Anabolic Effect of Exercise Training in People with End-Stage Renal Disease on Hemodialysis: A Systematic Review with Meta-analysis

Abstract

Purpose: The primary purpose of this systematic review was to evaluate the anabolic effect of exercise intervention in adults with end-stage renal disease on hemodialysis (HD). The secondary objectives were to evaluate the influences of participant characteristics and exercise parameters on changes in muscle size. Methods: Electronic databases (Cochrane, CINAHL, EMBASE, PEDro, PubMed and SCOPUS) were searched from inception to November 2012. Randomized clinical trials published in English that included adults on HD undergoing an exercise intervention where muscle mass was measured as an outcome were included in this review. Two reviewers independently selected the studies, extracted data, and assessed risk of bias within the included studies. Results were then combined by meta-analysis. The effect of exercises was determined using a standardized mean difference (SMD), expressed as Hedges' g, computed using a random effects model. Results: Seven SMDs extracted from five studies were included for final analysis. Strength training was used in all studies; one study used aerobic and mixed strength and aerobic training with two subgroups of participants. The overall effect of exercise on muscle mass was statistically significant (SMD: 0.272; 95% CI, 0.020-0.525). Conclusions: Our results confirm a small but significant effect of strengthening exercise as an anabolic intervention to increase muscle mass. Exercise training should be included in routine management of people on maintenance HD. Although current results indicate that one in nine people on HD is likely to benefit from exercise intervention, parameters influencing these results require further research.Key Words: bioelectrical impedance; computed tomography scan; dual energy x-ray absorptiometry; exercise; hemodialysis; magnetic resonance imaging; skeletal muscle. RÉ SUMÉObjectif : Cette critique systé matique visait principalement à é valuer l'effet anabolique de l'exercice chez des adultes vivant avec une insuffisance ré nale chronique au stade ultime et suivant des traitements d'hé modialyse (HD). Les objectifs secondaires consistaient à é valuer l'influence des caracté ristiques des participants et des paramè tres de l'exercice sur les changements de la taille des muscles. Mé thodes : On a effectué des recherches dans des bases de donné es é lectroniques (Cochrane, CINAHL, EMBASE, PEDro, PubMed et SCOPUS) depuis leur cré ation jusqu'en novembre 2012. On a inclus des essais cliniques randomisé s publié s en anglais et portant sur des adultes en HD suivant un programme d'exercice au cours duquel on a mesuré la masse musculaire comme ré sultat. Deux examinateurs agissant indé pendamment ont choisi les é tudes, extrait des donné es et é valué le risque de biais dans les é tudes incluses. Les ré sultats ont ensuite é té combiné s par mé ta-analyse. On a dé terminé l'effet de l'exercice au moyen d'une diffé rence moyenne normalisé e (DMN) exprimé e par la mesure g de Hedges, calculé au moyen d'un modè le à effet alé atoire. Ré sultats : Sept DMV extrai...

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