Exercising to offset muscle mass loss in hemodialysis patients: The disconnect between intention and intervention

Abstract

Skeletal muscle loss is the most important hallmark of protein energy wasting syndrome as it contributes to declines in physical independence, poor quality of life, and higher mortality risk in individuals with ESRD on maintenance hemodialysis (HD). As such, exercise and nutritional interventions have been investigated with the goal to preserve skeletal muscle mass and overall quality of life. Unfortunately, current efforts are unable to confirm the capacity of exercise to mitigate ESRD‐associated muscle wasting. However, the inconclusive data are often accompanied by suboptimal exercise prescriptions. Exercise sessions are often implemented in‐clinic during the catabolic and proinflammatory period of dialysis treatment and without concurrent nutritional support. Additionally, indirect considerations like exercise intolerance and exercise program compliance/adherence also inhibit exercise training potential. These shortcomings all stem from the current lack of understanding in skeletal muscle mass regulation within the context of ESRD and intermittent HD. As such, this review summarizes the current understanding of exercise regulation on skeletal muscle mass and ESRD‐related obstacles of anabolism to contextualize the ineffectiveness of current exercise interventions for HD patients.

Anabolic Resistance of Muscle Protein Turnover Comes in Various Shapes and Sizes

“…Nonetheless, an unresolved question arises from this work: how do you fix it? We believe a logical starting point is to reduce the inflammatory and/or uremic milieu to ultimately reduce basal muscle protein turnover in MHD patients ( 103 ). The latter will perhaps allow for dietary amino acids to properly act as anabolic signaling molecules and substrates for the stimulation of postprandial MPS in individuals on MHD.…”

“…It seems reasonable to assume that breaking up prolonged sedentary blocks of time with so-called “exercise snacks” is likely beneficial for minimizing lower levels of anabolic resistance when compared to experiencing too much sedentary time together throughout the day ( 119 ). Moreover, certain populations (such as MHD patients) have a higher degree of anabolic resistance that cannot be simply solved by prescribing more physical activity and exercise as discussed previously ( 103 ). Instead, this compromised patient condition will require a more comprehensive lifestyle intervention strategy and individualized exercise prescription to overcome MHD-related anabolic resistance ( 104 ).…”

Effects of Intradialytic Exercise on Dialytic Parameters, Health-Related Quality of Life, and Depression Status in Hemodialysis Patients: A Randomized Controlled Trial

“…Scores ranged from 0-63 and higher scores indicated higher depression status. The BDI, comprising of emotional (5 items), cognitive (7 items), and somatic (9 items) categories, can also be used to screen depressive symptoms as minimal depression (0-9), mild depression (10)(11)(12)(13)(14)(15)(16)(17)(18), moderate depression (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), and severe depression (30-63). Cronbach's alpha of the scale in the present study was 0.92.…”

“…The most commonly reported barriers are fatigue on dialysis days and shortness of breath on non-dialysis days [15]. In addition, fatigue and muscle weakness after a long period of hemodialysis results in deconditioning, which might further reduce exercise tolerance, compliance/adherence to exercise, and overall motivation [18].…”

An introduction to Exercise and Physical Activity in Dialysis Patients: Preventing the unacceptable journey to physical dysfunction

“…Mckenna et al comprehensively address the importance of skeletal muscle, physical function, and quality of life in this issue. They argue that the short‐term nature and design of most exercise interventions are insufficient to offset the loss in muscle mass and suggest potential ways to optimize the implementation of exercise in people with end‐stage kidney disease.…”