Exercise training improves
cardiovascular fitness in people receiving haemodialysis for chronicrenal disease.
Source
Federal University of Sao Paulo (UNIFESP), Sao
Paulo, Brazil.
Abstract
SUMMARY OF: Smart N, Steele M (2011) Exercise training in haemodialysis patients: a systematic
review and metaanalysis. Nephrology 16: 626-632. [Prepared by Mark Elkins,
Journal Editor.]
OBJECTIVE:
To review the effects of exercise training on cardiovascular fitness, cardiac
function, strength, quality of life and safety in people on regular
haemodialysis for chronic renal disease.
DATA SOURCES:
CENTRAL, Embase, Medline
and CINAHL, searched up to December 2010. Reference lists of included studies
were hand searched for further eligible trials.
STUDY SELECTION:
Randomised controlled trials involving people with chronic renal disease on regular haemodialysis, in which exercise training was compared to no training or in which
different exercise modalities were compared. Trials assessing peak oxygen consumption
as a measure of cardiopulmonary fitness were included. Other outcome measures
were cardiac function, strength, quality of life, and safety. Exercise adherence was also considered.
DATA EXTRACTION:
: Two reviewers
determined the eligibility of studies. Methodological quality was assessed
using the Jadad scale.
RESULTS:
Of 69 studies initially identified by the searches, 15 studies
involving a total of 565 participants were eligible and were included in the
review. Study quality ranged from 1 to 3 out of 5 on the Jadad scale. Eight
studies involving 365 participants compared cardiovascular fitness between
training and control groups. The pooled result showed significantly greater
peak oxygen consumption in the training group by 5mL per kg per min (95% CI 4
to 7). Subgroup analyses indicated that this effect was greater among studies
where the exercise training was of longer duration, was not performed during dialysis, and included strength training as opposed to
aerobic training alone. The exercise group also had significantly lower heart rate variability (ie,
heart rate SD reduced by 16, 95% CI 8 to 24) and tended to have greater left
ventricular ejection fraction (by 5%, 95% CI 0 to 9). Two studies measured
cross-sectional area of limb muscles. Both showed significantly greater
improvement in the exercise group, but only one also showed significantly greater strength.
The effect of exercise training on quality of life was not clear, however the exercise training appeared to be safe with no deaths
reported during exercise training. Among those patients originally approached about
participation, 25% were ineligible due to comorbidities and a further 28%
refused to participate. Of those who commenced exercise, 15% withdrew, which was similar to the dropout rate in the
control group.
CONCLUSION:
Exercise training
is safe, substantially improves cardiovascular fitness and reduces cardiac
variability. To maximise the effect on cardiovascular fitness, the training
should be longterm, be performed outside of haemodialysis periods, and include
strength as well as aerobic training.
Sports Med. 2012 Jun 1;42(6):473-88. doi:
10.2165/11630800-000000000-00000.
Exercise training in chronic
kidney disease patients.
Source
School of Human Movement Studies, the University
of Queensland, Brisbane, QLD, Australia.
Abstract
Chronic kidney disease
(CKD) is a major public health problem that affects an estimated 1.7 million
Australians. Patients with CKD commonly progress to end-stage kidney disease
(ESKD) requiring dialysis and/or kidney transplantation. They are at high risk of
cardiovascular disease and many die from this prior to reaching ESKD. Few
therapies are available to slow CKD progression and reduce cardiovascular
morbidity and mortality. The benefit of exercise training has been well demonstrated in a range
of disease conditions including ESKD and was recently highlighted by a
systematic review in haemodialysis patients and a recent Cochrane review of all
stages of CKD. However, the effects of exercise training in patients with CKD have not been
extensively investigated. Our systematic search of the literature found only
ten clinical trials in this area. The aim of this review is to review these
studies, and to discuss the findings, safety considerations and suggest future
areas of research. Overall, the majority of the studies are small,
non-randomized, non-controlled trials. They have found that exercise training can increase exercise capacity, improve muscle strength and function,
decrease blood pressure, and improve inflammation and oxidative stress
biomarkers. The effects of exercise training on kidney function, cardiovascular disease and quality of
life are unknown. Studies are needed to answer these questions and develop
evidence-based exercisetraining
guidelines for individuals with CKD.
