An intriguing strategy to further enhance the anabolic effects of nutritional supplementation is to combine the administration of nutrients with resistance exercise. We hypothesized that the addition of resistance exercise to oral nutrition supplementation would lead to further increases in skeletal muscle protein accretion when compared to nutritional supplementation alone in chronic haemodialysis (CHD) patients. METHODS: We performed stable isotope protein kinetic studies in eight CHD patients during two separate settings: with oral nutritional supplementation alone (PO) and oral nutritional supplementation combined with a single bout of resistance exercise (PO + EX). Metabolic assessment was performed before, during and after haemodialysis. Both interventions resulted in robust protein anabolic response. RESULTS: There were no differences in metabolic hormones, plasma amino acid and whole-body protein balance between the interventions. During the post-HD phase, PO + EX retained a positive total amino acid (TAA) balance (primarily due to essential amino acid) while PO returned to a negative TAA balance although this difference did not reach statistical significance (78 +/- 109 versus -128 +/- 72 nmol/100 ml/min, respectively; P = 0.69). In the post-HD phase, PO + EX had significantly higher net muscle protein balance when compared to PO (19 +/- 16 versus -24 +/- 10 microg/100 ml/min, respectively; P = 0.036) We conclude that a single bout of resistance exercise augments the protein anabolic effects of oral intradialytic nutritional supplementation when examining skeletal muscle protein turnover.
- MeSH
- Amino Acids blood MeSH
- Kidney Failure, Chronic blood physiopathology therapy MeSH
- Renal Dialysis methods MeSH
- Dietary Proteins administration & dosage MeSH
- Adult MeSH
- Energy Metabolism physiology MeSH
- Cross-Over Studies MeSH
- Muscle, Skeletal metabolism MeSH
- Humans MeSH
- Nutritional Support methods MeSH
- Gas Chromatography-Mass Spectrometry MeSH
- Prognosis MeSH
- Prospective Studies MeSH
- Muscle Proteins metabolism MeSH
- Exercise Tolerance physiology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
PURPOSE: Clinical guidelines call for the inclusion of exercise interventions in every patient's dialysis session, but these recommendations are rarely adopted. Healthcare providers play a key role in this. Therefore, the aim of this study was to explore how healthcare providers perceive the benefits, risks and barriers of intradialytic exercise (IDE). METHODS: We conducted 21 individual, semi-structured interviews with 11 nurses, 5 nephrologists, 3 training assistants and 2 managers from two dialysis centres in Slovakia. Verbatim transcripts of digitally recorded interviews were thematically analysed using MAXQDA®. RESULTS: Participants reported the benefits of IDE as improvements in patients' physical and psychosocial functioning, independence and self-efficacy, clinical profile and quality of therapy. As risks of IDE, they most frequently reported exercise-related damage to vascular access, insufficient individualization of training and musculoskeletal injuries. The presence of psychological problems among patients was reported as a major barrier for initiating and maintaining patients' exercise. Other reported barriers included limitations in financial and personnel resources of haemodialysis care. CONCLUSIONS: Safe and sustainable implementation of IDE, which might improve a patient's well-being, need to be prescribed in alignment with the patient's clinical profile, be delivered individually according to the patient's characteristics and requires adjustments in the available resources.
- MeSH
- Exercise * psychology MeSH
- Renal Dialysis * MeSH
- Humans MeSH
- Attitude of Health Personnel MeSH
- Self Efficacy MeSH
- Health Personnel MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
INTRODUCTION: The purpose of this study is to identify the role of diabetes mellitus in the effectiveness of intradialytic exercise intervention among haemodialysis patients. METHODS: In this multicentre study 90 dialysed patients were allocated to the experimental (EXG, n=57) or control group (CNG, n=33). In EXG, we included 20 diabetic and 37 non-diabetic patients. In CNG, we enrolled 8 diabetic and 25 non-diabetic patients. EXG underwent a 12-week supervised, progressive, intradialytic resistance training programme, while CNG stayed inactive during dialysis. Baseline, post-interventional and post-follow-up assessments of maximal force during hip extension (HE), hip flexion (HF) and knee extension (KE) contractions were completed in both groups of patients. RESULTS: HE increased in diabetic and non-diabetic EXG patients (diabetic EXG, change: +14.5N; 95% CI=-5.5 to +34.5; non-diabetic EXG, +18.6N; 95% CI=+3.4 to +33.8) and diabetic CNG patients (change: +17.9N; 95% CI=-9.2 to +44.9). Only non-diabetic CNG patients experienced a decrease in HE (change: -22.8N; 95% CI=-36.9 to -8.7, P<.05). CONCLUSIONS: Resistance training improved muscle function among dialysis patients regardless of the presence of diabetes mellitus. We found that non-diabetic patients lose their muscle function extensively during inactivity, while diabetic patients retain their muscle function.
