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Dietetics, Nutrition and Biological Sciences

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    THE EFFECT OF POMEGRANATE ON ANTHROPOMETRIC, BIOCHEMICAL, COGNITIVE AND SATIETY INDICATORS OF RISK FACTORS FOR NON-COMMUNICABLE DISEASES
    (Queen Margaret University, Edinburgh, 2019) Stockton, Angela
    Non-communicable diseases (NCDs) such as cardiovascular, endocrine, metabolic and cerebrovascular diseases are increasing contributors to, and major causes of worldwide morbidity and mortality. Hypertension and obesity are the most preventable cardiovascular risk factors which can be modified by diet and lifestyle changes. The pomegranate, valued as a medicinal fruit since antiquity, and its extract (PE), are both rich in polyphenol antioxidants which have the potential to improve both the management and outcomes of chronic disease, to decrease blood pressure and increase satiety, thus assisting in the reduction of cardiovascular disease (CVD), overweight and obesity. Chronic pomegranate supplementation has recently been shown to improve memory retention, and verbal memory with increased functional brain activity during visual and verbal memory tasks. PE consumption may perform a role in enhancing cognitive performance or towards preventing cognitive decline. The primary aims of this research were to investigate the effects of PE on BP and stress hormones, and to explore the relationship between PE intake and satiety, anthropometry, quality of life (QoL) and cognitive function indicators. Four studies were conducted in healthy volunteers to fulfil these aims using double-blind, placebo-controlled, RCT designs. The first three parallel studies were conducted over 4 and 8 weeks. The exploratory (Pom-01; n=29), satiety (Pom-01s; n=29) and blood pressure and anthropometry (Pom-02; n=55) studies investigated the effect of PE consumption on anthropometric, physiological, biochemical, satiety and QoL parameters. The fourth crossover RCT (Pom-03; n=20) explored the acute effect of PE on cognitive function. In Pom-01, paired t-tests showed that systolic BP was significantly reduced following PE intake (4.75 mmHg; p = 0.012), with reductions in diastolic BP (1.73 mmHg; p˃0.05). Levels of HOMA-IR (p = 0.045), glucose, insulin and uric acid all decreased. No significant changes were recorded in volunteers taking the placebo (PL). ANOVA indicated no significant differences between the groups. PE consumption caused a highly significant drop in salivary cortisol levels (p = 0.016 to p<0.001), and the cortisol/cortisone ratio was also significantly reduced (p = 0.011 to p< 0.001). The RAND 36 QoL questionnaire showed significant improvements in physical (p = 0.018) and social functioning (p = 0.021), pain (p = 0.003), general health (p = 0.008) and overall QoL score (p = 0.007) over the 4-week study within the PE group compared to no significant changes in these parameters within the PL. In Pom-01s, volunteers taking PE reported feeling less hungry, with less desire to eat, felt fuller and more satisfied, and ate less (p = 0.05) than those who consumed the PL. There was a significant difference between the PE and PL groups in Pom-02 for diastolic BP (F2, 102 =4·4; p = 0·02), where PE decreased (2.79mmHg) compared to placebo. There was a similar non-significant decrease in magnitude of SBP (2.6mmHg) compared to PL. The QoL questionnaire, showed that significant improvements were also found in four parameters for the PE group between baseline and 8 weeks: energy (p = 0.017), emotional well-being (p = 0.003), social functioning (p = 0.046) and the overall QoL score (p = 0.022). There were no significant differences in the PL group. Acute PE ingestion in Pom-03 improved aspects of cognitive performance in healthy adults (Picture Recognition, p = 0.026; overall logical reasoning reaction time (RT), p<0.001; serial subtraction, p<0.001) compared to the non-biophenol PL. These results suggest that PE intake could be useful for public health. It may ameliorate non-communicable disease risk factors, reducing stress and blood pressure levels, improving cardiovascular health, perceived health related quality of life and aspects of cognitive function. The concurrent ability to decrease insulin resistance and modulate indicators of satiety could be of benefit to those who suffer from diabetes (type 2), metabolic syndrome or obesity. Future dietary intervention RCTs should focus on PE treatment effects over time and explore the most effective dosages in different population groups, age and body composition ranges. Key words: Pomegranate, Pomegranate Extract (PE), Polyphenols, Antioxidants, Anthropometry, Blood Pressure, Cholesterol, Cortisol, Diabetes, Stress, Insulin resistance, Satiety, Quality of Life, Health, Cognitive function, Memory, Ageing, Obesity, Cardiovascular Disease, Non-communicable diseases.