Effect of intradialytic
aerobic exercise on serum electrolytes
levels in hemodialysis patients.
Source
Department of Nephrology and the Cellular and
Molecular Research Center, Mazandaran University of Medical Sciences, Sari,
Iran.
Abstract
INTRODUCTION:
We aimed determine the impact of an 8-week intradialytic exercise program, consisting of 15 minutes of cumulative
duration low-intensity exercise during the first 2 hours of dialysis on serum electrolytes levels and hemoglobin.
MATERIALS AND METHODS:
In a randomized controlled trial of in an outpatient hemodialysis
unit, clinically stable hemodialysis patients (n = 47) were included and
assigned into the aerobic exercise group (n = 25) and the control group (n = 23). Aerobic exercises
were done in groups, 15 min/d, 3 times a week, for 2 months. The main outcome
measures were biochemical variables including serum levels of calcium,
phosphate, and potassium levels and hemoglobin level.
RESULTS:
After an 8-week intervention, significant improvements were seen
in serum phosphate levels (decreased by 1.84 mg/dL) and serum potassium levels
(decreased by 0.69 mg/dL). No side-effects were observed. Serum calcium and
hemoglobin levels did not change significantly in theexercise group.
CONCLUSIONS:
A simplified aerobic exercise program is a complementary, safe, and effective
clinical treatment modality in patients with end-stagerenal disease on dialysis.
A Program of Physical Rehabilitation during
Hemodialysis Sessions Improves the Fitness ofDialysis Patients.
Source
Department of Nephrology and Transplantation
Medicine, Medical University, Wroclaw, Poland.
Abstract
Aim: The aim of the
present study was to evaluate the influence of cycle exercise during hemodialysis (HD) on patients' physical proficiency, muscle strength, quality of life
and selected laboratory parameters. Patients and Methods: In a group of 29 (15
female, 14 male) HD patients (age 64.2 ± 13.1 years), 3 months of cycle
training during dialysis sessions was performed. The following data were analyzed: strength
of lower extremities (six-minute walk test, isokinetic knee extension, flexion
peak torque), nutrition parameters (albumin, BMI), inflammation intensity (CRP,
IL-6), and quality of life (SF-36v2). Results: In the six-minute walk test, the
increase in walk velocity was 4% (3.56 km/h before and 3.73 km/h after cycle
training; p < 0.01). At angular velocity (AV) of 60°/s, extension peak
torque in the knee joint rose by 7% and at AV of 300°/s by 4% (p = 0.04).
Flexion peak torque at AV of 180°/s increased by 13% (p = 0.0005). The program
does not influence nutrition or inflammation parameters. No complications
directly related to exercise were observed. Conclusion: Cycle exercise during dialysis is safe even in older HD patients with multiple
comorbidities. It results in a significant increase in general patient walking
ability and in a gain in lower extremity muscle strength.
Exercise in individuals with CKD.
Source
Division of Nephrology, University of California
San Francisco, San Francisco, CA; Nephrology Section, San Francisco VA Medical
Center, San Francisco, CA.
Abstract
There are few studies
evaluating exercise in the nondialysis chronic kidney disease (CKD) population. This
review covers the rationale for exercise in patients with CKD not requiring dialysis and the effects of exercise training on physical functioning, progression of kidney disease, and
cardiovascular risk factors. In addition, we address the issue of the risk of exercise and make recommendations for implementation of exercise in this population. Evidence from uncontrolled
studies and small randomized controlled trials shows that exercise training results in improved physical performance and functioning in patients with
CKD. In addition, although there are no studies examining cardiovascular
outcomes, several studies suggest that cardiovascular risk factors such as
hypertension, inflammation, and oxidative stress may be improved with exercise training in this population. Although the
current literature does not allow for definitive conclusions about whether exercise training slows the progression of kidney
disease, no study has reported worsening of kidney function as a result of exercise training. In the absence of guidelines specific
to the CKD population, recent guidelines developed for older individuals and
patients with chronic disease should be applied to the CKD population. In sum, exercise appears to be safe in this patient population if
begun at moderate intensity and increased gradually. The evidence suggests that
the risk of remaining inactive is higher. Patients should be advised to increase
their physical activity when possible and be referred to physical therapy or cardiac rehabilitation programs when
appropriate.
