common feature in patients receiving hemodialysis (HD) therapy, whilst is associated with an increased risk of ventricular arrhythmias and sudden cardiac death. The aim of this study is to investigate and compare the hemodynamic changes and responses of ANS function in HD patients using pupillometry and Heart Rate Variability (HRV) parameters. : Sixteen chronic kidney diseases (CKD) patients receiving HD (52.18 ± 17.7 years) underwent both pupillometric measurements using a portable handheld pupil-measuring device and standard HRV analysis pre HD, every hour and 30 min post-HD session under two different scenarios: at rest while the patient resting at HD bed and when the patient performed a single bout of intradialytic aerobic exercise lasting for 45 min during the second hour of the HD therapy. : No significant changes in ANS values were observed in neither of the pupillometric and the HRV values pre HD, for each hour and post-HD session. HRV parameters were significantly correlated with pupillometric parameters at pre HD and immediately after the single bout of intradialytic exercise. ANS activity did not differ during the conventional HD session and during the session included intradialytic exercise. Moreover, sympatho-vagal balance indices deriving from pupillometric assessment showed beneficial changes after the exercise event. : Pupillometry is a promising and robust technique with fewer artifacts compared to HRV especially in studies involving exercise sessions. Thus, pupillometry can be used as a complementary tool in the evaluation of cardiac autonomic dysfunction.
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http://dx.doi.org/10.1080/00325481.2019.1663707DOI Listing
September 2019

Associations between functional capacity, isokinetic leg strength, sleep quality and cognitive function in multiple sclerosis patients: a cross-sectional study.

Postgrad Med 2019 Sep 1;131(7):453-460. Epub 2019 Oct 1.

Department of Life and Health Sciences, University of Nicosia , Nicosia , Cyprus.

: Recent evidence suggests an association between functional capacity and cognitive function, at least in older adults. The aim of this cross-sectional study was to examine the association between cognitive function, functional capacity, isokinetic leg strength, health-related quality of life (HRQOL), sleep quality, body fat, handgrip strength, and fatigue among a sample of MS patients. : Fifty-one relapsing-remitting MS patients (age: 38.4 ± 7.1 yrs; 30 females) were recruited and agreed to participate in this study. Cognitive function was assessed by the Paced Auditory Serial Addition Test (PASAT). Functional capacity was examined using various functional tests commonly used in MS patients. Maximal voluntary unilateral leg strength was assessed using isokinetic dynamometer. Isometric handgrip strength was assessed by a dynamometer. Total body and visceral fat levels were assessed via bioelectrical impedance analyzers. Finally, the patients' HRQOL, sleep quality, and fatigue levels were evaluated using specific questionnaires. : A significant association was found between the PASAT score and the performance score in various functional capacity tests (p < 0.050). On the other hand, a weak but statistically significant association was found between the PASAT score and isokinetic strength of knee extensors (r = 0.319, p = 0.022) and knee flexors (r = 0.354 p = 0.011). Poor sleep quality was associated with lower performance in all the functional capacity tests examined (p < 0.05) whilst was negatively associated with the PASAT score (r = -0.334, p = 0.017). The multivariate regression analysis revealed that the performance on the TUG test was a significant predictor of cognitive function. : Based on the results of this study, functional capacity was found to be associated with both impaired cognitive performance and low HRQOL in MS patients. In addition, an association between sleep quality and cognitive performance was revealed, confirming existing literature. Functional capacity as assessed by the TUG test emerged as the best predictor of cognitive function.
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http://dx.doi.org/10.1080/00325481.2019.1662271DOI Listing
September 2019

Phosphorus nutritional knowledge among dialysis health care providers and patients: A multicenter observational study.

Clin Nutr ESPEN 2019 06 4;31:33-37. Epub 2019 Apr 4.

School of PE and Sport Sciences, University of Thessaly, Trikala, Greece; Faculty of Health, Plymouth Marjon University, Plymouth, UK.

