Effects of exercise training plus normalization of hematocrit on exercise capacity and health-related quality of life

Painter, Patricia; Moore, Geoffrey E.; Carlson, Luke; Paul, Steven M.; Myll, J; Phillips, William; Haskell, W. L.

doi:10.1053/ajkd.2002.30544

Cited by 183 publications

(174 citation statements)

References 23 publications

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“…These results are important because nutritional markers are potentially modifiable and, in some instances, can be intervened on with both pharmacologic and nonpharmacologic therapies. This is supported by data indicating that directed nutritional and exercise programs can improve HRQOL for dialysis patients (66). Coupled with data that nutritional indices are among the strongest predictors of overall mortality in ESRD (80), these results emphasize that nutritional biomarkers are central to dictating both morbidity and mortality.…”

Section: Discussionmentioning

confidence: 60%

“…We did attempt to acknowledge heterogeneity between studies by calculating sample sizeweighted means for all of our pooled estimates, a maneuver that accounts for the expectation that larger studies are theoretically more precise than smaller studies. Second, our analysis did not target other factors that may predict HRQOL in ESRD, including psychosocial variables (e.g., marital status, employment status [30,35,81]), dialysis practice variables (e.g., type and timing of dialysis [82,83]), individual comorbidities (47,84) and symptoms (e.g., poor appetite [47], insomnia), and structure/ process characteristics (e.g., availability of exercise programs [66,85], use of predialysis clinics [86]), among others. These factors undoubtedly have a major impact on outcomes in dialysis; however, expanding our analysis to this range of factors is beyond the scope of our more modest exercise, which is to focus explicitly on the predictive role of biomarkers in ESRD.…”

Section: Discussionmentioning

confidence: 99%

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Biomarkers and Health-Related Quality of Life in End-Stage Renal Disease

Spiegel

Melmed

Robbins

et al. 2008

Clinical Journal of the American Society of Nephrology

115

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Background and objectives: Health-related quality of life (HRQOL) predicts mortality in ESRD, yet adoption of HRQOL monitoring is not widespread, and regulatory authorities remain predominantly concerned with monitoring traditional biologic parameters. To assist with future efforts to adopt HRQOL monitoring while acknowledging the importance of biomarkers, this study sought to establish which domains of HRQOL are most affected by ESRD and to measure the strength of evidence linking common biomarkers to HRQOL in ESRD.Design, setting, participants, & measurements: A systematic review was performed to identify studies that measured HRQOL in ESRD. Data were abstracted according to a conceptual model regarding the measurement of HRQOL differences, and HRQOL data were converted to weighted mean effect sizes and correlation coefficients.Results: The impact of ESRD was largest in the Short Form 36 domains of physical functioning (e.g., role-physical, vitality) and smallest in mental functioning (e.g., mental health, role-emotional). Dialysis adequacy, as measured by Kt/V, was a poor correlate for Short Form 36 scores. Similarly, mineral metabolism (e.g., calcium ؋ phosphorous, parathyroid hormone) and inflammatory (e.g., C-reactive protein, TNF) biomarkers had small effect sizes and correlations with HRQOL. In contrast, hematocrit demonstrated small to moderate relationships with mental and physical HRQOL, and nutritional biomarkers (e.g., albumin, creatinine, body mass index) demonstrated moderate to large relationships.Conclusions: HRQOL in ESRD is most affected in the physical domains, and nutritional biomarkers are most closely associated with these domains. In contrast, Kt/V, mineral metabolism indices, and inflammatory markers are poor HRQOL correlates.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Biomarkers and Health-Related Quality of Life in End-Stage Renal Disease

Spiegel

Melmed

Robbins

et al. 2008

Clinical Journal of the American Society of Nephrology

115

View full text Add to dashboard Cite

show abstract

“…6 Interestingly, Matsumoto et al 14 demonstrated that renal transplantation reversed abnormalities in the oxidative metabolism of muscle in children with ESRD, yet disparities in clinical assessment of muscle strength continued after renal transplantation. 14,15 These results highlight the importance of investigating the role of exercise in improving the cardiovascular risk in patients with CKD. 16 One important consideration in the analysis was controlling for differences in body size between patients with CKD and controls, because several studies have demonstrated the influence of body composition on VO 2 max.…”