- MeSH
- Kidney Failure, Chronic * therapy MeSH
- Diabetes Mellitus * MeSH
- Renal Dialysis MeSH
- Humans MeSH
- Muscles MeSH
- Exercise Therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
PURPOSE: The loss of muscle functions is a significant health issue among dialysis patients. Poor muscle strength negatively affects a patient's mobility, independence and quality of life. The aim of the study was to assess the effects of an intradialytic resistance training (IRT) on lower extremity muscle functions among dialysed patients. MATERIALS AND METHODS: Ninety patients were allocated into an experimental group (n = 57) or control group (CNG) (n = 33) according to the location of the dialysis service center. Fifty-eight patients completed the study follow-up. The intervention regarded 12-week IRT, while the controls remained physically inactive during hemodialysis. In both groups of patients, we assessed lower extremity muscle functions by a diagnostics of maximal isometric force generated during hip flexion (HF), hip extension (HE), and knee extension (KE) contractions at baseline, after the 12-weeks intervention and after a further 12-weeks follow up. RESULTS: We found that improvements in HE between baseline and post-intervention were significantly larger for the experimental than the CNG (difference 32.0, 95% CI = 12.3-51.8, p = 0.002). For the other primary outcomes, we found no differences between the groups, and neither for the two other indices of muscle strength (HF and KE). At 12-weeks follow-up, we found no statistically significant differences between the two groups. CONCLUSIONS: Our findings indicate that exercise during dialysis not just suppresses adverse effects in muscle strength and functioning, but effectively and safely increases lower extremities muscle function in a relatively short time.Implications for RehabilitationRegular, progressive, resistance training realized during dialysis is well tolerated and safe for exercise interventions in hemodialysis patients.A 12-weeks intradialytic resistance training is effective in the prevention and clinical management of muscle function loss among hemodialysis patients.The range of improvements in muscle functions, demonstrated by the assessment of maximal isometric force, varied severely during different lower extremity movements of hemodialysis patients.
- MeSH
- Renal Dialysis adverse effects MeSH
- Lower Extremity MeSH
- Quality of Life MeSH
- Humans MeSH
- Resistance Training * MeSH
- Muscle Strength physiology MeSH
- Muscles MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Previous research shows the beneficial effects of an intradialytic resistance training (IRT) on muscle function in haemodialysis patients. However, patients vary highly in their functional responses to IRT, may be due to effects of age and sex heterogeneities in adaptation. Therefore, the aim of this study was to investigate the degree to which the effects of IRT on the muscle function of haemodialysis patients vary by age and sex. We included 57 patients who completed a 12-week IRT (EXG) and 33 patients who received no IRT (CNG) during haemodialysis. Muscle function (MF) was assessed using dynamometry before and after a 12-week intervention and after a 12-week follow-up. After the 12-week intervention, we found a moderation effect of age in the relative (%) change (p = 0.011) and absolute (Δ) change (p = 0.027) of MF, and a moderation effect of sex in %MF (p = 0.001), but not in ΔMF (p = 0.069). Regarding patients' age, the change of MF was only significantly different between EXG and CNG patients aged 60-70 years (%MF, EXG: + 34.6%, CNG: - 20.1%, p < 0.001; ΔMF, EXG: + 44.4 N, CNG: - 22.1 N, p < 0.001). Regarding patients' sex, the change of MF was only significantly different between EXG and CNG female patients (%MF, EXG: + 23.9%, CNG: - 23.6%, p < 0.001). Age and sex did not significantly moderate changes in MF measures after 12 weeks of follow-up. We conclude that both age and sex of haemodialysis patients affect their functional response to IRT in the short term.Trial Registration: Intradialytic Resistance Training in Haemodialysis Patients (IRTHEP)-#NCT03511924, 30/04/2018, https://clinicaltrials.gov/ct2/show/NCT03511924 .