Background-aims: Phosphorus nutritional knowledge level of hemodialysis patients and renal nurses has been found to be low, while respective knowledge of nephrologists has not been studied yet. There are equivocal results regarding the association of phosphorus nutritional knowledge level and serum phosphorus values. The aim of this study was to assess phosphorus nutritional knowledge of hemodialysis patients, nephrologists and renal nurses and seek potential interventions to improve patients' adherence to phosphorus and overall nutritional guidelines.

Methods: This cross-sectional observational study was conducted on sixty eight hemodialysis patients, 19 renal nurses and 11 nephrologists who were recruited from 3 hemodialysis units in Greece. Phosphorus nutritional knowledge of the participants was assessed by a 25-item item questionnaire (CKDKAT-N) which included 15 questions on phosphorus and 10 questions on protein, sodium, and potassium knowledge.

Results: Nephrologists had higher CKDKAT-N total (19.1 ± 3.6 vs 14.1 ± 2.8 and 13.2 ± 2.8, P < 0.01) and phosphorus knowledge scores (10.6 ± 2.7 vs 7.6 ± 2.2 and 7.3 ± 2.0, P < 0.01) compared to renal nurses and patients respectively. There were no differences in total and phosphorus knowledge scores between nurses and patients. Patients and nurses answered correctly significantly less questions regarding phosphorus compared with the rest of the questions (P < 0.01) while no such difference was found in nephrologists. Serum phosphorus was positively correlated with phosphorus knowledge score (r = 0.31, P = 0.02), and negatively correlated with patient age (r = -0.34, P < 0.05). None of the patients, 11% of the nurses and 27% of the nephrologists answered correctly all three questions regarding P, K and Na dietary recommendations (P < 0.01).

Conclusions: The study confirms that hemodialysis patients have low renal nutrition knowledge while higher nutritional phosphorus knowledge does not lead to lower serum phosphorus values. Alarmingly, renal nurses have been found to have a similar level of knowledge with hemodialysis patients, something that needs to be taken into account when training the new dialysis staff. Nephrologists have superior knowledge; however they are still lacking essential nutritional knowledge that could affect patients' and nurses' overall understanding. Continuing education on nutrition of nephrologists and renal nurses could improve nutrition care of hemodialysis patients.
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http://dx.doi.org/10.1016/j.clnesp.2019.03.005DOI Listing
June 2019

Hydration status, total water intake and subjective feelings of adolescents living in a hot environment, during a typical school day.

Int J Adolesc Med Health 2019 Apr 5. Epub 2019 Apr 5.

Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus.

Aim Individuals living in a hot environment appear to face increased risk of dehydration. Currently there is not extensive literature on the adolescent population in relation to hydration. The aim of the present study was to assess hydration status and total water intake (TWI) at school, of adolescents living in a hot environment, and to investigate the association of hydration and TWI with various subjective feelings. Methods The hydration status of 141 adolescents (boys n = 102), age 15-17 years, was assessed via urine specific gravity (USG), at the beginning (07:30 am) and at the end (1:30 pm) of one school day. TWI from fluids and solid food was assessed via detailed food and fluid records. Subjective feelings (i.e. thirst, alertness, ability to concentrate) were recorded by specific scales. Results Ninety percent of the students arrived dehydrated at school (USG >1.020). Thirteen students were hydrated (USG <1.020), 67 students were slightly dehydrated (USG 1.021-1.029), and 50 students were seriously dehydrated (USG >1.030). There was no difference in TWI between the three groups (765 ± 451 mL). TWI correlated with alertness (p = 0.005) and the ability to concentrate (p = 0.015), and inversely correlated with fatigue (p = 0.015). Seriously dehydrated students felt less alert in the morning (p < 0.035) whereas the feeling of thirst was similar between all groups. Conclusions The prevalence of the dehydration of the adolescents during school time appeared to be extremely high, and thirst was not driving those adolescents to drink enough. Apart from health concerns, school performance could be affected by dehydration and inadequate water intake.
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http://dx.doi.org/10.1515/ijamh-2018-0230DOI Listing
April 2019

Nocturnal Activity Is Not Affected by a Long-Duration, Low-Intensity Single Exercise Bout.

