Effect of an exercise program with blood flow restriction on the muscular strength of patients with chronic kidney disease: A randomized clinical trial

Silva, Isabella B.; Barbosa, Jefferson Belarmino Nunes; Araújo, Anna Xênya Patrício de; Marinho, Patrícia Érika de Melo

doi:10.1016/j.jbmt.2021.06.022

Cited by 3 publications

(12 citation statements)

References 24 publications

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“…However, this was self-resolving, and ultrafiltration resumed within 5 minutes. Another randomized clinical study compared the effects of 8 weeks of exercise training including tennis ball, dumbbell weights, and handgrip exercise five times a week between BFRT group and exercise training alone observed isolated reports of tingling and fatigue in the upper limb of some patients who underwent BFRT at the time of exercise; however, these complaints were not sufficient for them to withdraw from the study ( Silva et al, 2021 ).…”

Section: Chronic Kidney Disease and Blood Flow Restriction Trainingmentioning

confidence: 99%

A Useful Blood Flow Restriction Training Risk Stratification for Exercise and Rehabilitation

et al. 2022

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Blood flow restriction training (BFRT) is a modality with growing interest in the last decade and has been recognized as a critical tool in rehabilitation medicine, athletic and clinical populations. Besides its potential for positive benefits, BFRT has the capability to induce adverse responses. BFRT may evoke increased blood pressure, abnormal cardiovascular responses and impact vascular health. Furthermore, some important concerns with the use of BFRT exists for individuals with established cardiovascular disease (e.g., hypertension, diabetes mellitus, and chronic kidney disease patients). In addition, considering the potential risks of thrombosis promoted by BFRT in medically compromised populations, BFRT use warrants caution for patients that already display impaired blood coagulability, loss of antithrombotic mechanisms in the vessel wall, and stasis caused by immobility (e.g., COVID-19 patients, diabetes mellitus, hypertension, chronic kidney disease, cardiovascular disease, orthopedic post-surgery, anabolic steroid and ergogenic substance users, rheumatoid arthritis, and pregnant/postpartum women). To avoid untoward outcomes and ensure that BFRT is properly used, efficacy endpoints such as a questionnaire for risk stratification involving a review of the patient’s medical history, signs, and symptoms indicative of underlying pathology is strongly advised. Here we present a model for BFRT pre-participation screening to theoretically reduce risk by excluding people with comorbidities or medically complex histories that could unnecessarily heighten intra- and/or post-exercise occurrence of adverse events. We propose this risk stratification tool as a framework to allow clinicians to use their knowledge, skills and expertise to assess and manage any risks related to the delivery of an appropriate BFRT exercise program. The questionnaires for risk stratification are adapted to guide clinicians for the referral, assessment, and suggestion of other modalities/approaches if/when necessary. Finally, the risk stratification might serve as a guideline for clinical protocols and future randomized controlled trial studies.

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Section: Chronic Kidney Disease and Blood Flow Restriction Trainingmentioning

confidence: 99%

A Useful Blood Flow Restriction Training Risk Stratification for Exercise and Rehabilitation

et al. 2022

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“…Another randomized clinical trial compared the effects of 8 weeks of exercise training including tennis ball, dumbbell weights, and handgrip exercise 5 times a week (2 being supervised by the physiotherapist and 3 unsupervised) between the BFR group and exercise training alone ( Silva et al, 2021 ). Male and female patients with stage 4/5 CKD under conservative or dialysis treatment participated in this study.…”

Section: Effects Of Bfr Exercise On Physical Fitness Physical Functio...mentioning

confidence: 99%

“…For muscle mass, arm circumference is considered a readily available criteria for assessing PEW in CKD patients ( Fouque et al, 2008 ), and the lack of change observed in Silva et al (2021) might demonstrate that CKD patients are at increased risk for PEW. Causes of PEW include endocrine disorders, vitamin D deficiency, diabetes, nutrient loss during dialysis, production of inflammatory cytokines, oxidative stress, and low nutrient intake ( Fouque et al, 2008 ).…”

Section: Effects Of Bfr Exercise On Physical Fitness Physical Functio...mentioning

confidence: 99%

“…Even though higher RPE and reports of fatigue during BFR training appear to occur to a greater degree compared to similar exercise performed without BFR, it does not appear to interfere with adherence ( Silva et al, 2021 ). There may even be a habituation effect with chronic training.…”