Section: Discussionmentioning

confidence: 87%

Decreased Maximal Aerobic Capacity in Pediatric Chronic Kidney Disease

Weaver

Kimball

Knilans

et al. 2008

Journal of the American Society of Nephrology

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Adult and pediatric patients with ESRD have impaired maximum oxygen consumption (VO 2 max), a reflection of the cardiopulmonary system's ability to meet increased metabolic demands. We sought to determine factors associated with decreased VO 2 max in pediatric patients with different stages of CKD. VO 2 max was measured using a standardized exercise testing protocol in patients with stage 2 to 4 chronic kidney disease (CKD) (n ϭ 46), in renal transplant recipients (n ϭ 22), in patients treated with maintenance hemodialysis (n ϭ 12), and in age-matched healthy controls (n ϭ 33). VO 2 max was similar between children with stage 2 CKD and controls, whereas lower VO 2 max was observed among children with stage 3 to 4 CKD, those treated with hemodialysis, and transplant recipients. In univariate analysis, VO 2 max was significantly associated with body mass index, resting heart rate, C-reactive protein, serum triglycerides, serum creatinine, and measures of diastolic function; no significant associations with left ventricular structure or systolic function were identified. In multivariate regression analysis, patient category versus control and the presence of diastolic dysfunction were independent predictors of lower VO 2 max. These results suggest that aerobic capacity is decreased in the early stages of CKD in children and that lower VO 2 max can be predicted by the presence of diastolic dysfunction, even if systolic function is normal. Maximal aerobic capacity (VO 2 max) represents the cardiovascularsystem'sabilitytotakeup,distribute,andutilize oxygen to perform work during maximal exercise. Healthy individuals can sustain a three-fold increase in heart rate (HR) and a two-fold increase in stroke volume to generate maximal aerobic capacity. 1 Therefore, VO 2 max has been used to assess the capacity of the cardiovascular system to respond to metabolic challenge in numerous disease states including ESRD. 2,3 Impaired maximal aerobic capacity was observed in adult and adolescent patients with ESRD as well as after renal transplantation. [4][5][6][7] The significance of these findings was underscored by studies suggesting lower survival rates in adults with ESRD and decreased VO 2 max. 8 The impairedVO 2 maxinthesepatientswasassociatedwithseveralfactors,includinglowerserumalbumin,anemia,and chronic heart failure. 9 Symptomatic heart disease is a rare event in pediatric patients with CKD. However abnormal cardiac structure and function in children with CKD is well recognized. These patients have left ventricular (LV) diastolic dysfunction and increased LV mass even before the onset of ESRD. 10,11 LV systolic function is generally preserved at rest, but altered contractile reserve was observed during exercise in di-

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“…Estudos de Depaul et al 34 e Painter et al 31 documentaram que o uso de EPO combinado ao exercício promoveu melhora da tolerância ao exercício, aumento do consumo de oxigênio e redução da fadiga.…”

Section: Adaptações Crônicasunclassified

Efeitos do exercício físico durante a hemodiálise em indivíduos com insuficiência renal crônica: uma revisão

Moura

Silva²,

Ribeiro³

et al. 2008

Fisioter. Pesqui.

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FISIOTERAPIA E PESQUISA 2008; 15(1): 86-91 RESUMO: As principais alterações observadas em indivíduos com insuficiência renal crônica são anemia, hipertensão arterial sistêmica e atrofia muscular, que levam à baixa capacidade aeróbica e perda de força muscular. Assim, parte do tratamento desses indivíduos consiste em programas de exercício físico. O objetivo desta revisão da literatura foi documentar os efeitos agudos e as adaptações crônicas, cardiovasculares e musculares em indivíduos no estágio final da doença renal, submetidos a programas de exercício físico durante a hemodiálise. Foram selecionados artigos científicos nas bases eletrônicas Medline, Lilacs e PEDro, assim como no acervo de periódicos da biblioteca da Faculdade de Medicina da UFMG. Foram analisados 13 artigos envolvendo exercício físico aeróbico associado ou não a fortalecimento muscular durante a hemodiálise, variando quanto à intensidade, freqüência e duração da intervenção. A maioria demonstrou que exercícios físicos realizados durante a hemodiálise promovem efeitos benéficos na melhora da capacidade aeróbica, força muscular e no controle dos fatores de risco cardiovasculares, auxiliando a remoção dos solutos durante a hemodiálise. Embora o tema seja ainda pouco explorado, a literatura disponível evidencia benefícios do exercício durante a hemodiálise sobre a capacidade aeróbica e força muscular dos pacientes.DESCRITORES: Diálise renal; Insuficiência renal crônica; Terapia por exercício ABSTRACT: Main alterations seen in patients with chronic renal insufficiency are anemia, systemic arterial hypertension, and muscular atrophy, which lead to low aerobic capacity and loss of muscle strength. Hence part of these patients treatment consists in programs of physical exercise. The purpose of this literature review was to assess muscle and cardiovascular acute effects and chronic adaptations in end-stage renal disease patients submitted to physical exercise during hemodialysis. After browsing through Medline, Lilacs and PEDro databases, as well as searching for periodic articles at the UFMG Medicine School library, 13 articles were selected, related to aerobic exercise associated or not to muscle strengthening during hemodialysis. Studies varied as to exercise intensity, frequency and duration. Most articles found that physical exercise performed during hemodialysis favoured better aerobic capacity, muscle strength, and control of cardiovascular risk factors, helping solute removal during hemodialysis. Though the subject is scarcely studied, available literature shows that exercises during hemodialysis are beneficial to patients' aerobic capacity and muscle strength.

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Effects of exercise training plus normalization of hematocrit on exercise capacity and health-related quality of life

Cited by 183 publications

References 23 publications

Biomarkers and Health-Related Quality of Life in End-Stage Renal Disease

Biomarkers and Health-Related Quality of Life in End-Stage Renal Disease

Decreased Maximal Aerobic Capacity in Pediatric Chronic Kidney Disease

Efeitos do exercício físico durante a hemodiálise em indivíduos com insuficiência renal crônica: uma revisão

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