Intradialytic exercise programs for
hemodialysis patients.
Source
Department of Rehabilitation Medicine, Kyungpook
National University Hospital, Daegu, Korea.
Abstract
Although it is widely
accepted that exercise is beneficial in patients with end-stage renal disease as in the general population, it is not
easy to incorporate exercise programs into routine clinical practice. This review aimed to
investigate the beneficial effects of exercise during hemodialysis and also to introduce
various intradialytic exercise programs and their advantages as a first step in combining exercise programs into clinical practice. Aerobic and
resistance exercise are beneficial not only in improving physical functioning, including maximal oxygen uptake and
muscle strength, but also in improving anthropometrics, nutritional status,
hematological indexes, inflammatory cytokines, depression, and health-related
quality of life. However, it is not clear whether the beneficial effects of exercise are limited to only relatively healthy dialysis patients. Therefore, the effects of
individualized exercise programs for elderly patients or patients with comorbid conditions
need to be studied further.
[Effects of exercise training on ergocycle
during hemodialysis in patients with end stage renaldisease: Relevance of
the anaerobic threshold intensity.]
[Article in French]
Source
AUB Santé, 2, rue Le Guilloux, 35000 Rennes,
France.
Abstract
BACKGROUND:
Chronic kidney failure (CRF) in addition to cardiovascular
comorbidities and aging decrease physical activity capacity. An adapted rehabilitation
program might be strongly recommended in this population. The aim of the study
is to evaluate a 3months exercise training program with ergocycle at the anaerobic threshold (AT)
during dialysis sessions on effort tolerance, quality of life, blood pressure and
lipidic disorders.
METHODS:
Six patients meanly aged
72 were evaluated before (t(0)) and after (t(3)) the rehabilitation program by:
maximal cardiorespiratory ergotest, a 6-Minute Walk Test (6MWT) and 2 quality
of life tests: Medical Outcome Survey Short Form 36-items and the Kidney Disease
Quality of Life (SF 36, KDQol).
RESULTS:
Physical activity during dialysis is well tolerated. There was no undesirable event during
rehabilitation sessions. The dyspnea and muscular weariness threshold linked to
the AT increased meanly by 39% (8.83±0.87 vs. 12.25±1.23mL/min per kg).
Distances walked during 6 MWT increased for all patients (351.83±72.17 vs.
412.80±82meters) Moreover, physical component scale improved (+4.7), mean systolic blood pressure
(-7mmHg) and mean triglycerides concentration (-19%) decreased.
CONCLUSION:
An exercise training program during dialysis sessions with ergocycle and working intensity
based on AT seems safe and an effective alternative to improve the effort
functional capacity by hemodialysis patients.
Benefits of regular
walking exercise in advanced pre-dialysis chronic kidney disease.
Source
John Walls Renal Unit,
University Hospitals of Leicester NHS Trust, Leicester, UK.
Abstract
BACKGROUND:
There is increasing evidence of the benefit of regular physical exercise in a number of long-term conditions including
chronic kidney disease (CKD). In CKD, this evidence has mostly come from
studies in end stage patients receiving regular dialysis. There is little evidence in pre-dialysis patients with CKD Stages 4 and 5.
METHODS:
A prospective study compared the benefits of 6 months regular
walking in 40 pre-dialysis patients
with CKD Stages 4 and 5. Twenty of them were the exercising group and were
compared to 20 patients who were continuing with usual physical activity. In addition, the 40 patients were
randomized to receive additional oral sodium bicarbonate (target venous
bicarbonate 29 mmol/L) or continue with previous sodium bicarbonate treatment
(target 24 mmol/L).