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    ASSESSING THE LIFESTYLE (PHYSICAL ACTIVITY LEVELS, SEDENTARY BEHAVIOUR AND EATING HABITS) OF OMANI ADOLESCENT GIRLS: A MIXED METHODS STUDY
    (Queen Margaret University, Edinburgh, 2019) Al-Mahrouqi, Zuwaina Humaid
    Background: Rising body mass index (BMI) in the world population is a serious global health issue of 21st century. Epidemiology and management of high BMI have been the themes of many studies. In the Arab world, including in Oman where this study is based, the prevalence of obesity and inactivity emerged late but is accelerating rapidly, particularly among the youth. The aim of this study is to bridge the research gap that exists regarding Omani adolescent girls’ lifestyle and their association with body weight status by studying the diet and activity habits of this population using a mixed method approach. To date, this is the first study of its kind from Oman. Methods: An explanatory sequential mixed methods study was conducted to assess the lifestyle characteristics (physical activity level, sedentary behaviour, and eating habits) among Omani girls aged 15–18 years, and to understand their perceptions related to this lifestyle. A total of 421 female students were randomly selected from two schools in Ibri, Oman, to participate in this study. A validated online ATLS questionnaire (N = 421), diet diary and pedometer (n = 59) and focus groups (n = 16) were used as data collection instruments. Ethical approvals were granted by the Queen Margaret University (QMU) ethics committee and Oman Ministry of Education (MOE). Informed consent was obtained from the participants and their parents and the confidentiality of the collected data maintained. Results: The prevalence of overweight was 21% and obesity 14% among this sample of Omani female adolescents. The average footstep tally of the participants (n=59) was 5,755 footsteps per day against the recommended 10,000–11,700 with significant differences between BMI groups. The pedometer data indicated that normal weight participants scored mean footstep counts of 6,625 per day, while it was 6,094 in the overweight girls, falling further to 5,755 for their obese peers. The majority of the participants (56%) who maintained diet diaries were normal reporters, while misreporters were 44%. After excluding the misreporters, the energy intake (EI) of the diet diary cohort was lower than the recommended value of 2400 Kcal/day. The overweight participants were significantly more likely to consume French fries/ chips (82%) and cake/ doughnuts (74%) than the other BMI groups, while the obese participants consumed more sweets (61%) and fast food (42%). The participants perceived environmental and sociocultural factors, rapid modernisation and acculturation of Omani society, lack of encouragement from family, friends, and teachers, as well as lack of self-motivation and role models as barriers to physical activity. Even though they perceived fast food as unhealthy, they were attracted to these due to the taste and advertisements. The study also found that increased digital screen-time, sleeping less, and missing breakfast were other factors that positively correlated with inactivity and increased the BMI among Omani female adolescents. Conclusion: The current study establishes a positive correlation between the overweight and obesity in Omani teenage girls and their physical inactivity and nutritional habits. While the current results are similar to those from other parts of the world, there are also factors that are specific to the region such as the climate and culture that makes the problem complex. The trend for BMI to rise with age among teenagers raises apprehension that it may continue in their adulthood. Urgent action needs to be taken by adolescent girls in Oman, their parents, and higher authorities at Oman ministries of education and health to improve the nutritional habits and physical activity of this age group. Specific culture-sensitive suggestions are provided in this thesis to meet these challenges. Key words: adolescent girls, obesity, overweight, BMI, Arab, Oman, school children, lifestyle, physical activity, dietary habits, sedentary behaviour, fast food, sleep, Ibri
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    SARCOPENIC OBESITY IN SCOTISH OLDER COMMUNITY-DWELLERS: A WEIGHT LOSS INTERVENTION USING HIGH PROTEIN INTAKE AND MIXED EXERCISE TRAINING TO AUGMENT BODY COMPOSITION AND FUNCTION IN OLDER AGE
    (Queen Margaret University, Edinburgh, 2018) Theodorakopoulos, Christos
