Intradialytic Cardiovascular Exercise Training Alters Redox Status, Reduces Inflammation and Improves Physical Performance in Patients with Chronic Kidney Disease

Abstract

Redox status (RS) perturbations and inflammation are fundamental features of chronic kidney disease (CKD) that are substantially exacerbated in end-stage renal disease (ESRD). This study aimed at investigating the efficacy of a 6-month intradialytic exercise training program on RS, inflammation and physical performance in patients with ESRD. Twenty hemodialysis (HD) patients (17 males, three females) were randomly assigned to either an intradialytic training (bedside cycling) group (TR; n = 10) or a control group (CON; n = 10) for 6 months. Anthropometrics [body mass and height, body mass index (BMI), body composition], physical performance (VO2peak), functional capacity [North Staffordshire Royal Infirmary (NSRI) walk test, sit-to-stand test (STS-60)], quality of life (short form-36 (SF-36) as well as RS [thiobarbituric acid reactive substances (TBARS), protein carbonyls (PC), reduced (GSH) and oxidized (GSSG) glutathione, GSH/GSSG, total antioxidant capacity (TAC), catalase activity (CAT)] and high-sensitivity C-reactive protein (hs-CRP) were assessed at baseline and after the 6-month intervention. Peak oxygen consumption (VO2peak) increased by 15% only in TR (p < 0.01). Performance in NSRI, STS-60 and SF-36 improved by 4–13% only in TR (p < 0.01). Exercise training reduced TBARS (by 28%), PC (by 31%) and hs-CRP (by 15%), and elevated GSH (by 52%), GSH/GSSG (by 51%), TAC (by 59%) and CAT (by 15%) (p < 0.01). These findings suggest that engagement in chronic intradialytic cardiovascular exercise alters RS, reduces inflammation and improves performance in patients with ESRD.

Epidemiology of haemodialysis outcomes

“…Of the non-pharmacological interventions, regular physical activity has a positive effect on fatigue 139 . Intradialytic cardiovascular exercise training reduced inflammation and improved physical performance in patients receiving HD 140 . A systematic review comprising 20 trials (677 participants) 141 reported that aerobic and combined exercise was useful for improving QOL in patients treated with HD.…”

Effect of Exercise on Inflammation in Hemodialysis Patients: A Systematic Review

“…The 24 studies included were conducted in Iran [ 19 ], Brazil [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], Poland [ 30 ], the United Kingdom [ 31 , 32 , 33 , 34 , 35 , 36 ], Taiwan [ 37 ], China [ 38 ], Indonesia [ 39 ], Spain [ 40 , 41 ] and Greece [ 42 ], and published from 2010 to 2022.…”

“…The characteristics of the included studies are presented in Table 1 . The 24 studies were clinical trials, of which thirteen were randomized controlled trials [ 19 , 25 , 26 , 27 , 28 , 29 , 35 , 36 , 37 , 38 , 39 , 41 , 42 ], four were uncontrolled trials [ 20 , 21 , 30 , 40 ], one was a non-randomized clinical trial [ 23 ], one was a non-randomized controlled trial [ 32 ], four were randomized crossover trials [ 22 , 24 , 31 , 33 ], and one was a non-randomized crossover trial [ 34 ].…”

“…The methodological quality of the studies was evaluated with the PEDro scale, and scores are shown in Table 2 . In total, seventeen studies were evaluated as being of excellent quality [ 19 , 22 , 24 , 25 , 26 , 27 , 28 , 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 41 , 42 ], two studies were of good quality [ 23 , 29 ] and five studies were of acceptable quality [ 20 , 21 , 30 , 32 , 40 ].…”

“…In total, seventeen studies were evaluated. Five studies were at low risk of bias [ 26 , 28 , 31 , 37 , 39 ], five studies had an unclear risk [ 25 , 35 , 36 , 41 , 42 ] and seven studies were at high risk of bias [ 19 , 22 , 24 , 27 , 29 , 33 , 38 ].…”