- MeSH
- Acclimatization MeSH
- Genetic Heterogeneity MeSH
- Middle Aged MeSH
- Humans MeSH
- Resistance Training * MeSH
- Sex Characteristics * MeSH
- Aged MeSH
- Muscles MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Hemodialyzed (HD) patients with end-stage renal disease (ESRD) exhibit lower fitness as a consequence of chronic uremic changes that trigger various structural, metabolic, and functional abnormalities in skeletal muscles. The aim of this randomized study was to compare the effect of rehabilitation (RHB) training on a bicycle ergometer and electromyostimulation (EMS) of leg extensors in HD patients with ESRD. Thirty-two HD patients (18 men/14 women; mean age 61.1 ± 8.8 years) were randomized into three groups: (i) exercise training (ET; n = 11) on bicycle ergometer 2 × 20 min; (ii) EMS (n = 11) where stimulation (10 Hz) of leg extensors was applied for 60 min; and (iii) controls (CON; n = 10) without exercise. Exercising was performed between the 2nd and the 3rd hour of HD, three times a week, 20 weeks in total. Ergometric test was performed in order to evaluate peak workload (W(peak)), 6-min corridor walking test (CWT) to evaluate the distance walked, and dynamometry of leg extensors to assess muscle power (F(max)). Urea clearance was monitored and expressed as standard parameters: spKt/V, spKt/V equilibrated (spKt/V-e), and the urea removal ratio (URR). Quality of life (QoL) was assessed by the questionnaire SF-36. A significant increase of F(max) (P = 0.040 in group ET; P = 0.032 in group EMS), of 6-min CWT (P < 0.001 in ET group; P = 0.042 in EMS group), and of W(peak) (P = 0.041 in ET group) was observed. In both exercising groups, significant increase of spKt/V, spKt/V-e, and URR was found as compared with initial values (P < 0.05). In both exercising groups, highly significant changes in summarized mental functions were found (P = 0.001); in summarized physical components, significant improvement was observed in the ET group (P = 0.006). Intradialytic RHB showed comparable positive effects on functional parameters, urea clearance, and QoL. Intradialytic EMS might represent wide therapeutic possibility in the near future.
- MeSH
- Leg MeSH
- Kidney Failure, Chronic physiopathology therapy MeSH
- Activities of Daily Living MeSH
- Renal Dialysis adverse effects MeSH
- Electric Stimulation methods MeSH
- Ergometry MeSH
- Muscle, Skeletal physiology MeSH
- Quality of Life MeSH
- Middle Aged MeSH
- Humans MeSH
- Prospective Studies MeSH
- Surveys and Questionnaires MeSH
- Exercise Therapy methods MeSH
- Exercise Tolerance physiology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
Chronická urémie způsobuje vznik závažných strukturálních, metabolických a funkčních abnormalit v kosterním svalstvu u dlouhodobě hemodialyzovaných (HD) pacientů v terminálním stádiu chronické renální insuficience (CRI). Výsledný pokles tělesné zdatnosti a zvýšený výskyt komorbidit má velmi nepříznivý dopad na kvalitu života. Dle zahraničních zkušeností lze zdravotní stav těchto pacientů efektivně ovlivnit rehabilitací, zejména formou kondičního tréninku prováděného v průběhu dialýzy. Cílem této studie bylo porovnat účinek kondičního tréninku a elektromyostimulace (EMS) extenzorů dolních končetin (DK) u pacientů s HD. Pacienti a metodika. Třináct HD pacientů (8 žen/ 4muži, průměrný věk 61.1 ± 5.8 let, průměrná doba HD 5.2 ± 2.2 let) bylo rozděleno do 2 skupin: a) skupina kondiční trénink (KT; n = 6) na bed-side ergometru (2 x 30 minut), b) skupina EMS (n = 7) s použitím stimulace extenzorů DK (frekvence 