    Background: Sarcopenic obesity is the condition where obesity and sarcopenia (age-related low muscle mass and strength) occur together, which may predispose older individuals to more adverse health effects than either of the two conditions alone. Thus, improvements in body composition and function are of vital importance. Aim: The aims of this study were to A) systematically search the databases for nutritional and/or exercise interventions in sarcopenic obesity and assess their effectiveness in augmenting body composition and function. B) Screen Scottish older community-dwellers for sarcopenia and obesity. C) Implement a nutritional and exercise programme for individuals with sarcopenic obesity. Methods: A) Four databases were systematically searched for trials with sarcopenic obese older adults. B) Scottish community dwellers (≥ 65 years) were screened for body fat (using bioelectrical impedance analysis; BIA), body mass index (BMI), muscle mass, and grip strength. C) Those with a high % body fat (≥ 28 % in men; ≥ 40 % in women) and low skeletal muscle mass index (≤ 10.75 kg·m-2 in men; ≤ 6.75 kg·m-2 in women) were randomly allocated to a 16-week intervention with exercise (EX) or exercise plus dietary modifications (EXD). The EX group followed a mixed-exercise training programme, whereas the EXD followed the same exercise protocol alongside an energy-deficit (500 kcal daily deficit) and high protein diet (1.2 – 1.5 g kg bodyweight-1). Results: A) Two studies were identified from the literature with sarcopenic obese participants (one diet and one resistance-exercise trial) but neither noted a significant change in body composition. However, resistance exercise training significantly improved physical function. B) In total, 108 (men, n=29; women, n=79) adults (median (IQR) age, 70 (67, 75) yr) took part in the screening test. Prevalence of sarcopenia was 14.8%, of obesity 27.8 % (using BMI) vs 63.0 % (using BIA), and sarcopenic obesity 4.6 % (using BMI) vs 12.0 % (using BIA). C) After 16 weeks of the intervention, the median (IQR) changes in EXD vs EX in bodyweight, fat mass and muscle mass were: -5.0 (-5.0, -6.8) kg vs. +0.5 (0.0, 1.0) kg, -4.7 (-4.8, -4.2) kg vs 0.0 (-0.4, 0.7) kg, and +0.1 (-0.4, 0.7) kg vs +0.5 (0.3, 0.7) kg, respectively. Improvements that may be of clinical significance were noted in both groups for strength and physical function. Conclusion: More intervention trials are needed with sarcopenic obese older adults. Prevalence of high adiposity in Scottish older adults may be higher than what has been previously documented. High adiposity and the use of BMI may mask sarcopenia and sarcopenic obesity. A high-protein energy-restriction diet with exercise training can potentially improve body compostion, and augment physical function in older adults with low muscle and high fat mass. Keywords: sarcopenia, obesity, sarcopenic obesity, body composition, older age, weight loss, high protein diet, exercise training, physical function
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    THE EFFECTS OF OAT β-GLUCAN CONSUMPTION ON THE ENERGY INTAKES OF HEALTHY INDIVIDUALS
    (Queen Margaret University, Edinburgh, 2018) Zaremba, Suzanne
    Overweight and obesity are disease states of a huge public health concern, therefore strategies to impede or reverse the current detrimental overweight and obesity epidemic are of fundamental importance. It is important to understand dietary factors that affect appetite and food intake both in short- and long-term, as energy intake can lead to positive energy balance. Following the discovery of the bioactivity of cereal soluble fibre, (1→3,1→4)-β-ᴅ-glucan, there has been extensive attention among researchers, the food industry and consumers since the 1980s. Several authorities, including the U.S Food and Drug Administration (FDA) and European Food and Safety Administration (EFSA) have acknowledged the cardiovascular (CV) health benefits of β-glucan consumption by broadcasting ratified health claims based on robust scientific evidence. Yet despite evidence to suggest that cereal β-glucan can beneficially impact on appetite, the underpinning mechanisms whereby β-glucan influences energy intakes remain elusive. Given that there is no ratified health claim for β-glucan consumption and satiety, the aim of this work was to investigate the impact of oat β-glucan consumption on energy intakes of healthy individuals over both short- and medium-term. β-glucan enrichment of a semi-solid, viscous breakfast (4 g oat β-glucan) had no effect on subsequent eating (p=0.388) in 33 normal-weight subjects (22 female/11 male, mean age (y): 27.0 ± 1.0, BMI (kg/m2): 23.5 ± 0.4), however there was a significant increase in subjective feelings of satiety (p=0.034) and fullness (p=0.048). Additionally, attenuation of glucose (p<0.001) and insulin (p=0.001) were reported alongside a decreased response in GLP-1 after 90 minutes (p=0.021) in study A. A novel β-glucan-enriched oatcake snack (4.46 g β-glucan) had no effect on daily energy intakes of healthy overweight and obese subjects (11 female/2 male, mean age (y): 34 ± 9, BMI (kg/m2): 29.8 ± 4.4) when consumed daily for six weeks when compared to a control snack group during week 3 (p=0.39) or week 6 (p=0.58) of the study. Moreover, there were no significant improvements in markers of abdominal obesity, waist circumference (WC, p=0.67), sagittal abdominal diameter (SAD, p=0.38), BMI (p=0.99) or body fat percentage (BF%, p=0.54) between groups in study B following 6 weeks of β-glucan-enriched snack consumption. To conclude, evidence reported in this thesis supports evidence that oat β-glucan consumption does not influence short- or medium-term energy intakes in healthy individuals, however, in the short term β-glucan does increase subjective ratings of appetite and attenuates postprandial glucose, insulin and GLP-1 responses. Keywords: oat β-glucan, energy intake, appetite, GLP-1, body composition
