Abstract
BackgroundA randomized trial of a pedometer-based intervention with weekly activity goals led to a modest increase in step count among dialysis patients. In a secondary analysis, we investigated the effect of this intervention on body composition.MethodsSixty dialysis patients were randomized to standard care or a 6-month program consisting of 3 months of pedometers and weekly step count targets and 3 months of post-intervention follow-up. We obtained bioelectrical impedance spectroscopy (BIS) data on 54 of these patients (28 control, 26 intervention) and used linear mixed-modeling (adjusted for sex and dialysis modality) to estimate differences in change in total-body muscle mass (TBMM) adjusted for height2, fat mass (kg), and body mass index (BMI) (kg/m2) between control and intervention groups.ResultsThe median age of participants was 57.5 years (53–66), and 76% were men. At baseline, there was no significant difference between groups in age, BMI, race, or body composition, but there were more men in the intervention group. After 3 months, patients in the intervention group increased their average daily steps by 2414 (95% CI 1047, 3782) more than controls (p < 0.001), but there were no significant differences in body composition. However, at 6 months, participants in the intervention had a significantly greater increase from baseline in TBMM of 0.7 kg/m2 (95% CI 0.3, 1.13), decrease in fat mass (− 4.3 kg [95% CI -7.1, − 1.5]) and decrease in BMI (− 1.0 kg/m2 [95% CI -1.8, − 0.2]) relative to controls. In post-hoc analysis, each increase of 1000 steps from 0 to 3 months was associated with a 0.3 kg decrease in fat mass (95% CI 0.05, 0.5) from 0 to 6 months, but there was no dose-response relationship with TBMM/ht2 or BMI.ConclusionA pedometer-based intervention resulted in greater decreases in fat mass with relative preservation of muscle mass, leading to a greater decrease in BMI over time compared with patients not in the intervention. These differences were driven as much by worsening in the control group as by improvement in the intervention group. Step counts had a dose-response relationship with decrease in fat mass.Trial registrationClinicalTrials.gov (NCT02623348). 02 December 2015.
Highlights
A randomized trial of a pedometer-based intervention with weekly activity goals led to a modest increase in step count among dialysis patients
Given the increasing prevalence of obesity among end-stage renal disease (ESRD) patients over the last decade [11], recent studies have examined the presence of low muscle mass concurrent with high fat mass in the dialysis population and found that sarcopenic obesity is associated with poor physical performance and lower extremity function [12]
Higher physical activity is associated with higher muscle mass in dialysis [20, 21], and prior studies of exercise in dialysis patients have shown that vigorous exercise is associated with increase in muscle mass [19, 22, 23], as well as improvement in physical functioning [24,25,26]
Summary
A randomized trial of a pedometer-based intervention with weekly activity goals led to a modest increase in step count among dialysis patients. Lower muscle mass [3, 4] in dialysis patients is associated with impairments in physical function [5]. Given the increasing prevalence of obesity among ESRD patients over the last decade [11], recent studies have examined the presence of low muscle mass concurrent with high fat mass in the dialysis population (sarcopenic obesity) and found that sarcopenic obesity is associated with poor physical performance and lower extremity function [12]. The Kidney Disease Outcomes Quality Initiative (K/ DOQI) guidelines recommend that all dialysis patients should be encouraged to increase their physical activity levels [13] based on evidence for the general population and for individuals at high risk of cardiovascular disease [14]. The effect of a walking intervention on measures of body composition has not been studied
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