Sports (Basel) 2019 Mar 1;7(3). Epub 2019 Mar 1.

School of PE and Sport Science, University of Thessaly, 42100 Trikala, Greece.

The aim of the current study was to examine whether prolonged low-intensity aerobic exercise could affect nocturnal activity in healthy individuals. Twenty-one healthy adults (24 ± 3.7 years; 9 females) were enrolled in this study. All participants participated in a 3-h low-intensity walking exercise protocol. Standard biochemical indices were assessed before the exercise protocol and at 72 h. Nocturnal activity and various indices of health were recorded for five consecutive days. The score of muscle pain peaked the night after the exercise protocol ( < 0.05) and returned to baseline two days after. No statistical differences were found in any of the parameters examined, including nocturnal activity. Prolonged low-intensity exercise does not affect nocturnal activity. The anecdotal reports suggesting that exercise or/and physical activity could worsen symptoms of motor restlessness during sleep in sleep disorders, such as restless legs syndrome and periodic limb movements, are not supported by this study. However, these findings need to be verified in clinical populations, as well as by using protocols with different forms of exercise.
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http://dx.doi.org/10.3390/sports7030056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473573PMC
March 2019

Sleep Abnormalities in Multiple Sclerosis.

Curr Treat Options Neurol 2019 Jan 31;21(1). Epub 2019 Jan 31.

Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland.

Purpose Of Review: This review summarizes the most well-documented sleep disorders seen in patients with multiple sclerosis (MS), with a special focus on the impact on quality of life.

Recent Findings: Sleep abnormalities in patients with MS are a multifactorial and relatively complex issue affecting approximately 60% of the patients while the pathophysiology of these symptoms is not fully understood. Circadian rhythm disorders and increased levels of pro-inflammatory cytokines have been recognized as potential players in affecting sleep homeostasis in MS patients. Medication-related side effects such as in immunotherapy and other factors such as lesion load can contribute to the disruption of normal sleep patterns. Most frequently encountered sleep disorders are insomnia, sleep-related movement disorders, sleep-related breathing disorders, and circadian rhythm disorders affecting both adults and paediatric MS populations. Aetiology still remains unknown with treatment options focusing on behavioural cognitive therapy and lifestyle modification including improvement in sleep hygiene as well as melatonin supplementation. Given MS prevalence is still rising affecting millions of people, more personalized medicine applications should possibly form the key approach for improving patients' quality of life and quality years.
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http://dx.doi.org/10.1007/s11940-019-0544-7DOI Listing
January 2019

Effects of high-intensity interval training frequency on perceptual responses and future physical activity participation.

Appl Physiol Nutr Metab 2019 Sep 17;44(9):952-957. Epub 2019 Jan 17.

Department of Life and Health Sciences, University of Nicosia, Nicosia CY-1700, Cyprus.

The effectiveness of high-intensity interval training (HIIT) in inducing positive physiological adaptations is well documented. However, its impact on perceptual responses and on future physical activity (PA) engagement is less evaluated. The present study aimed to examine the effects of HIIT frequency on perceptual responses, health-related quality of life (HRQOL), and its influence in future PA participation. Thirty-five inactive adults were randomly assigned to a control (CON) and to 2 training groups that performed HIIT (10 × 60 s cycling, ∼83% peak power output) for 2 (HIIT-2) or 3 (HIIT-3) times per week for 8 weeks. Following the HIIT intervention, exercise enjoyment, HRQOL, and the intention to implement HIIT in the future were evaluated. Eight weeks after cessation of training, follow-up evaluations of HRQOL and PA were performed. Following the intervention, both training frequencies induced high levels of enjoyment (HIIT-2: 6.0 ± 1.1, HIIT-3: 6.0 ± 1.1, scale 1-7), improved HRQOL (HIIT-2: = 0.040; HIIT-3: = 0.024), and reported intention to implement HIIT in the future (HIIT-3: 100%, HIIT-2: 93% of participants). At follow-up, HIIT-3 participants reported higher completion of HIIT compared with HIIT-2 and CON ( < 0.05). Both training groups sustained improved HRQOL and increased vigorous and total PA ( < 0.05). This study showed that performing HIIT either 2 or 3 times per week is an enjoyable exercise modality that promotes a sustainable increase in habitual PA levels and improves HRQOL. Moreover, the higher training frequency resulted in greater HIIT completion in the 8-week period following the cessation of training.
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http://dx.doi.org/10.1139/apnm-2018-0707DOI Listing
September 2019