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    Role of eating frequency and macronutrient content of in-between-meal snacks incompliance with a low fatdietary advice in overweight men aged 25-50 years
    (Queen Margaret University, 2007) Zaveri, Swati
    The prevalence of obesity is increasing rapidly. Eating frequency has been shown to be inversely related to body weight status and appetite control. In addition, macronutrients have a role to play in appetite control, as protein has shown to be more satiating than either carbohydrate or fat. This dietary intervention study aimed to assess the impact of increasing daily eating frequency (EF), by providing either high carbohydrate (HC), high protein (HP), high fat (HF) snacks, or no snacks (control, C) on energy intake (EI), hunger ratings (HR), body weight status and metabolic parameters over 12 weeks in 59 healthy overweight to moderately obese Scottish men. Subjects were also followed up at 24 weeks (12 weeks post intervention). The HC (n = 14) and HF (n = 14) groups did not show a significant change in EF, HR, EI, body weight and % body fat at 6, 12 and 24 weeks compared to baseline. In contrast, the HP group (n = 18) showed a significant increase in the EF compared to HC group at 12 weeks, however, this did not result in a corresponding increase in EI, body weight or % body fat. Additionally, at 12 weeks, HP group tended to feel less hungry compared to baseline and HC group. However, the difference in the EF in HP group was not sustained after removing the under-reporters (URs). The C group (n = 13) showed a significant increase in HR at 12 weeks and an increase in % body fat at 24 weeks. There was no change in metabolic parameters in any study groups in the total sample. However, after removing the URs, there was a significant increase in total cholesterol level in HC group and a significant decrease in triglycerides level in control group. The study demonstrates that addition of extra energy, in the form of snacks, to the habitual diet may be compensated at the subsequent meals and does not result in an increase in EI and body weight. Including snacks that are healthy and of a reasonable portion size may help in maintaining a healthy diet and lifestyle.
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    The Effect Of Alcohol Toxicology In The Form Of Different Alcohol Drinking Patterns On A Biomarker Of Cardiovascular Disease Risk
    (Queen Margaret University, 2011) Murdoch, Julie M.
    Introduction The amino acid homocysteine has been identified as a risk factor for cardiovascular disease (CVD), as elevated levels induce atherosclerosis, through a direct effect on arterial tissue. In alcohol dependent individuals an association between plasma homocysteine levels and alcohol consumption has been found (Bleich et al. 2000d). However this link has not been explored in individuals who have a range of nondependent alcohol drinking patterns. This fact has informed the design of the present work. Material and Methods A convenience sample of abstainers (N=7), non-dependent drinkers (N=28) and alcohol dependent individuals (N=18) was recruited. Alcohol consumption was recorded using questionnaires and diaries. All study participants’ biological samples were analysed for the following biomarkers: plasma homocysteine (HPLC); serum folate and vitamin B12 (competitive immunoassay); serum Carbohydrate Deficient Transferrin (N-Latex immunoassay); urinary creatinine (colorimetric assay) and the methylenetetrahydrofolate (MTHFRC677T) polymorphism (Real-Time Polymerase Chain Reaction (PCR)). Results There was no association between alcohol consumption during drinking days and plasma homocysteine levels in non-dependent drinkers. However when this group was categorised according to pattern of consumption, plasma homocysteine levels were found to be lower in abstainers (median 5.60 μmol/l), but higher in sessional drinkers (median 7.15 μmol/l) and alcohol-dependent individuals (median 7.89 μmol/). The mutant MTHFR(C677T) polymorphism when present was associated with an increase in plasma homocysteine levels, which correlated with alcohol consumption (R=0.975). CDT levels were found to be elevated in both sessional and alcohol-dependent individuals at baseline (median 2.68% and 5.95% respectively) compared with abstainers (2.16%). Additionally there was a linear relationship between the number of drinking days in a week and a positive CDT result, in a sample of sessional drinkers (R=0.98). Discussion The work undertaken has shown that sessional drinking and alcohol dependence does increase homocysteine levels in comparison to abstainers. This may have important implications in relation to CVD risk. Additionally new evidence of the utility of CDT as a biomarker of alcohol consumption within a sample of sessional drinkers, has been identified.
