Abstract
Objective: This study aimed to investigate the effects of moderate- to high-intensity intradialytic progressive resistance training (IPRT) on muscle strength (MS), physical capacity (PC), and quality of life (QoL) in end-stage renal disease patients. Methods: Twenty-seven sedentary hemodialysis patients (55.5±10.6 years) were divided into a resistance training group (RTG, n=15) and a control group (CG, n=12). Patients of RTG were submitted to IPRT, three times per week for 12 weeks. The Borg’s scale was used for exercise prescription. Muscle strength was measured using hand grip dynamometry (MS). The sit-to-stand (STS) test and usual walking speed (UWS) test were performed to measure the physical capacity, and the SF-36 questionnaire to evaluate the quality of life (QoL). All patients were evaluated at baseline and after 12 weeks. Results: Moderate- to high-intensity IPRT significantly increased the MS (p=0.001, effect size (ES)=0.98), the physical capacity evaluated by the STS (p=0.002, ES=0.85) and UWS (p=0.014, ES=1.11), and all domains of SF-36 questionnaire (p<0.05). On the other hand, in the CG these variables did not change significantly. The protocol was well tolerated and was not associated with significant clinical complications. Conclusion: Twelve weeks of moderate- to high-intensity IPRT in HD patients was safe and improved MS, PC, and QoL.
Highlights
Patients with end-stage renal disease undergoing hemodialysis (HD), have a sedentary lifestyle that is associated with increased rates of morbidity and mortality, due to cardiovascular events (Vanholder et al 2005; Eckhard et al 2009).In this population, cardiovascular diseases, endocrine and metabolic disorders, malnutrition, inflammation, bone mineral disease and neuromuscular dysfunction, contribute to lower levels of muscle strength (MS), physical capacity (PC), and exercise tolerance (Junyent et al 2010; Odden et al 2004; Beddhu et al 2009) when compared to healthy individuals or patients in earlystage chronic kidney diseases (CKD) (Lin and Curhan, 2008; Johansen et al 2010)
Cardiovascular diseases, endocrine and metabolic disorders, malnutrition, inflammation, bone mineral disease and neuromuscular dysfunction, contribute to lower levels of muscle strength (MS), physical capacity (PC), and exercise tolerance (Junyent et al 2010; Odden et al 2004; Beddhu et al 2009) when compared to healthy individuals or patients in earlystage chronic kidney diseases (CKD) (Lin and Curhan, 2008; Johansen et al 2010). These factors contribute to a vicious cycle that is associated with sedentary lifestyle, increased risk of falls, hospitalization, and decreased quality of life (QoL) (Cheema et al 2014; Li et al 2016; Seckinger et al 2016)
In the RTG the increase of approximately 20% in MS confirms the findings of previous studies and is within the range reported in the literature (Headley et al 2002; Cheema et al 2007; Chen et al 2010; Molsted et al 2013; Kirkman et al 2014; Martin-Alemany et al 2014) In one of the first studies that investigated the effects of RT on MS and PC in HD patients, Headley et al (2002) observed an increase of approximately 13% in the MS of the knee extensor muscles after 12 weeks of intervention
Summary
Patients with end-stage renal disease undergoing hemodialysis (HD), have a sedentary lifestyle that is associated with increased rates of morbidity and mortality, due to cardiovascular events (Vanholder et al 2005; Eckhard et al 2009) In this population, cardiovascular diseases, endocrine and metabolic disorders, malnutrition, inflammation, bone mineral disease and neuromuscular dysfunction, contribute to lower levels of muscle strength (MS), physical capacity (PC), and exercise tolerance (Junyent et al 2010; Odden et al 2004; Beddhu et al 2009) when compared to healthy individuals or patients in earlystage chronic kidney diseases (CKD) (Lin and Curhan, 2008; Johansen et al 2010). In patients undergoing HD treatment, the effects of this training modality on physical capacity remains controversial (Zhao et al 2019)
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