Effects of High vs. Low Glycemic Index of Post-Exercise Meals on Sleep and Exercise Performance: A Randomized, Double-Blind, Counterbalanced Polysomnographic Study.

Nutrients 2018 Nov 18;10(11). Epub 2018 Nov 18.

Department of Life and Health Sciences, University of Nicosia, 46 Makedonitisas Avenue, Nicosia CY 1700, Cyprus.

The aim of the current study was to investigate the effect of the glycemic index of post-exercise meals on sleep quality and quantity, and assess whether those changes could affect the next day's exercise performance. Following a baseline/familiarization phase, 10 recreationally trained male volunteers (23.2 ± 1.8 years) underwent two double-blinded, randomized, counterbalanced crossover trials. In both trials, participants performed sprint interval training (SIT) in the evening. Post-exercise, participants consumed a meal with a high (HGI) or low (LGI) glycemic index. Sleep parameters were assessed by a full night polysomnography (PSG). The following morning, exercise performance was evaluated by the countermovement jump (CMJ) test, a visual reaction time (VRT) test and a 5-km cycling time trial (TT). Total sleep time (TST) and sleep efficiency were greater in the HGI trial compared to the LGI trial ( < 0.05), while sleep onset latency was shortened by four-fold ( < 0.05) and VRT decreased by 8.9% ( < 0.05) in the HGI trial compared to the LGI trial. The performance in both 5-km TT and CMJ did not differ between trials. A moderate to strong correlation was found between the difference in TST and the VRT between the two trials ( < 0.05). In conclusion, this is the first study to show that a high glycemic index meal, following a single spring interval training session, can improve both sleep duration and sleep efficiency, while reducing in parallel sleep onset latency. Those improvements in sleep did not affect jumping ability and aerobic endurance performance. In contrast, the visual reaction time increased proportionally to sleep improvements.
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http://dx.doi.org/10.3390/nu10111795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267571PMC
November 2018

Restless legs syndrome in Multiple Sclerosis patients: a contributing factor for fatigue, impaired functional capacity, and diminished health-related quality of life.

Neurol Res 2018 Jul 26;40(7):586-592. Epub 2018 Mar 26.

b The Cyprus Institute of Neurology and Genetics , Nicosia , Cyprus.

Objectives Restless legs syndrome (RLS) symptoms are common in Multiple Sclerosis (MS) patients. The aim of the current study was to examine for the first time whether RLS could affect the functional capacity and various contributing parameters related to quality of life and fatigue in MS patients. Methods According to their RLS status, 50 relapsing-remitting MS patients were divided into the RLS (n = 10) and non-RLS groups (n = 40). Specific questionnaires were used in order to assess the health-related quality of life (HRQoL), fatigue levels, sleep quality, daily sleepiness, and depression symptoms of the patients. Functional capacity was examined using a battery of functional tests. Total body and visceral fat levels were assessed via bioelectrical impedance analyzers. Results Sleep quality, depression, fatigue, and HRQoL levels were found to be significantly worse in the patients with RLS compared to their free-RLS counterparts (P < 0.05). In addition, patients with RLS were found to exhibit further impairments in their performance in various functional tests related mainly with strength levels of lower extremities (P < 0.05). Finally, the patients with RLS were found to have significantly higher both total and trunk fat levels compared to patients without RLS (P < 0.05). A strong correlation was observed between the severity of RLS symptoms, sleep quality, fatigue, and QoL levels. Discussion It seems that RLS contributes even further to impairments on sleep quality, fatigue, functional capacity, and therefore HRQoL levels in relapsing-remitting MS patients, whilst for the first time a link between high fat levels has been revealed.
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http://dx.doi.org/10.1080/01616412.2018.1454719DOI Listing
July 2018

Effects of controlled dehydration on sleep quality and quantity: A polysomnographic study in healthy young adults.