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    The inhibitory properties and mode of action of plant essential oils and fruit extracts on protozoan parasites
    (Queen Margaret University, 2008) Anthony, Jean-Paul
    The main aims and objectives of this study was to determine if plant essential oils (PEOs) and polyphenol-rich fruit extracts (PRFEs) could reduce the viability of Giardia duodenalis trophozoites, Trypanosoma cruzi epimastigotes and Cryptospordium parvum oocysts in vitro. All PEOs tested reduced epimastigote and trophozoite viability at a concentration of 0.02% v/v, with titrations of the PEOs showing a concentration dependant decrease in viability. The minimum inhibitory concentrations (MICs) of PEOs demonstrated that myrtle and elemi oil were the most active PEOs (trophozoites = 0.005% v/v; epimastigotes = 0.00125% v/v) with the terpenes, α-pinene and limonene, constituents of these oils, being responsible for their action. Incubation of palmarosa oil and its terpene, geraniol, with C. parvum oocysts caused the almost complete excystation of oocysts (in the presence of increased temperature and time), with geranium oil and its terpene, citronellol, being nearly as effective. PRFEs reduce trophozoite viability, with 4 members of the Rosaceae Family causing complete reduction at 167 μg ml-1, possibly through their ellagitannin content. Cloudberry extract was found to have an MIC comparable to the drug metronidazole (67 μg ml-1). The historical use of blueberries for the treatment of diarrhoeal diseases was demonstrated by the ability of blueberry PRFE, pressed juice and drink to kill trophozoites. Protein expression was both inhibited and upregulated in several proteins in whole cell lysates of PEO treated trophozoites, indicating a supplemental intracellular mode of action. Both PEOs and PRFEs cause morphological changes to epimastigotes and trophozoites through flagellar truncation and internalisation, swelling and rounding of the cell body, cytoplasmic condensation and the formation of large membrane protrusions. These indicate an action on the membrane itself with possible changes in osmoregulation. Both PEOs and PRFEs can be considered to be candidates for novel drug discovery for the treatments of cryptosporidiosis, giardiasis and American trypanosomiasis.
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    An Investigation Into The Effectiveness Of Homeopathy In Improving Perceived Well Being And Quality Of Life In The 55+ Age Group
    (Queen Margaret University, 2010) Schyma, Jan
    The purpose of this study is to investigate the effectiveness of homeopathy in improving perceived health and well being in the 55+ age group. Homeopathy is defined as a complex intervention including the homeopathic remedy, the therapeutic relationship and participant choices about self care. The literature on health care for the 55+ age group suggests growing concern about the need to find ways of improving the health and quality of life of older people. Smallwood (2005) suggests that homeopathy and Complementary and Alternative Medicine (CAM) may contribute to improvement in the health and well being of older people in our society. Research has been carried out into the use of homeopathy to improve health and well being, but has not focused on homeopathy as a complex intervention or its use for the 55+ age group. A mixed methodology was chosen for this research study based on a pragmatic approach. An embedded design was used, with qualitative measures as the primary source of data and quantitative measures as the secondary source. Twenty participants were recruited and received homeopathic treatment. Their response to treatment was recorded in interview transcripts, case notes, the practitioner‟s reflective journal, and results from Measure Your Own Medical Outcomes Profile (MYMOP) and SF-36 questionnaires. The practitioner was also the researcher. The participants in this study clearly identified the outcomes and the nature of the experience. 18 out of 20 participants noted a definite or limited improvement in their health which they associated with homeopathic treatment. Additionally, participants valued the opportunity to review life experiences, to make connections between life events and health issues and the resulting increase in self awareness. They reported benefits that were consistent with classical homeopathic philosophy and practice, and other research studies into homeopathic treatment. Their evidence confirmed that homeopathy provided a healing experience both physically and emotionally which met the complex needs of participants in the study, and potentially future health care needs of this age group.
