Beneficial effects of an intradialytic cycling training program in patients with end-stage kidney disease

Abstract

In chronic kidney disease (CKD), oxidative stress (OS) plays a central role in the development of cardiovascular diseases. This pilot program aimed to determine whether an intradialytic aerobic cycling training protocol, by increasing physical fitness, could reduce OS and improve other CKD-related disorders such as altered body composition and lipid profile. Eighteen hemodialysis patients were randomly assigned to either an intradialytic training (cycling: 30 min, 55%-60% peak power, 3 days/week) group (EX; n = 8) or a control group (CON; n = 10) for 3 months. Body composition (from dual-energy X-ray absorptiometry), physical fitness (peak oxygen uptake and the 6-minute walk test (6MWT)), lipid profile (triglycerides (TG), total cholesterol, high-density lipoprotein, and low-density lipoprotein (LDL)), and pro/antioxidant status (15-F2α-isoprostanes (F2-IsoP) and oxidized LDL in plasma; superoxide dismutase, glutathione peroxidase, and reduced/oxidized glutathione in erythrocytes) were determined at baseline and 3 months later. The intradialytic training protocol did not modify body composition but had significant effects on physical fitness, lipid profile, and pro/antioxidant status. Indeed, at 3 months: (i) performance on the 6MWT was increased in EX (+23.4%, p < 0.001) but did not change in CON, (ii) plasma TG were reduced in EX (-23%, p < 0.03) but were not modified in CON, and (iii) plasma F2-IsoP concentrations were lower in EX than in CON (-35.7%, p = 0.02). In conclusion, our results show that 30 min of intradialytic training, 3 times per week for 3 months, are enough to exert beneficial effects on the most sensitive and reliable marker of lipid peroxidation (IsoP) while improving CKD-associated disorders (lipid profile and physical fitness). Intradialytic aerobic cycling training represents a useful and easy strategy to reduce CKD-associated disorders. These results need to be confirmed with a larger randomized study.

Pengaruh Exercise Intradialytic Terhadap Nilai Adekuasi Hemodialysis

“…Hasil serupa ditemukan oleh Mohseni et al (2013) bahwa pasien yang menjalani HD di dialysis canter of Imam Khomeini hospital in Sari, Iran dengan 47 pasien dilakukan terapi hemodialysis ditemukan nilai Kt/V masih dibawah 1.2 dan URR masih dibawah 65%. Untuk dapat meningkatkan nilai adekuasi dialysis dapat dilakukan exercise intradialytic, terapi ini terbukti memiliki manfaat potensial pada kardiovaskular, adekuasi dialysis, fungsi fisik, kualitas hidup terkait kesehatan dan High Sensitivity C-Reactive Protein (hs-CRP) (Groussard et al, 2015). Keuntungan jika exercise intradialytic dilakukan di rumah sakit tidak melibatkan waktu ekstra, pasien di bawah pengawasan dokter dan mesin, komplikasi dapat dideteksi dan ditangani di tempat, meningkatkan zat terlarut, meningkatkan aliran darah ke otot, dan lebih besar menghapus agen beracun (Sheng et al, 2014).…”

“…Alat yang dipakai dalam melakukan exercise resistance training adalah menggunkan elastic band (Moraes et al, 2014;Marinho et al, 2017). Lima studi menggunakan intervensi exercise cycle ergometer (Paglialonga et al, 2014;Orcy et al, 2014;Groussard et al, 2015;Musavian et al, 2015;Parker et al, 2015). Satu studi menggunakan intervensi airogym dengan bantal (Adam, Mtech, & Sbn, 2017).…”

“…Intervensi exercise intradialytic dilakukan dengan durasi waktu yang berbeda-beda termasuk kapan dilakukan dan berapa lama exercise dilakukan. tujuh studi intervensi pemberian exercise dilakukan pada saat dua jam pertama dilakukan hemodialysis (Moraes et al, 2014;Marinho et al, 2017;Orcy et al, 2014;Groussard et al, 2015;Musavian et al, 2015;Parker et al, 2015;Mohseni et al, 2013), satu studi exercise dilakukan satu jam pertama saat hemodialysis (Paglialonga et al, 2014) serta satu studi dilakukan 15 menit/jam saat hemodialysis (Adam, Mtech, & Sbn, 2017). Selain kapan waktu exercise intradialytic diterapkan, dari 12 artikel memberikan data lama pemberian intervensi exercise intradialytic.…”

“…Lima studi memberikan intervensi exercise selama enam bulan (Moraes et al, 2014;Marinho et al, 2017;Parker et al, 2015;Adam et al, 2017;Smart et al, 2013). Dua studi memberikan intervensi selama tiga bulan (Paglialonga et al, 2014;Groussard et al, 2015). Tiga studi memberikan intervensi selama delapan minggu (Ribeiro et al, 2013 ;Musavian et al, 2015;Mohseni et al, 2013).…”

Effects of supervised exercise on depressive symptoms in hemodialysis patients: a systematic review and meta-analysis of randomized controlled trials

“…Although supervised exercise training has been suggested to improve exercise capacity, muscular strength, and QOL in hemodialysis patients [19][20][21][22], it remains unclear whether such exercise regimes can ameliorate depressive symptoms in these patients. Systematic reviews with meta-analyses are generally considered good means of determining the efficacy and effectiveness of treatments on selected outcomes.…”