J Sleep Res 2019 06 7;28(3):e12662. Epub 2018 Feb 7.

Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus.

Dehydration is associated with several alternations in body homeostasis involving both physiological and mental aspects. In addition some studies have reported a negative effect of dehydration on subjectively assessed sleep-related parameters. The aim of the current study was to examine for the first time the effect of controlled dehydration on sleep quality and quantity using the gold-standard method of polysomnography. Twelve healthy male volunteers participated in this study (23.4 ± 0.8 years). Participants performed an in-house full polysomnographic assessment in two different occasions taking place in random order: (i) in a dehydrated state; and (ii) in a euhydrated state. In the dehydration scenario, the participants were allowed to consume only 1.25 L of non-caffeinated fluids, while during the euhydrated state participants had to drink at least 3 L of non-caffeinated fluids during the last 24 hr before the polysomnographic study. Urine specific gravity was assessed by refractrometry on collection day in order to assess hydration status. Participants who did not fulfil the hydration criteria were rescheduled. All participants successfully completed the two polysomnographic studies without any complaints or adverse effects reported. No significant differences were found in any of the examined indices of sleep quality and quantity between the dehydration and euhydration scenarios (p > .05). This is the first study to show that controlled mild dehydration does not seem to affect sleep quality and quantity in young healthy adults. More research is necessary to further verify these conclusions and assess whether other parameters are involved in the manifestation of sleep disturbances.
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http://dx.doi.org/10.1111/jsr.12662DOI Listing
June 2019

High-intensity Interval Training Frequency: Cardiometabolic Effects and Quality of Life.

Int J Sports Med 2018 02 2;39(3):210-217. Epub 2018 Feb 2.

Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus.

The effects of high intensity interval training (HIIT) frequency on cardiometabolic health and quality of life were examined in 35 healthy inactive adults (age: 31.7±2.6 yrs, VOpeak: 32.7±7.4 ml·: kg ·: min). Participants were randomly assigned to a control (CON) and two training groups, which performed 10×60-s cycling at ~83% of peak power, two (HIIT-2) or three times per week (HIIT-3) for eight weeks. Compared with CON, both training regimes resulted in similar improvements in VOpeak (HIIT-2: 10.8%, p=0.048, HIIT-3: 13.6%, p=0.017), waist circumference (HIIT-2: -1.4 cm, p=0.048, HIIT-3: -2.4 cm, p=0.028), thigh cross-sectional area (HIIT-2: 11.4 cm, p=0.001, HIIT-3: 9.3 cm, p=0.001) and the physical health component of quality of life (HIIT-2: 8.4, p=0.001, HIIT-3: 12.2, p=0.001). However, HIIT-3 conferred additional health-related benefits by reducing total body and trunk fat percentage (p<0.05, compared with CON), total cholesterol and low-density lipoprotein-cholesterol (p<0.02, compared with CON) and by improving the mental component of quality of life (p=0.045, compared with CON). In conclusion, performing HIIT only twice per week is effective in promoting cardiometabolic health-related adaptations and quality of life in inactive adults. However, higher HIIT frequency is required for an effect on fat deposits, cholesterol and mental component of well-being.
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http://dx.doi.org/10.1055/s-0043-125074DOI Listing
February 2018

Restless legs syndrome in adolescents: relationship with sleep quality, cardiorespiratory fitness and body fat.

Sleep Sci 2017 Jan-Mar;10(1):7-10

Faculty of Sport and Health Sciences, University of St Mark & St John, Plymouth, UK.

Objective: The aim of the current study was to investigate the relationship between restless legs syndrome (RLS) and cardiorespiratory fitness, body composition and sleep quality in a sample of adolescents.

