Dynamic not isometric training blunts osteo-renal disease and improves the sclerostin/FGF23/Klotho axis in maintenance hemodialysis patients: a randomized clinical trial

Abstract

This study compared the effectiveness of dynamic resistance training (DRT) versus isometric RT (IRT) on osteogenesis and hormonal mechanisms involved in maintenance hemodialysis (MHD) patients. One hundred and ninety-three MHD patients were randomized into three groups: control (CTL; n=60), DRT (n=66), and IRT (n=67). A first visit was required for an anamnesis to evaluate the number of medications, biochemical and anthropometric measurements (dialysis adequacy, creatinine, urea, body mass, height, and body mass index). Grip strength, bone mineral density (BMD), and renal-bone markers were assessed pre- and post-protocol. The DRT and IRT training was six months with a frequency of three times per week, on alternate days. Each training session consisted of 3 sets of 8 to 12 repetitions at lower and moderate intensities. Both training sessions were prescribed approximately one-hour prior to dialysis. Statistical significances were adopted with p<0.05. There was a greater dropout in the IRT group (24%) as compared with the DRT group (14%), which in turn had less adverse clinical effects (67%, 24%, 61% for CTL, DRT, IRT, respectively). DRT promoted gains in BMD in different body locations, in addition to increasing pro-osteogenic factors (Klotho and calcitriol), and reducing those related to bone loss, such as sclerostin, FGF23, and PTH. There was an improvement in Ca × PO43 for DRT, while these benefits did not occur in the IRT group (p<0.05). These novel findings suggest that the DRT generates biopositive adaptations in bone tissue in MHD and can be used as a non-pharmacological strategy to improve BMD.

Klotho, much more than an anti-aging protein, an emerging exerkine: A systematic review and meta-analysis

“…Corrêa et al 36 was split into two independent reports: (a) conventional resistance training and b) blood-ow restricted resistance training. Neves et al 37 was split into 2 independent reports: (a) conventional resistance training and b) isometric resistance training. There were 5 reports with healthy subjects and 7 with diseased patients.…”

“…There were 5 reports with healthy subjects and 7 with diseased patients. The diseases analyzed were chronic obstructive pulmonary disease 38 , stage two of chronic kidney disease 36 , end-stage renal disease 37,39 , and coronary artery disease 40 . Moreover, 5 reports investigated the effect of resistance training [36][37][38] , 5 reports investigated aerobic training 35,[40][41][42] , and only 2 studies examined the combined effect of aerobic and resistance training 35,39 .…”

Literature Review: Effect of Exercise on Serum Fgf23

“…The exercise intervention that showed positive results ranged from one day to three weeks, while studies showing no change were carried out for six weeks to 12 months. 13,15,20,[23][24][25] The absence of an increase in serum FGF23 after long term exercise was probably due to metabolic adaptation in the study subjects. 15 After repeated exposure to exercise, the body made adaptations to conserve energy which causes the body to become more 'blunt' to exercise.…”

Impact of Low Hemoglobin on Body Composition, Strength, and Redox Status of Older Hemodialysis Patients Following Resistance Training

“…Therefore, a possible alternative explanation for the divergent responses to RT found previously in those with CKD is the confounding issue of low hemoglobin concentration. Therefore, it is already known that RT might act as an alternative therapy counteracting the CKD-related comorbidities ( Corrêa et al, 2020 ; Moura et al, 2020 ; Neves et al, 2020 ). Nonetheless, it remains unknown if anemia or low hemoglobin impairs the aforementioned benefits on strength, body composition, and redox balance in hemodialysis patients.…”