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Abstract
Background and objectivesExercise capacity is reduced in chronic kidney failure (CKF). Intra-dialytic cycling is beneficial, but comorbidity and fatigue can prevent this type of training. Low–frequency electrical muscle stimulation (LF-EMS) of the quadriceps and hamstrings elicits a cardiovascular training stimulus and may be a suitable alternative. The main objectives of this trial were to assess the feasibility and efficacy of intra-dialytic LF-EMS vs. cyclingDesign, setting, participants, and measurementsAssessor blind, parallel group, randomized controlled pilot study with sixty-four stable patients on maintenance hemodialysis. Participants were randomized to 10 weeks of 1) intra-dialytic cycling, 2) intra-dialytic LF-EMS, or 3) non-exercise control. Exercise was performed for up to one hour three times per week. Cycling workload was set at 40–60% oxygen uptake (VO2) reserve, and LF-EMS at maximum tolerable intensity. The control group did not complete any intra-dialytic exercise. Feasibility of intra-dialytic LF-EMS and cycling was the primary outcome, assessed by monitoring recruitment, retention and tolerability. At baseline and 10 weeks, secondary outcomes including cardio-respiratory reserve, muscle strength, and cardio-arterial structure and function were assessed.ResultsFifty-one (of 64 randomized) participants completed the study (LF-EMS = 17 [77%], cycling = 16 [80%], control = 18 [82%]). Intra-dialytic LF-EMS and cycling were feasible and well tolerated (9% and 5% intolerance respectively, P = 0.9). At 10-weeks, cardio-respiratory reserve (VO2 peak) (Difference vs. control: LF-EMS +2.0 [95% CI, 0.3 to 3.7] ml.kg-1.min-1, P = 0.02, and cycling +3.0 [95% CI, 1.2 to 4.7] ml.kg-1.min-1, P = 0.001) and leg strength (Difference vs. control: LF-EMS, +94 [95% CI, 35.6 to 152.3] N, P = 0.002 and cycling, +65.1 [95% CI, 6.4 to 123.8] N, P = 0.002) were improved. Arterial structure and function were unaffected.ConclusionsTen weeks of intra-dialytic LF-EMS or cycling improved cardio-respiratory reserve and muscular strength. For patients who are unable or unwilling to cycle during dialysis, LF-EMS is a feasible alternative.
Highlights
The severely reduced exercise capacity associated with chronic kidney failure (CKF) is an inevitable consequence of hypertension, chronic uraemia and low grade systemic inflammation
At 10-weeks, cardio-respiratory reserve (VO2 peak) (Difference vs. control: Low–frequency electrical muscle stimulation (LF-EMS) +2.0 [95% confidence intervals (95% CI), 0.3 to 3.7] ml.kg-1.min-1, P = 0.02, and cycling +3.0 [95% CI, 1.2 to 4.7] ml.kg-1.min-1, P = 0.001) and leg strength (Difference vs. control: LF-EMS, +94 [95% CI, 35.6 to 152.3] N, P = 0.002 and cycling, +65.1 [95% CI, 6.4 to 123.8] N, P = 0.002) were improved
For patients who are unable or unwilling to cycle during dialysis, LF-EMS is a feasible alternative
Summary
The severely reduced exercise capacity associated with chronic kidney failure (CKF) is an inevitable consequence of hypertension, chronic uraemia and low grade systemic inflammation. Structural and functional changes to the cardiovascular system and skeletal muscle contribute to an exercise capacity (peak oxygen uptake, VO2 peak) that is commonly only 50–60% of normal [2, 3]. Debilitating is the inflammatory cytokine and inactivity mediated imbalance in protein homeostasis which results in the catabolic destruction of structural and functional proteins with skeletal muscle wasting [9]. Some of the cardiovascular and skeletal muscle sequelae that typify the CKF phenotype are modified by exercise interventions in other disease states [10]. There may be scope for structured exercise training during hemodialysis to attenuate CKF specific cardiovascular dysfunction. Exercise capacity is reduced in chronic kidney failure (CKF). The main objectives of this trial were to assess the feasibility and efficacy of intra-dialytic LF-EMS vs. cycling
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