Methods: One hundred fifty seven volunteer adolescents (16.6 ± 0.7 yrs) participated in the study. Sleep quality was assessed by the Pittsburg sleep quality index. Cardiorespiratory fitness was assessed by the 20 m shuttle run test and body composition by bioelectrical impedance analysis.

Results: The prevalence of RLS was 5.1%. The adolescents with RLS were found to exhibit significantly higher body fat levels (=0.019) and poorer sleep quality score (=0.000) compared with their free-RLS counterparts.

Conclusions: Adolescents with RLS are subjects of higher body fat and impaired sleep quality compared with adolescents without RLS. Early diagnosis and appropriate management of RLS is essential in the adolescents.
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http://dx.doi.org/10.5935/1984-0063.20170002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611766PMC
October 2017

Restless legs syndrome is contributing to fatigue and low quality of life levels in hemodialysis patients.

World J Nephrol 2017 Sep;6(5):236-242

the Cyprus Institute of Neurology and Genetics, Nicosia CY 1683, Cyprus.

Aim: To examine whether hemodialysis (HD) patients with restless legs syndrome (RLS) are subjects of greater fatigue and impaired quality of life (QoL) compared to HD patients without RLS.

Methods: Eighty five stable HD patients participated in this study. According to their RLS status, the patients were divided into the RLS group ( = 23) and the non-RLS group ( = 62). QoL, fatigue, sleep quality, daily sleepiness and depression symptoms were assessed by using various questionnaires. Finally, biochemical parameters including iron, ferritin, hemoglobin, hematocrit and parathormone were assessed.

Results: The HD patients with RLS scored worse in all the questionnaires used in the study ( < 0.05). The patients with RLS were more likely to receive the HD therapy on the morning shift, whilst 43.5% of the RLS patients reported to experience the RLS symptoms also during HD. The severity of RLS was correlated with fatigue, depression score and sleep quality ( < 0.05).

Conclusion: HD patients with RLS are subject to lower QoL related parameters and greater fatigue compared to HD patients without RLS. RLS should be successfully managed in order to improve the QoL of the sufferers.
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http://dx.doi.org/10.5527/wjn.v6.i5.236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592428PMC
September 2017

The Effect of Cold Dialysis in Motor and Sensory Symptoms of RLS/WED Occurring During Hemodialysis: A Double-Blind Study.

ASAIO J 2018 Jan/Feb;64(1):110-114

Restless legs syndrome/Willis-Ekbom disease (RLS/WED) is a common sensorimotory disorder affecting almost 30% of hemodialysis (HD) patients. RLS/WED induces discomfort during rest hours, and its symptoms have also been observed during HD sessions. Anecdotal reports suggest that cooling the dialysate solution during dialysis could help patients overcome those symptoms and improve restlessness. The aim of this double-blind study was to assess whether a reduction of the dialysate temperature by 1°C could reduce motor and sensory symptoms of RLS/WED occurring during HD. Thirty-two HD patients participated in the study. Patients were divided into two groups: the RLS (N=16) and the non-RLS groups (N=16). Patients were studied on two different scenarios for two consecutive HD sessions, 1 week apart: 1) standard temperature of the dialysate (37°C) and 2) low temperature of the dialysate (36°C cold dialysis scenario). In all sessions, motor (leg movement per hour of HD [LM/hHD]) and sensory symptoms were assessed. The reduction of dialysate temperature by 1°C was effective in reducing motor symptoms as they assessed the LM/hHD by 36% only in patients with RLS, while a significant interaction was found between "LM/hHD affected by temperature" and "RLS status" (p = 0.039). Sensory symptoms also reduced by 10% after the reduction of the dialysate temperature. The reduction of the dialysate temperature by 1°C reduced motor symptoms by 36-54% and sensory symptoms by 10% in HD patients with RLS/WED. Cold dialysis could be considered a safe nonpharmacological approach for the amelioration of RLS/WED symptoms occurring during HD.
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http://dx.doi.org/10.1097/MAT.0000000000000622DOI Listing
July 2018

Physical fitness and obesity levels during an academic year followed by summer holidays: an issue of insufficient time for physical activity.