10 Hz, režim „20s on – 20s off“, délka aplikace 60 min). Oba typy cvičení byly realizovány vždy mezi 2. a 3. hodinou HD, 3x týdně po celkovou dobu 20 týdnů. Na počátku a na konci daného typu intradialytické rehabilitace (ID-RHB) byl proveden ergometrický test ke stanovení maximální zátěže (W max ), 6 min test chůzí k určení ušlé vzdálenosti a dynamo- metrické vyšetření maximální síly extenzorů DK (F max ). Výsledky. ID-RHB v délce 20 týdnů vedla k statisticky významnému zvýšení W max ve skupině KT (z 82.4 ± 9.7 W na 99.1 ± 15.5 W ; P < 0.05). Zvýšení W max bylo zjištěno také ve skupině EMS, avšak bez statistické významnosti (z 75.6 ± 21.4 W na 90.2 ± 22.2 W, NS). Svalová síla (F max ) stat. významně stoupla v obou skupinách: ve skupině KT z 195.3 ± 25.1 N na 228.4 ± 28.7 N (P < 0.05), a ve skupině EMS z 198.9 ± 40.0 N na 217.3 ± 44.1 N (P < 0.05). Rovněž hodnoty vzdálenosti ušlé za 6 min byly významně zvýšeny v obou skupinách: ve skupině KT z 421 ± 31 m na477±9m(P< 0.05) a ve skupině EMS z 378 ± 79 m na 452 ± 77 m (P < 0.05). Závěr. Z výsledků vyplývá, že oba typy ID-RHB mají srovnatelný příznivý vliv na vybrané parametry tělesné zdatnosti u pacientů s HD. Přes prokazatelně příznivé účinky ID-RHB a více než 30 let zkušeností jen minimum HD center v rámci EU nabízí pacientům některou z forem kondičního cvičení v průběhu dialýzy. Výše uvedené výsledky týkající se aplikace EMS, patří k celosvětově prvním zkušenostem v oblasti intradialytické RHB u pacientů v terminálním stádiu CRI.
- Keywords
- hemodialýza, kondiční trénink, elektrostimulace,
- MeSH
- Renal Insufficiency, Chronic rehabilitation MeSH
- Kidney Failure, Chronic MeSH
- Exercise MeSH
- Renal Dialysis MeSH
- Financing, Organized MeSH
- Humans MeSH
- Physical Fitness MeSH
- Check Tag
- Humans MeSH
- Publication type
- Abstracts MeSH
BACKGROUND: Intradialytic resistance training (IRT) protects patients' muscle mass and functions against protein-energy wasting, malnutrition and cachexia. However, the evidence of the effects of such an intervention in haemodialysis patients is limited and not conclusive. To improve the applicability of such interventions, we need a better understanding of molecular, functional and psycho-social adaptation in dialysed patients following a physical training. Therefore, the aim of this study is to investigate the effects of IRT on lower extremity muscle functions, quality of life, and anxiety and depression, clinical outcomes and circulatory micro-ribonucleic acid (miRNA) profiles in patients on chronic haemodialysis therapy. METHODS: We will perform a quasi-experimental study in 3 dialysis centres. Patients will be recruited via their nephrologists and will be allocated to an experimental and a control group based on the location of the patients' dialysis centre. Patients allocated to the experimental group will undergo a 12-week IRT, while the control group will remain physically inactive during dialysis. The primary outcome is the change in the maximal force produced during an isometric contraction of lower extremity muscles. Secondary outcomes regard quality of life, anxiety and depression, clinical outcomes and circulatory miRNA profiles. Patients' level of health literacy defined as the ability to get and understand health information will be also measured in the study as a potential modifier of effects. DISCUSSION: This quasi-experimental study can add in an important way to our understanding of the effects of resistance training on dialysis patients' muscle strength, quality of life and disease-specific outcomes.