RESULTS:
Improvements noted after 1 month were sustained to 6 months in the
18 of 20 who completed the exercise study. These included improvements in exercise tolerance (reduced exertion to achieve the same
activity), weight loss, improved cardiovascular reactivity, avoiding an
increase in blood pressure medication and improvements in quality of health and
life and uraemic symptom scores assessed by questionnaire. Sodium bicarbonate
supplementation did not produce any significant alterations.
CONCLUSIONS:
This study provides
further support for the broad benefits of aerobic physical exercise in CKD. More studies are needed to understand
the mechanisms of these benefits, to study whether resistance exercise will add to the benefit and to evaluate
strategies to promote sustained lifestyle changes, that could ensure continued
increase in habitual daily physical activity levels.
Exercise training in
haemodialysis patients: a systematic review and meta-analysis.
Source
Department of Exercise Science, University of New England, Armidale, Queensland,
Australia. nsmart2@une.edu.au
Abstract
BACKGROUND:
We quantified baseline and observed change in peak VO(2) , quality
of life, cardiac function, strength and energy intake followingexercise training in haemodialysis patients and optimal exercise delivery for producing greatest adherence,
safety and patient improvements.
METHODS:
A systematic literature search was completed in August 2010 to
identify randomized, controlled trials of exercise training studies in haemodialysis patients. A
subsequent meta-analysis was conducted and the search repeated in December
2010.
RESULTS:
Fifteen studies, yielding 565 patients were included. Baseline,
peak VO(2) values were 70% of age-predicted values, exercise intervention patients improved post-training
peak VO(2) to 88% predicted. Exercise training produced mean 26 ± 12% improvements in eight studies that
reported peak VO(2) , mean difference 5.22 mL O(2) /kg per min (95% confidence
interval 3.86, 6.59, P < 0.00001). Equivocal results for change in
short-form 36 health questionnaire scores were reported post-training. Heart
rate variability was improved after exercise training of normal to normal interval, mean
difference 1634 milliseconds (95% confidence interval 8.3, 24.3, P <
0.0001). Significant improvements in lean body mass, quadriceps muscle area,
knee extension, hip abduction and flexion strength were also reported (all P
< 0.0001). Exercise training appears safe, with no deaths directly associated with exercise in 28 400 patient-hours and no differences in
withdrawal rates between exercise and control participants, P = 0.98. Exercisetraining for 6 months or more conveyed larger improvements in peak
VO(2) than shorter programmes. Data indicate about 25% of patients were
excluded from exercise training studies for medical reasons.
CONCLUSION:
Exercise training
is safe and imparts large improvements in peak VO(2) , and heart rate
variability.
Effects of aerobic
training during hemodialysis on heart rate variability and left ventricular
function in end-stage renal disease patients.
[Article in English, Portuguese]
Source
Federal Institute of Education, Science and
Technology of Southeast of Minas Gerais. mayconreboredo@yahoo.com.br
Abstract
INTRODUCTION:
Decreased heart rate variability (HRV) in patients with end stage renal disease (ESRD) undergoing hemodialysis is
predictive of cardiac death, especially due to sudden death.
OBJECTIVE:
To evaluate the effects
of aerobic training during hemodialysis on HRV and left ventricular function in
ESRD patients.
METHODS:
Twenty two patients were randomized into two groups: exercise (n = 11; 49.6 ± 10.6 years; 4 men) and control
(n = 11; 43.5 ± 12.8; 4 men). Patients assigned to the exercise group were submitted to aerobic training,
performed during the first two hours of hemodialysis, three times weekly, for
12 weeks. HRV and left ventricular function were assessed by 24 hours Holter
monitoring and echocardiography, respectively.
RESULTS:
After 12 weeks of protocol, no significant differences were
observed in time and frequency domains measures of HRV in both groups. The
ejection fraction improved non-significantly in exercise group (67.5 ± 12.6% vs. 70.4 ± 12%) and
decreased non-significantly in control group (73.6 ± 8.4% vs. 71.4 ± 7.6%).
CONCLUSION:
A 12-week aerobic
training program performed during hemodialysis did not modify HRV and did not
significantly improve the left ventricular function.