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    Nutrient content of different types of lunchtime meal, and their contribution towards the overall daily nutrient intakes of 11-14-year-old schoolchildren from two schools in Scotland
    (Queen Margaret University, 2010) Norris, Carina
    Introduction Due to concern regarding the quality and health implications of schoolchildren's diets, large amounts of funding have been invested into improving school canteen lunches. However, children may also have packed lunches, or 'street' lunches (those purchased outside school). This study was undertaken to ascertain whether canteen lunches are nutritionally superior to packed and street lunches, the contribution of the lunch types towards total nutritional intake, and whether children who eat nutritionally poor lunches compensate with food consumed at other times. Method During 2007 and 2008, dietary intake data was collected from 332 children aged 11 - 14, from two secondary schools in Fife, Scotland. Using 5-day estimated intake food diaries, data from 1,532 days was collected. Nutrient intake and density for 9 nutrients (plus fruit/vegetables) included in the Scottish Nutrient Standards for School Meals (2003) were compared with the Scottish Nutrient Standards for School Lunches (for lunchtimes) and Dietary Reference Values (for the whole day). Comparisons were undertaken between canteen, packed and street lunches, and between days including them. Results Many children 'flitted' between canteen, packed and street lunches on different days. Some children also consumed food from more than one lunch type on a single day. Dietary quality was poor; intakes of non starch polysaccharide, iron, and fruit and vegetables (at lunchtime and over the whole day) were of particular concern. When canteen lunches were consumed, the diet was closest to guidelines. However, many dietary targets remained unmet. When street lunches were consumed, the diet was furthest from the guidelines. This was the case both at lunchtime and over the whole day. There was some compensation for poor lunchtime nutrient intake by foods eaten at other times during the day. However, this was not as great as noted by previous studies, and many significant differences between the lunch types existed at the end of the day. Conclusion Due to the superior nutritional quality of canteen lunches compared with the other options available, and the contribution of canteen lunches towards overall nutrient intake, children should be encouraged to have canteen lunches.
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    The effect of a 12 month intradialytic exercise intervention on function, quality of life, nutritional status and clinical status
    (Queen Margaret University, 2010) Smith, Sara
    Haemodialysis (HD) patients are reported to have low levels of physical function, poor quality of life, protein energy wasting and inflammation, which negatively impact on morbidity and mortality. Exercise has previously been used as an intervention in HD patients; however the majority of previous studies have been of short duration and utilised moderate or high intensities requiring individual supervision of each exercise session. These studies recruited young patients with low levels of comorbidity and primarily focused on changes in VO2max/peak. This limits the ability to generalise findings to the wider prevalent HD population. The aims of the present study were therefore to determine whether a low to moderate intensity intradialytic exercise intervention with broad applicability, could over a 12 month period improve functional status and in turn quality of life, nutritional status and clinical status in a prevalent HD population in Scotland. Patients were recruited from NHS Fife, to a non-randomised controlled study and followed a progressive intradialytic aerobic exercise programme. One exercise session was conducted with individual supervision and two sessions with general supervision from dialysis staff. Outcome measures included measures of function (sit to stand, timed up and go, and handgrip), quality of life (SF36v2), nutritional status (anthropometric measurements, dual frequency bioelectrical impedance analysis, dietary intake and appetite) and clinical status (dialysis adequacy, biochemistry, high sensitivity C-reactive protein, blood pressure, medications). Measurements were taken at 6 time points: -1, 0, 3, 6, 9 and 12 months. 25 patients (mean age 56 + 11.4 years) volunteered for the intervention and 13 patients (mean age 60.8 + 14.6 years) volunteered as controls. At baseline groups demonstrated functional impairment, poor quality of life, and low fat free mass and had evidence of low grade inflammation. 25 patients completed 3 months of the exercise intervention, 20 completed 6 months, 16 completed 9 months and 13 patients completed 12 months. Of the 13 control patients 6 remained at 3 months and 5 at 6 months. In the exercise group, significant improvements were observed in all measures of function and 6 out of 8 physical and psychosocial quality of life domains. Anthropometric measures of fat free mass increased. Clinical status improved significantly seen as reductions in systolic blood pressure and prescribed erythropoietin stimulating agent doses. These improvements were observed in the intervention group at 3 and 6 months. No improvements were observed in the control group. Improvements in the majority of outcome measures were also seen in the intervention group at 6 and 12 months. These results suggest that the introduction of a low to moderate intensity intradialytic exercise programme requiring minimal individual supervision is feasible and provides clinically significant improvements in function from 3 months onwards. Such improvements are accompanied by higher quality of life scores and improved aspects of nutritional and clinical status.