Section: Effects Of Bfr Exercise On Cardiovascular Outcomes and Renal...mentioning

confidence: 99%

“…Although concerns related to the safety of BFR in medically compromised populations is an undeniable requisite to mitigate risk, there appears to be limited reporting of adverse events in the CKD literature with BFR exercise. One randomized clinical study observed isolated reports of tingling and fatigue in the upper limb of some patients who underwent BFR exercise; however, these complaints were not sufficient for them to withdraw from the study ( Silva et al, 2021 ). Clarkson et al (2020) reported one case of exercise-related syncope that occurred with BFR exercise during hemodialysis (systolic and diastolic blood pressure of 88 and 68 mmHg, respectively).…”

Section: Bfr Exercise and Safety Concernsmentioning

confidence: 99%

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Potential implications of blood flow restriction exercise on patients with chronic kidney disease: a brief review

Rolnick¹,

Neto²,

Fonseca³

et al. 2022

J Exerc Rehabil

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Combining blood flow restriction (BFR) with exercise is considered a relevant, helpful method in load-compromised individuals and a viable replacement for traditional heavy-load strength training. BFR exercise may be particularly useful for those unable to withstand high mechanical stresses on joints resulting in skeletal muscle dysfunction, such as patients with chronic kidney disease (CKD). Current literature suggests that BFR training displays similar positive health benefits to exercise training alone for CKD patients, including maintenance of muscle strength, glomerular filtration rate maintenance, uremic parameters, inflammatory profile, redox status, glucose homeostasis, blood pressure adjustments, and low adverse reports. In this review of nine studies in CKD patients, we clarify the potential safety and health effects of exercise training with BFR compared to exercise training alone and recommend insights for future research and practical use. Furthermore, we introduce relevant gaps in this emerging field, providing substantial guidance, critical discussion, and valuable preliminary conclusions in this demographic of patients. However, based on the limited studies in this area, more research is necessary to determine the optimal BFR exercise programming.

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Physical exercise in kidney disease: A commonly undervalued treatment modality

Kanbay,

Copur,

Yildiz

et al. 2023

Eur J Clin Investigation

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BackgroundPhysical inactivity has been identified as a risk factor for multiple disorders and a strong association exists between chronic kidney disease (CKD) and a sedentary lifestyle. Even though physical activity is crucial in the development and progression of disease, the general focus of the current medical practice is the pharmacological perspective of diseases with inadequate emphasis on lifestyle intervention.MethodsIn this narrative review we explain the pathophysiological mechanisms underlying the beneficial effects of physical exercise on CKD in addition to discussing the clinical studies and trials centred on physical exercise in patients with CKD.ResultsPhysical activity influences several pathophysiological mechanisms including inflammation, oxidative stress, vascular function, immune response and macromolecular metabolism. While exercise can initially induce stress responses like inflammation and oxidative stress, long‐term physical activity leads to protective countermeasures and overall improved health. Trials in pre‐dialysis CKD patients show that exercise can lead to reductions in body weight, inflammation markers and fasting plasma glucose. Furthermore, it improves patients' functional capacity, cardiorespiratory fitness and quality of life. The effects of exercise on kidney function have been inconsistent in these trials. In haemodialysis, peritoneal dialysis and kidney transplant patients exercise interventions improve cardiorespiratory fitness, walking capacity and quality of life. Combined training shows the best performance to increase peak oxygen uptake in haemodialysis patients. In kidney transplant recipients, exercise improves walking performance, quality of life and potentially arterial stiffness. However, exercise does not affect glucose metabolism, serum cholesterol and inflammation biomarkers. Long‐term, adequately powered trials are needed to determine the long‐term feasibility, and effects on quality of life and major clinical outcomes, including mortality and cardiovascular risk, in all CKD stages and particularly in kidney transplant patients, a scarcely investigated population.ConclusionPhysical exercise plays a crucial role in ameliorating inflammation, oxidative stress, vascular function, immune response and macromolecular metabolism, and contributes significantly to the quality of life for patients with CKD, irrespective of the treatment and stage. Its direct impact on kidney function remains uncertain. Further extensive, long‐term trials to conclusively determine the effect of exercise on major clinical outcomes such as mortality and cardiovascular risk remain a research priority.

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Effect of an exercise program with blood flow restriction on the muscular strength of patients with chronic kidney disease: A randomized clinical trial

Cited by 3 publications

References 24 publications

A Useful Blood Flow Restriction Training Risk Stratification for Exercise and Rehabilitation

A Useful Blood Flow Restriction Training Risk Stratification for Exercise and Rehabilitation

Potential implications of blood flow restriction exercise on patients with chronic kidney disease: a brief review

Physical exercise in kidney disease: A commonly undervalued treatment modality

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