Anabolic exercise in haemodialysis patients: a randomised controlled pilot study

Abstract

BackgroundThe anabolic response to progressive resistance exercise training (PRET) in haemodialysis patients is unclear. This pilot efficacy study aimed to determine whether high-intensity intradialytic PRET could reverse atrophy and consequently improve strength and physical function in haemodialysis patients. A second aim was to compare any anabolic response to that of healthy participants completing the same program.MethodsIn a single blind controlled study, 23 haemodialysis patients and 9 healthy individuals were randomly allocated to PRET or an attention control (SHAM) group. PRET completed high-intensity exercise leg extensions using novel equipment. SHAM completed low-intensity lower body stretching activities using ultra light resistance bands. Exercises were completed thrice weekly for 12 weeks, during dialysis in the haemodialysis patients. Outcomes included knee extensor muscle volume by magnetic resonance imaging, knee extensor strength by isometric dynamometer and lower body tests of physical function. Data were analysed by a per protocol method using between-group comparisons.ResultsPRET elicited a statistically and clinically significant anabolic response in haemodialysis patients (PRET—SHAM, mean difference [95 % CI]: 193[63 to 324] cm3) that was very similar to the response in healthy participants (PRET—SHAM, 169[−41 to 379] cm3). PRET increased strength in both haemodialysis patients and healthy participants. In contrast, PRET only enhanced lower body functional capacity in the healthy participants.ConclusionsIntradialytic PRET elicited a normal anabolic and strength response in haemodialysis patients. The lack of a change in functional capacity was surprising and warrants further investigation.

Progressive Resistance Training in End-Stage Renal Disease: Systematic Review

“…Skeletal Muscle and Protein-Energy Malnutrition Nine trials [26,28,30,31,[34][35][36][37][38][39][43][44][45][46][47] , including 7 RCT with a mean quality score of 7.6/10 [26,28,30,31,[34][35][36][37] have investigated the effect of PRT on measures of skeletal muscle hypertrophy. The majority of these studies have shown that PRT prescribed for a minimum of 12 weeks, both during [26,31,34,35,[37][38][39] or outside of dialysis treatment [28,46] can induce statistically significant increases in one or more measures of hypertrophy, including muscle size and quality (attenuation).…”

“…Of the 16 trials, 11 were RCT [26][27][28][29][30][31][32][33][34][35][36][37] , 4 were singletreatment, group-uncontrolled trials [20,[38][39][40][41][42] and one trial by Molsted et al [43][44][45][46][47] involved both a withinsubjects control period and an RCT comparing PRT + protein drink to PRT + placebo drink.…”

Body Composition and Its Clinical Outcome in Maintenance Hemodialysis Patients

“…In hemodialysis patients, aerobic exercise was positively associated with skeletal muscle mass volumes after adjustment for age, sex, and dialysis vintage [111]. Data from randomized controlled trials have demonstrated that intradialytic resistance exercise training can improve muscle volume and enhance muscle strength [112] or physical performance [113,114] among hemodialysis patients. The use of resistance exercise combined with anabolic steroid (nandrolone decanoate) has been shown to increase muscle mass and decrease body fat among patients with ESRD [115,116].…”

Cardiac cachexia: hic et nunc

“…Data are now emerging for patients with chronic kidney disease [106][107][108] and cancer, 109 while there are already existing guidelines for HF 110 and chronic obstructive pulmonary disease. 111 The current gold standard against muscle wasting is exercise training.…”