Randomized Controlled Trial of Intradialytic Resistance Training to Target Muscle Wasting in ESRD: The Progressive Exercise for Anabolism in Kidney Disease (PEAK) Study

Effects of Progressive Resistance Training on Body Composition, Physical Fitness and Quality of Life of Patients on Hemodialysis

“…Resistance exercises using elastic bands are safe and affordable, and are more effective than aerobic exercises in enhancing muscle strength; they are also known to have similar levels of effectiveness as resistance exercises that use fixed equipment (Page & Ellenbecker, 2003). Cheema et al (2007b) reported that the 12 week intra-dialytic PRT has shown more improvements in muscle strength, intramuscular lipid, C-reactive protein (CRP) level, and indices of body composition and quality of life than the 12 week usual care. The intra-dialytic PRT can be efficient in that it is done while patients are receiving dialysis, so that they can save time spent on exercising independently.…”

“…Skeletal muscle wasting is common and insidious problems in ESRD (Cheema et al, 2007b). Muscle loss is associated with functional and metabolic deficits and reduced quality of life in ESRD patients (Cheema et al, 2007b).…”

“…Skeletal muscle wasting is common and insidious problems in ESRD (Cheema et al, 2007b). Muscle loss is associated with functional and metabolic deficits and reduced quality of life in ESRD patients (Cheema et al, 2007b). Metabolic abnormalities due to skeletal muscle wasting can also increase visceral obesity, which increases the risk of cardiovascular disease, the leading cause of death in ESRD patients (U.…”

Given the Science on Malnutrition, How Does the Clinician Respond? Practical Lessons for and Application to the Dialysis Patient

“…Two studies underline the potential impact of even small amounts of resistance exercise during dialysis sessions. Johansen et al (56) showed that short periods of weight training during dialysis could increase not only quadriceps size but also quality-of-life measures; and Cheema et al (57), as part of the Progressive Exercise for Anabolism in Kidney Disease (PEAK trial) demonstrated a decrease in C-reactive protein and a small increase in quadriceps cross-sectional area among dialysis patients who were given a 24-wk protocol of resistance training. Unfortunately, in the latter study, a control group without exercise was not used (instead, comparison was with a 12-wk exercise protocol), so statistical differences between groups was minimal.…”

Combined walking exercise and alkali therapy in patients with CKD4–5 regulates intramuscular free amino acid pools and ubiquitin E3 ligase expression

“…Alkali therapy (sodium bicarbonate) is commonly used to correct acidosis, and in dialysis patients is associated with improved nitrogen balance (Reaich et al 1993) increased body weight, and decreased morbidity (Stein et al 1997;Szeto et al 2003) and reduced protein catabolism (Movilli et al 2009). There is evidence that muscle catabolism is also slowed by strength plus endurance training in dialysis patients (Workeneh et al 2006), but this does not result in marked gains in lean body mass (LBM) at whole body level (Cheema et al 2007a;Johansen et al 2006;Kopple et al 2007). The reason for this failure to increase LBM is unknown, but exercise-induced lactic acid generation in nondialysed patients might result in transient worsening of acidosis, thereby off-setting benefits from exercise.…”