The Effect of Nutrition and Exercise on Body Composition, Exercise Capacity, and Physical Functioning in Advanced CKD Patients

Abstract

Patients with stages 4 and 5 chronic kidney disease (CKD), and particularly chronic dialysis patients, commonly are found to have substantially reduced daily physical activity in comparison to age- and sex-matched normal adults. This reduction in physical activity is associated with a major decrease in physical exercise capacity and physical performance. The CKD patients are often physically deconditioned, and protein energy wasting (PEW) and frailty are commonly present. These disorders are of major concern because physical dysfunction, muscle atrophy, and reduced muscle strength are associated with poor quality of life and increased morbidity and mortality in CKD and chronic dialysis patients. Many randomized controlled clinical trials indicate that when CKD and chronic dialysis are provided nutritional supplements or undergo exercise training their skeletal muscle mass and exercise capacity often increase. It is not known whether the rise in skeletal muscle mass and exercise capacity associated with nutritional support or exercise training will reduce morbidity or mortality rates. A limitation of these clinical trials is that the sample sizes of the different treatment groups were small. The aim of this review is to discuss the effects of nutrition and exercise on body composition, exercise capacity, and physical functioning in advanced CKD patients.

Time-restricted feeding’s effect on overweight and obese patients with chronic kidney disease stages 3-4: A prospective non-randomized control pilot study

“…These results also suggest that TRF may lead to too much reduction in CKD patient intakes. Reduced protein intake may lead to sarcopenia, decreasing muscle strength, which in turn could lead to disease progression and increased mortality ( 49 ). Therefore, TRF should be accompanied by as much exercise as possible for patients to maintain muscle mass.…”

Prognostic role of pretreatment skeletal muscle index in gastric cancer patients: A meta-analysis

“…These proteins and amino acids enter the bloodstream and stimulate an increase in the inflammatory response, which can promote tumor growth and metastasis ( 57 , 58 ). Second, muscle wasting leads to decreased nutrient uptake and metabolic capacity ( 59 ). Muscle tissue has high energy and nutrient demands, and when muscle wasting occurs, the body’s metabolic rate and energy expenditure also decrease.…”

“…Moreover, muscle tissue can break down protein to produce amino acids, which are essential building blocks for protein synthesis and cellular function. Muscle wasting can therefore result in amino acid deficiency, which can further affect tumor cell growth and division ( 59 , 60 ). Third, muscle wasting leads to decreased immune function ( 61 ).…”

Nocturnal Hemodialysis Leads to Improvement in Physical Performance in Comparison with Conventional Hemodialysis

“…Perhaps, it might be difficult to expect changes in strength or body composition, without offering exercise and nutritional intervention. Previous studies on HD patients showed improvement in strength and muscle mass when patients followed an exercise program [ 49 ]. No difference was found in daily activities measured with PAM or LAPAQ, although our data did show that 6 patients in the NHD group started with exercise activities in comparison with 1 CHD patient during our study.…”