Intradialytic aerobic cycling exercise alleviates inflammation and improves endothelial progenitor cell count and bone density in hemodialysis patients

Abstract

Inflammation, endothelial dysfunction, and mineral bone disease are critical factors contributing to morbidity and mortality in hemodialysis (HD) patients. Physical exercise alleviates inflammation and increases bone density. Here, we investigated the effects of intradialytic aerobic cycling exercise on HD patients. Forty end-stage renal disease patients undergoing HD were randomly assigned to either an exercise or control group. The patients in the exercise group performed a cycling program consisting of a 5-minute warm-up, 20 minutes of cycling at the desired workload, and a 5-minute cool down during 3 HD sessions per week for 3 months. Biochemical markers, inflammatory cytokines, nutritional status, the serum endothelial progenitor cell (EPC) count, bone mineral density, and functional capacity were analyzed. After 3 months of exercise, the patients in the exercise group showed significant improvements in serum albumin levels, the body mass index, inflammatory cytokine levels, and the number of cells positive for CD133, CD34, and kinase insert domain-conjugating receptor. Compared with the exercise group, the patients in the control group showed a loss of bone density at the femoral neck and no increases in EPCs. The patients in the exercise group also had a significantly greater 6-minute walk distance after completing the exercise program. Furthermore, the number of EPCs significantly correlated with the 6-minute walk distance both before and after the 3-month program. Intradialytic aerobic cycling exercise programs can effectively alleviate inflammation and improve nutrition, bone mineral density, and exercise tolerance in HD patients.

Cardiovascular adaptations associated with exercise in patients on hemodialysis

“…These findings are corroborated by a randomized controlled trial by Liao et al who demonstrated that a 3‐month program of intra dialytic cycling may lead to reductions C‐reactive protein and circulating Il‐6 . Importantly, this finding was reported as a “change from baseline” in the cycling group and not a between group comparison, despite there being a control group in the study.…”

Intradialysis Exercise in Hemodialysis Patients: A Systematic Review

“…Perawatan ini menghilangkan metabolit, termasuk racun uremik, dan air melalui difusi, konvensi, dan ultrafiltrasi (Marinho, Carraro, & Mafra, 2017). Pasien dengan penyakit ginjal stadium akhir (ESRD) yang menjalani hemodialisis (HD) cenderung memiliki beberapa komorbiditas terutama penyakit kardiovaskular, gangguan mineral dan tulang yang merupakan faktor penting dan berkontribusi terhadap morbiditas dan mortalitas pasien HD (Liao et al, 2016). Selain itu, hemodialisis menyebabkan imobilisasi lebih dari 12-18 jam seminggu, sehingga secara langsung berpengaruh terhadap aktifitas fisik yang dapat semakin memperburuk kondisi medis pasien HD (Magnard et al, 2013).…”

“…Hal ini dikarenakan peningkatan cardiac output oleh beberapa mekanisme seperti penurunan volume over-load cairan ekstraselular, penurunan resistensi vaskuler perifer, dan pengeluaran toksin uremik yang menjadi faktor cardiopressor (Kamasita et al, 2018). Dalam teori, olahraga mencegah efek samping ketidakaktifan dan kematian akibat kardiovaskular, kelangsungan HD, fungsi fisik, dan kualitas hidup yang baik yang berhubungan dengan kesehatan pada pasien yang menjalani HD (Liao et al, 2016). Koh et al (2010) dalam penelitiannya menunjukkan bahwa latihan intradialytic memiliki efek positif bagi pasien HD, seperti meningkatkan kebugaran kardiorespirasi, fungsi fisik dan kesehatan.…”

Influence of normobaric hypoxic exercise on endothelial progenitor cell senescence byin vitrocultivation with conditioned media

“…In the last two decades, EPCs became a promising target of regenerative medicine research and several interventional approaches have been performed to investigate the mobilization of EPCs. In particular, abundant research has been conducted showing enhanced levels of circulating EPCs after exercise interventions in patients [4–6] as well as in the healthy population [7,8].…”