- MeSH
- Kidney Failure, Chronic physiopathology psychology therapy MeSH
- Depression therapy MeSH
- Renal Dialysis * MeSH
- Isometric Contraction MeSH
- Clinical Studies as Topic * MeSH
- Quality of Life MeSH
- Humans MeSH
- MicroRNAs blood MeSH
- Multicenter Studies as Topic MeSH
- Resistance Training * methods MeSH
- Muscle Strength MeSH
- Anxiety therapy MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial Protocol MeSH
Východisko: Více než 30 let jsou dokumentovány pokusy o testování a úpravu fyzické zdatnosti pacientů s chronickým selháním ledvin a příznivý vliv pravidelné pohybové rehabilitace na jejich celkový funkční stav a kvalitu života. Cíl: Vyhodnocení vlivu 6měsíční pravidelné aplikace pohybové aktivity v průběhu hemodialýzy na funkční stav a kvalitu života vybraných pacientů. Metodika: Sledovali jsme smíšený soubor 15 hemodialyzovaných pacientů (muži - N = 7; průměrný věk - 67,9 ± 17,8 let; Ženy - N = 8; průměrný věk = 65,0 ±11.6 let). Hodnocení funkčního a psychosociálního stavu probíhalo ve dvou fázích jako vstupní a výstupní šetření. Pro hodnocení vybraných parametrů jsme použili baterii motorických testů Senior Fitness Test Manuál, test ruční dynamometrie a standardizované dotazníky WHOQOL-BREF a SF36. Pro zpracování výsledků byla použita deskriptivní analýza a neparametrický Wilcoxonův znaménkový test. Statistická významnost rozdílu mezi výsledky vstupního a výstupního měření byla hodnocena na hladině p< 0,05. Výsledky: Ve výsledcích výstupních motorických testů jsme zaznamenali jedno statisticky významné zlepšení (p < 0,04) u testu Step test 2 minuty u žen. U dalších provedených testů nebyla zjištěna statistická významnost rozdílů výsledků před a po pohybové intervenci. V kvalitě života po proběhlé pohybové intervenci nedošlo ve většině případů ke změně. U domén kvality života „fyzická činnost", .vitalita' a .duševní zdraví" však lze hovořit o tendenci ke zlepšení. Zlepšení byla zaznamenána především u těch pacientů, kteří cvičili pravidelně. Závěry: Výsledky naznačují, že pravidelná pohybová intervence během hemodialyzační procedury by mohla vést jak ke zlepšení funkční síly dolních končetin, tak ke zlepšení kvality života.
Introduction: Attempts to evaluate and to improve physical capacity in end-stage renal patients started already some three deca- des ago. Positive impact of regular exercise patients on their functional status and quality of life (QOL) has been documented. Aim: To evaluate 6 months period of regular application of specifically designed intradialytic exercise program on functional statu s and selected parameters of QOL. Methods: We studied 15 hemodialysis patients (male = 7, mean age = 67,9 ± 17,8 years; female – N = 8; mean age = 65,0 ± 11,6 years). Assessment of functional and psychosocial status were performed twice, before and after six months of regular exercise program. Senior Fitness Test Manual, hand-grip dynamometer and standardized questionnaires WHOQOL-BREF and SF36 were applied. Results were analyzed using descriptive statistics and non-parametric Wilcoxon signed-rank test. P lower than 0,05 was considered statistically significant. Results: One significant improvement after six-month of regular exercise during dialysis was observed (p < 0,04) – in step test 2 min u (female group). Results of other tests did not differ in post versus pre-exercise evaluation. Quality of life did not s ignificantly changed overall, but a trend to improvement was found in components „physical activity”, „vitality” and „mental health”, namely in those patients, who did not miss exercises sessions during 6-months follow-up. Conclusion: Results indicate that regular exercise during hemodialysis procedure may improve some components of physical acti- vity, as well as improvement of QOL in certain components.
Cardiovascular comorbidities are independent risk factors for mortality in dialysis patients. MicroRNA signaling has an important role in vascular aging and cardiac health, while physical activity is a primary nonpharmacologic treatment for cardiovascular comorbidities in dialysis patients. To identify the relationships between muscle function, miRNA signaling pathways, the presence of vascular calcifications and the severity of cardiovascular comorbidities, we initially enrolled 90 subjects on hemodialysis therapy and collected complete data from 46 subjects. A group of 26 subjects inactiv group (INC) was monitored during 12 weeks of physical inactivity and another group of 20 patients exercise group (EXC) was followed during 12 weeks of intradialytic, moderate intensity, resistance training intervention applied three times per week. In both groups, we assessed the expression levels of myo-miRNAs, proteins, and muscle function (MF) before and after the 12-week period. Data on the presence of vascular calcifications and the severity of cardiac comorbidities were collected from the patients' EuCliD® records. Using a full structural equitation modelling of the total study sample, we found that the higher the increase in MF was observed in patients, the higher the probability of a decrease in the expression of miR-206 and TRIM63 and the lower severity of cardiac comorbidities. A reduced structural model in INC patients showed that the higher the decrease in MF, the higher the probability of the presence of calcifications and the higher severity of cardiac comorbidities. In EXC patients, we found that the higher the increase in MF, the lower the probability of higher severity of cardiovascular comorbidities.
- MeSH
- Endothelium, Vascular metabolism MeSH
- Exercise physiology MeSH
- Renal Dialysis * MeSH
- Cardiovascular Diseases blood genetics therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- MicroRNAs biosynthesis blood genetics MeSH
- Sedentary Behavior MeSH
- Aged MeSH
- Gene Expression Profiling methods MeSH
- Aging blood genetics MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
