Effect of Oral Nutritional Supplementation With and Without Exercise on Nutritional Status and Physical Function of Adult Hemodialysis Patients: A Parallel Controlled Clinical Trial (AVANTE-HEMO Study)

Abstract

Protein energy wasting affects the nutritional status (NS) and physical function (PF) of dialysis patients. Among the different anabolic strategies to improve NS and PF, oral nutritional supplementation (ONS) and resistance exercise (RE) or aerobic exercise (AE) have been shown to be effective. Nevertheless, the combination of both anabolic strategies has not been completely evaluated. The aim of this study is to assess the effect of exercise combined with ONS versus ONS without exercise during hemodialysis sessions on PF and NS indicators. Young hemodialysis patients (29±9.3years) with predominantly unknown causes of renal disease (80%) were divided into the following 3 groups during a period of 12weeks: (1) ONS (n=15), (2) ONS+RE (n=15), and (3) ONS+AE (n=15). Anthropometric, biochemical, PF, and quality of life measurements were recorded at baseline and after 3months. Repeated measures analysis of variance and effect sizes (Cohen's d) were used to assess the effect of exercise and nutrition (ISRCTN registry 10251828). At the completion of the study, the ONS and ONS+RE groups exhibited statistically significant increases in body weight, body mass index, and in the percentage of fat mass (P<.05); the greatest effect sizes were observed in the ONS+RE group (d=0.30 for body weight, d=0.63 for body mass index, and d=0.90 for the percentage of fat mass). Groups with RE and AE had statistically significant increases and large effect sizes in the six-minute walk test (RE: d=0.94, P=.02; AE: d=1.11, P=.03), sit-to-stand test (RE: d=0.81, P=.041; AE: d=1.20, P=.002), timed up and go test (RE: d=1.04, P=.036; AE: d=1.6, P=.000), and muscle strength (RE: d=1.01, P=.000; AE: d=0.60, P=.003). Regarding quality of life, the ONS+RE group had more areas of improvement at the end of the study, followed by the ONS+AE group. No statistically significant differences were found in the repeated measures ANOVA. The combination of exercise with ONS had larger effects on PF than on ONS alone. Further studies to examine the impact of exercise on the effect of oral nutritional supplementation in dialysis patients are indicated.