Abstract
BackgroundReduced muscle strength and physical performance are prevalent in patients of maintenance hemodialysis (MHD), and deleterious changes in these parameters are associated with increased mortality.MethodsThis retrospective observational study included 306 patients, who received a 6-month resistance exercise program during hemodialysis, three times per week on an outpatient basis. The training protocol consisted of two sets of 10 repetitions of knee extension, hip abduction, and hip flexion, using an elastic band in a sitting or supine position. Primary outcome measures included muscle strength, measured by percent knee extension muscle power to dry body weight (pKEMP-dBW), and physical performance, measured by short physical performance battery (SPPB). The adjusted mean differences in these variables during the 6 months were estimated using a multivariate linear regression model.ResultsThe mean age with standard deviation was 70 ± 11 years. One hundred and sixty patients (52.3%) were men and the dry weight was 55.6 ± 11.3 kg. Sarcopenia, defined as SPPB ≤8, was present in 21.4% patients. Their hemodialysis adequacy was acceptable, with a Kt/V of 1.65 ± 0.29, and their nutritional status was good, with a normalized protein catabolism rate of 0.89 ± 0.18 g/kg/day. During the 6 months, both pKEMP-dBW and SPPB showed a slight but significant increase with an adjusted mean difference of 2.8 (95% confidence interval 1.3–4.3, p < 0.001) and 0.6 (0.4–0.9, p < 0.001), respectively.ConclusionsSix-month resistance training was associated with improved muscle strength and physical performance in patients with MHD.
Highlights
Reduced muscle strength and physical performance are prevalent in patients of maintenance hemodialysis (MHD), and deleterious changes in these parameters are associated with increased mortality
Among the several forms of exercise training, intra-dialytic resistance training has been suggested as a potential strategy to correct and/or prevent reductions of muscle strength and physical performance in MHD patients, considering its convenience, adherence, and safety, with little influence on cardiovascular systems [11, 12]
We evaluated physical performance using short physical performance battery (SPPB), where an SPPB ≤8 was defined as the presence of sarcopenia [19]
Summary
Reduced muscle strength and physical performance are prevalent in patients of maintenance hemodialysis (MHD), and deleterious changes in these parameters are associated with increased mortality. Most studies evaluated the short-term impact on muscle strength or physical performance within 3 months by enrolling only a small number of patients (< 50), and little evidence is available regarding the association between resistance training during MHD and muscle strength or physical performance in a longer time period and with a larger number of patients [13,14,15,16,17,18] The purpose of this multicenter retrospective observational study was to evaluate the association between the 6-month intra-dialytic resistance training and serial changes in muscle strength and physical performance
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