Int J Adolesc Med Health 2017 Jun 9;31(1). Epub 2017 Jun 9.

Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus.

Today, available time for physical activity has been continuously decreasing, whilst, school-time physical education (PE) classes appear to be the only real option for many adolescents to engage in physical activity and exercise. The aim of the present study was to investigate fitness and health related parameters over one academic year, and after the summer holidays for adolescents who do not engage in out-of-school physical activities. Participants were 153 students (age: 15-17 years; boys n = 86) who exercised only during PE (2 × 45-min periods per week). Body fat, flexibility, handgrip strength, squat jump, 30 m sprint and cardiorespiratory fitness were examined at the beginning and end of a school year, and after the ensuing summer holidays. The boys improved handgrip and flexibility, but no other significant improvement was observed over the school year in any of the examined physical fitness parameters, or obesity indices. Instead, the girls' cardiorespiratory fitness decreased over the summer holidays. It seems that exercising only twice a week during school PE classes is insufficient to induce significant improvements in physical fitness, body composition and health parameters.
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http://dx.doi.org/10.1515/ijamh-2016-0137DOI Listing
June 2017

Cold dialysis and its impact on renal patients' health: An evidence-based mini review.

World J Nephrol 2017 May;6(3):119-122

Giorgos K Sakkas, Christina Karatzaferi, Faculty of Sport and Health Sciences, University of St Mark and St John, Plymouth PL6 8BH, United Kingdom.

Chronic renal disease is associated with advanced age, diabetes, hypertension, obesity, musculoskeletal problems and cardiovascular disease, the latter being the main cause of mortality in patients receiving haemodialysis (HD). Cooled dialysate (35 °C-36 °C) is recently employed to reduce the incidence of intradialytic hypotension in patients on chronic HD. The studies to date that have evaluated cooled dialysate are limited, however, data suggest that cooled dialysate improves hemodynamic tolerability of dialysis, minimizes hypotension and exerts a protective effect over major organs including the heart and brain. The current evidence-based review is dealing with the protective effect of cold dialysis and the benefits of it in aspects affecting patients' quality of care and life. There is evidence to suggest that cold dialysis can reduce cardiovascular mortality. However, large multicentre randomized clinical trials are urgently needed to provide further supporting evidence in order to incorporate cold dialysis in routine clinical practice.
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http://dx.doi.org/10.5527/wjn.v6.i3.119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424433PMC
May 2017

Restless legs syndrome/Willis-Ekbom disease prevalence in beta thalassemia patients.

Sleep Breath 2018 03 19;22(1):175-179. Epub 2017 Apr 19.

Department of PE and Sport Science, University of Thessaly, Trikala, Greece.

Purpose: Both beta thalassemia and restless legs syndrome (RLS) patients share some common pathophysiological characteristics related to iron handling. In the present study, the aim was to explore the prevalence of RLS as well as to explore potential association between the syndrome and various quality of life-related parameters in a sample of beta thalassemia patients.

Methods: One hundred fourteen (age 40 ± 11 yr, 59 M/55F) beta thalassemia patients participated in this cross-sectional descriptive study. Patients were screened for RLS based on the international RLS study group diagnostic criteria as well as a battery of validated questionnaires.

Results: The prevalence of RLS in this sample of beta thalassemia patients was zero. The quality of life score was low (78 ± 18). Iron levels were within normal range (191 ± 66 mcg/dL) while ferritin levels were high as expected (1836 ± 225 ng/dL).

Conclusions: Our sample of patients comes from central Greece where the prevalence of RLS in the general population is 4% while in renal failure patients is 27%. To our surprise, there was no presence of RLS among this sample of beta thalassemia patients. The adequate levels of iron and ferritin often seen in these patients could be the reason of the absence of RLS symptoms.
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http://dx.doi.org/10.1007/s11325-017-1497-2DOI Listing
March 2018