Exercise training in dialysis patients: impact on cardiovascular and skeletal muscle health

Abstract

Dialysis patients show a high rate of reduced functional capacity, morbidity and mortality. Cardiovascular disorders, muscle atrophy and malnutrition, play an essential role among the etiological factors. Sedentary life characterizes them and contributes to the aggravation of these disorders. On the contrary, exercise training is an important preventive and therapeutic tool both for cardiovascular problems and for the appearance of muscle atrophy in dialysis patients. Regular exercise causes both central (cardiac) and peripheral (muscular) adaptations, improving functional capacity. In particular, in the circulatory system.clinical trials in hemodialysis patients documented that exercise has favorable effects on heart function, promotes the balance on the cardiac autonomic nervous system and contribute into the management of arterial hypertension. In the muscular system, it prevents muscle atrophy or contributes significantly to its treatment. The main preventive mechanisms of the beneficial effect of exercise on the muscles constitute the inhibition of the apoptotic processes and protein degradation. Exercise training in hemodialysis patients leads to an increase of muscle fibers, mitochondria and capillaries, and the combination of regular exercise and dietary strategies is even more effective in preventing or treating muscle atrophy. Finally, an improvement in functional capacity and quality of life was found also in peritoneal dialysis patients following exercise training.

Evaluation of the impact of an intradialytic exercise programme on sarcopaenia in very elderly haemodialysis patients

“…Moreover, none of the trials explored the impact on sarcopaenia as assessed by EWGSOP2, which was published in 2019. More recent reviews have emphasized the benefits of exercise training, although they were not limited to intradialytic exercise [ 40 , 41 ]. Again, the age range of the studies was either not mentioned [ 40 ] or ranged from 36 to 71 years [ 41 ].…”

“…More recent reviews have emphasized the benefits of exercise training, although they were not limited to intradialytic exercise [ 40 , 41 ]. Again, the age range of the studies was either not mentioned [ 40 ] or ranged from 36 to 71 years [ 41 ]. Thus, although the authors concluded that there is convincing evidence that exercise training improves physical function measured as aerobic capacity, muscle endurance strength and balance at all ages and all stages of CKD [ 41 ], in fact, the evidence so far is thin regarding the age range of participants in the present study.…”

Effect of Exercise on Health-Related Quality of Life in Patients with End-Stage Renal Disease

“…Increased phosphorylation of mRNA translational signalling proteins due to RE and whey protein intake leads to enhanced protein synthesis in untrained individuals. In addition, ingestion of whey protein after RE activates the mTOR signalling pathway in a dose-dependent manner [63]. Supplementing PE with proper energy sources such as carbohydrates, protein, vitamins and iron will help keep muscle protein breakdown under control.…”

“…As a result of reduced sympathetic tone, these beneficial adaptations may be due to increased parasympathetic activity, decreased catecholamine levels, and decreased endogenous cardiac output stimulation. PE, particularly the AE, raises resting vagal tone while lowering sympathetic tone in both healthy people and those with kidney disease [63].…”

Shortcoming of Measuring Patient Satisfaction’s Association With Anemia-Based Cardiovascular Risk in End-Stage Kidney Disease Patients

“…ESKD causes a considerable financial burden to society [ 14 ]. In ESKD receiving hemodialysis, cardiovascular disease is a major cause of death (42%) due to secondary complications [ 15 - 17 ]. Despite advances in dialysis technology, cardiovascular mortality of these patients remains high.…”