Exercise training by individuals with predialysis renal failure: Cardiorespiratory endurance, hypertension, and renal function

Boyce, Mary L.; Robergs, Robert A.; Avasthi, Pratap S.; Roldan, Carlos A.; Foster, Angelique; Montner, P.; Stark, D.; Nelson, Chris

doi:10.1016/s0272-6386(97)90051-2

Cited by 96 publications

(70 citation statements)

References 21 publications

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“…The findings demonstrated that patients with moderate CKD randomized to receive an exercise and lifestyle intervention improved CRF, body composition, diastolic function, and preserved ventriculovascular coupling. Our results are in agreement with previous reported findings from small studies (29)(30)(31)(32)(33)(34)(35) showing that exercise training is effective in improving CRF in patients with CKD. Uremic cardiomyopathy, comprising LV dilation, hypertrophy, and impaired diastolic and systolic function, is common in late stage CKD and a strong predictor of adverse cardiovascular prognosis (8).…”

Section: Discussionsupporting

confidence: 93%

Effects of Exercise and Lifestyle Intervention on Cardiovascular Function in CKD

Howden

Leano

Petchey

et al. 2013

Clinical Journal of the American Society of Nephrology

116

131

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SummaryBackground and objectives CKD is associated with poor cardiorespiratory fitness (CRF). This predefined substudy determined the effect of exercise training and lifestyle intervention on CRF and explored the effect on cardiovascular risk factors and cardiac and vascular function. Results Ten percent of randomized patients had subclinical myocardial ischemia at screening and completed the study without incident. There was no baseline difference among 72 patients who completed follow-up (36 in the lifestyle intervention group and 36 in the control group). The intervention increased peak _ VO 2 (2.860.7 ml/kg per minute versus 20.360.9 ml/kg per minute; P=0.004). There was small weight loss (21.864.2 kg versus 0.763.7 kg; P=0.02) but no change in BP or lipids. Diastolic function improved (increased e' of 0.7561.16 cm/s versus 20.4761.0 cm/s; P=0.001) but systolic function was well preserved and did not change. The change in arterial elastance was attenuated (0.1160.76 mmHg/ml versus 0.7660.96 mmHg/ml; P=0.01). D peak _ VO 2 was associated with group allocation and improved body composition.Conclusions Exercise training and lifestyle intervention in patients with CKD produces improvements in CRF, body composition, and diastolic function.

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Section: Discussionsupporting

confidence: 93%

Effects of Exercise and Lifestyle Intervention on Cardiovascular Function in CKD

Howden

Leano

Petchey

et al. 2013

Clinical Journal of the American Society of Nephrology

116

131

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“…Exercise training improves BP levels and decreases the use of antihypertensive medications in patients who are on HD (17) and patients with predialysis renal failure (18). An increased systolic BP and widening of pulse pressure are common in patients who are on HD.…”

Section: Discussionmentioning

confidence: 99%

Impact of an Exercise Program on Arterial Stiffness and Insulin Resistance in Hemodialysis Patients

Mustata¹,

Chan²,

Lai³

et al. 2004

Journal of the American Society of Nephrology

164

122

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Abstract. Cardiovascular disease remains the primary cause of mortality in patients who are maintained on hemodialysis. Arterial stiffness and insulin resistance are independent risk factors for cardiovascular mortality in this population. In healthy individuals, higher physical conditioning is associated with reduced arterial stiffness. Exercise reduces insulin resistance and glucose intolerance in sedentary, overweight individuals and diabetic patients. The purpose of this study was to determine the impact of an exercise program on arterial stiffness and insulin resistance in a group of patients on hemodialysis. The effect of exercise training on arterial stiffness and insulin resistance in 11 patients who were on chronic hemodialysis was evaluated. Exercise classes of 1-h duration were conducted twice weekly for 3 mo. Arterial stiffness was assessed using the radial artery pressure waveform analysis. Aerobic exercise improved arterial stiffness from 17 Ϯ 3 u at baseline to 12.2 Ϯ 3 u at the end of the intervention (P ϭ 0.01). After 1 mo of detraining, arterial stiffness reverted to preexercise levels (17.3 Ϯ 3 u). Pulse pressure paralleled arterial stiffness changes, and the correlation between them was statistically significant (r ϭ 0.725, P ϭ 0.012). Insulin resistance was calculated using the homeostatic model assessment formula. Exercise at the intensity and duration used in our study had no impact on insulin resistance (P ϭ 0.38). These findings suggest that 3 mo of aerobic exercise training improves arterial stiffness, an independent risk factor for cardiovascular mortality in patients who are on hemodialysis, and has no impact on insulin resistance. The beneficial effect on arterial stiffness dissipates within 1 mo of detraining. To obtain therapeutic benefits, an exercise program for patients who are maintained on hemodialysis should be designed to promote regular long term exercise, Ͼ3 h/wk. Despite significant advances in the technique and quality of their treatment, patients who are on hemodialysis (HD) continue to display high morbidity and mortality. Cardiovascular (CV) events account for up to 50% of deaths in this population (1). Recent studies have demonstrated that both arterial stiffness and insulin resistance are independent risk factors for CV mortality in patients with ESRD (2,3).In patients who are on HD, arterial stiffness is associated with increased left ventricular afterload, left ventricular hypertrophy, decreased subendocardial perfusion, and increased mechanical fatigue of the arteries. Moreover, uremic patients are universally insulin resistant. Insulin resistance may be involved in the pathogenesis of atherosclerosis, hypertension, and dyslipidemia.Rehabilitation programs, focusing on exercise, benefited patients after myocardial infarction, bypass surgery, chronic lung disease, rheumatologic disorders, strokes, and other neurologic conditions. Central effects of exercise training in patients who are on HD include improved left ventricular function, a beneficial effect on corona...

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“…Boyce et al reported that exercise training at 70% of heart rate reserve increased peak V O2, but deteriorated renal function in moderate to advanced CKD patients. 8 In contrast, Eidemak et al 9 and Clyne et al 21 reported that exercise training at 60-75% of the maximal exercise capacity increased peak V O2 and did not influence renal function in moderate to advanced CKD patients. In addition, Toyama et al recently reported that exercise training at level 12-13 of Borg' score improved eGFR in mild CKD patients.…”

Section: Previous Studiesmentioning

confidence: 95%

Impact of Cardiac Rehabilitation on Renal Function in Patients With and Without Chronic Kidney Disease After Acute Myocardial Infarction

Takaya

Kumasaka

Arakawa

et al. 2014

Circ J

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Exercise training by individuals with predialysis renal failure: Cardiorespiratory endurance, hypertension, and renal function

Cited by 96 publications

References 21 publications

Effects of Exercise and Lifestyle Intervention on Cardiovascular Function in CKD

Effects of Exercise and Lifestyle Intervention on Cardiovascular Function in CKD

Impact of an Exercise Program on Arterial Stiffness and Insulin Resistance in Hemodialysis Patients

Impact of Cardiac Rehabilitation on Renal Function in Patients With and Without Chronic Kidney Disease After Acute Myocardial Infarction

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