Aerobic Exercise Training and Nontraditional Cardiovascular Risk Factors in Hemodialysis Patients: Results from a Prospective Randomized Trial

Abstract

Introduction: Chronic kidney disease (CKD) patients have a high incidence of cardiovascular diseases (CVD) which increases their morbidity and mortality. A sedentary lifestyle in CKD is directly linked to the onset of CVD. Physical activity can bring beneficial effects to CKD patients. Aims: The aim of this study was assess the impact of aerobic training on nontraditional cardiovascular risk factors in CKD patients on hemodialysis. Materials and Methods: This is a prospective, controlled, and randomized clinical trial with analysis of intention to treat. Thirty patients underwent an exercise treadmill test, an arterial stiffness evaluation, echocardiography and analysis of endothelial reactivity, and carotid ultrasound and laboratorial tests, including analysis of serum aldosterone. The intervention group (IG) (n =15) underwent aerobic exercise during hemodialysis 3 times a week for 4 months. The control group (CG) (n =15) had no intervention. All of the patients were reassessed after 4 months. Results: In the IG, there was a statistically significant improvement in flow-mediated vasodilation (FMV; p = 0.002) and a reduction in left ventricular hypertrophy (p = 0.006) and serum aldosterone (p = 0.016). There was an increase in C-reactive protein in the CG (p = 0.002). Conclusion: This aerobic training protocol was able to improve endothelial function with enhanced FMV and reduce left ventricular hypertrophy and serum aldosterone, which could have a positive impact on the reduction of nontraditional cardiovascular risk factors in CKD patients on hemodialysis.

Effect of Intradialytic Exercise on Cardiovascular Outcomes in Maintenance Hemodialysis: A Systematic Review and Meta-Analysis

“…In total, six studies (total n5315) examined outcomes related to myocardial structure (Table 4). 32,53,55,60,64,66 4B). 53,60,64,66 Cardiac Autonomic Dysfunction/Increased Sympathetic Activity Four RCTs (total n5205) assessed the effect of intradialytic cycling for 30-90 minutes, thrice weekly over 12-52 weeks of duration on various measures of HRV (Table 4).…”

“…32,53,55,60,64,66 4B). 53,60,64,66 Cardiac Autonomic Dysfunction/Increased Sympathetic Activity Four RCTs (total n5205) assessed the effect of intradialytic cycling for 30-90 minutes, thrice weekly over 12-52 weeks of duration on various measures of HRV (Table 4). 49,53,60,68 Meta-analysis of these studies showed no statistically significant difference in the SD of normal R-R intervals during a 24-hour period (SD of N-N intervals [SDNN]) in the exercise group as compared with the control group (MD 16.05 ms; 95% CI, 214.60 to 46.70; I 2 599%; P , 0.001).…”

“…49,53,60,68 Meta-analysis of these studies showed no statistically significant difference in the SD of normal R-R intervals during a 24-hour period (SD of N-N intervals [SDNN]) in the exercise group as compared with the control group (MD 16.05 ms; 95% CI, 214.60 to 46.70; I 2 599%; P , 0.001). By contrast, meta-analysis of three Cheng et al 61 Cooke et al 48 Fernandes et al 62 Graham−Brown et al 66 Greenwood et al 67 Huang et al 63 Koh et al 47 Kouidi et al 60 Kouidi et al 49 Liao et al 50 Martinez−Olmos et al 70 Momeni et al 32 Oliveira E Silva et al 64 Palar and Lobo 77 Paluchamy et al 65 Parsons et al 51 Pereira et al 68 Petraki et al 52 Reboredo et al 58 Toussaint et al 69 Random sequence generation (selection bias)…”

Importance of Resistance Training in the Management of Cardiovascular Disease Risk

“…In addition to its independent effects on traditional CVD risk factors, regular physical activity can also improve cardiovascular health and impact upon nontraditional or novel CVD risk factors, such as C-reactive protein and oxidative stress [21,22]. Physical activities' effectiveness at preventing and managing CVD is due to its ability to target various pathways through which it influences different physiological systems, such as its ability to promote a healthy anti-inflammatory environment, largely through the release of muscle-derived myokines, its ability to stimulate myocardial regeneration and its ability to improve age-related loss of muscle mass and strength, a frequently overlooked non-traditional CVD risk factor [23][24][25].…”

The effect of exercise on cardiovascular function of patients with chronic kidney disease

“…Endothelial dysfunction appears in the early stages of CKD 28 and can be evaluated noninvasively by flow mediated vasodilation (fmv), which is an important predictor of coronary events in patients with CKD, further increasing the correlation between endothelial dysfunction and CVD risk 38 . It can be attributed to intrinsic microenvironment's alterations observed in CKD such as high aldosterone levels 39 , subclinical inflammation 39 , excessive oxidative stress, and NO dysregulation 3 , as well as defective endothelial repair mechanisms due to reduced levels of bone marrowderived endothelial progenitor cells and impaired migratory function of circulating angiogenic cells 40 . Unfortunately there are only two trials meeting our inclusion criteria.…”