Exercise Training in Hemodialysis Patients: A Systematic Review and Meta-Analysis

Smart, Neil A.; Steele, Michael

doi:10.1111/j.1440-1797.2011.01471.x

Cited by 100 publications

(124 citation statements)

References 24 publications

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“…11,12 Another study also showed that resistance training combined with aerobic training produces greater effectiveness compared with aerobic exercise alone in patients with CKD who receive dialysis. 13 These studies clearly demonstrate the beneficial effects of exercise training on kidney diseases; however, the mechanisms are largely unknown. Although exercise may be a reasonable treatment for patients with CKD, it is not clear whether improvements in muscle mass per se can affect kidney function or whether the beneficial effects of exercise are the consequence of general systemic improvements, such as an accompanying increase in cardiovascular function.…”

mentioning

confidence: 99%

Akt1-Mediated Fast/Glycolytic Skeletal Muscle Growth Attenuates Renal Damage in Experimental Kidney Disease

Hanatani

Izumiya

Araki

et al. 2014

Journal of the American Society of Nephrology

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Muscle wasting is frequently observed in patients with kidney disease, and low muscle strength is associated with poor outcomes in these patients. However, little is known about the effects of skeletal muscle growth per se on kidney diseases. In this study, we utilized a skeletal muscle-specific, inducible Akt1 transgenic (Akt1 TG) mouse model that promotes the growth of functional skeletal muscle independent of exercise to investigate the effects of muscle growth on kidney diseases. Seven days after Akt1 activation in skeletal muscle, renal injury was induced by unilateral ureteral obstruction (UUO) in Akt1 TG and wild-type (WT) control mice. The expression of atrogin-1, an atrophy-inducing gene in skeletal muscle, was upregulated 7 days after UUO in WT mice but not in Akt1 TG mice. UUO-induced renal interstitial fibrosis, tubular injury, apoptosis, and increased expression of inflammatory, fibrosis-related, and adhesion molecule genes were significantly diminished in Akt1 TG mice compared with WT mice. An increase in the activating phosphorylation of eNOS in the kidney accompanied the attenuation of renal damage by myogenic Akt1 activation. Treatment with the NOS inhibitor L-NAME abolished the protective effect of skeletal muscle Akt activation on obstructive kidney disease. In conclusion, Akt1-mediated muscle growth reduces renal damage in a model of obstructive kidney disease. This improvement appears to be mediated by an increase in eNOS signaling in the kidney. Our data support the concept that loss of muscle mass during kidney disease can contribute to renal failure, and maintaining muscle mass may improve clinical outcome.

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mentioning

confidence: 99%

Akt1-Mediated Fast/Glycolytic Skeletal Muscle Growth Attenuates Renal Damage in Experimental Kidney Disease

Hanatani

Izumiya

Araki

et al. 2014

Journal of the American Society of Nephrology

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“…However, ET might increase aerobic capacity, muscle mass or strength, physical quality of life, and Kt/V [16,30]. Additionally, ET during dialysis therapy is associated with few adverse events [16,31,32]. However, a study from the Dialysis Outcomes and Practice Patterns Study (DOPPS) showed that the percentage of units offering exercise programs was 14% in Japan from 2009 to 2011, while 27 and 37% of the facilities offered ET in Europe or Australia/New Zealand and in North America, respectively [33].…”

Section: Discussionmentioning

confidence: 99%

Questionnaire survey on nutritional supplement therapy and exercise training at hemodialysis facilities in Japan

et al. 2017

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Background: Nutritional therapy and exercise training (ET) are important interventions for hemodialysis patients. We investigated the status of nutritional therapy and ET provided at hemodialysis facilities across Japan. Method: This was a cross-sectional study. The facilities investigated were 3993 facility member institutions of the Japanese Society for Dialysis Therapy in August 2015. Data was collected on the facility type, number of staff (doctors, nurses, and medic al engineers), presence of staff (clinical dietitians, pharmacists, and physical therapists), proportion of elderly patients (age ≥ 65 years), patients with albumin ≤ 3.5 g/dL, and types of oral nutritional supplements (ONS), intradialytic parenteral nutrition (IDPN), and ET in the facility. We summarized data on facilities and patient characteristics and calculated the proportion of the nutrition that were ONS, IDPN, and exercise interventions provided. We used multiple logistic analyses to examine the facility characteristics associated with the provision of nutritional support and ET. Results: We obtained responses from 1048 facilities (response rate 26.2%) and 88,492 patients (27.6%). Patients aged ≥ 65 years accounted for 63.4% of all investigated patients. Patients with Alb ≤ 3.5 g/dL accounted for 37.6% of all investigated patients. Meals during hemodialysis sessions were provided at 601 facilities (64%), ONS were used at 382 facilities (40%), and IDPN was administered at 471 facilities (46%). Exercise during hemodialysis sessions was provided at 190 facilities (20%). These trends did not change after adjustment of response rates by affiliations of facility type and region. At the patient level, only a limited number of patients were provided with ONS, IDPN, and ET, 2.1, 2.7, and 3.0%, respectively. ONS and IDPN were less likely to be offered in hospitals than in clinics without beds (odds ratio (OR) 0.21; 95% confidence interval (CI) 0.09-0.45) (OR 0.37; 95% CI 0.17-0.82). ET was also less likely to be offered in hospitals (OR 0.20; 95% CI 0.08-0.49). Conclusions: Nutritional support therapy is provided in a considerable number of hemodialysis facilities, ET is increasing but offered by fewer facilities compared to other countries, while a limited number of patients were provided with ET.

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“…Patients with CKD have reported severe limitations of daily activities as well as emotional difficulties including depression, anxiety, irrational fear, getting easily irritable, and mood swings (49). Studies in adults with CKD have shown positive effects of exercise on physical and emotional aspects of quality of life, and ability to continue to work and pursue academics (50)(51)(52).…”

Section: Effects Of Exercise On Quality Of Lifementioning

confidence: 99%

Chronic kidney disease and sports participation by children and adolescents

Raj¹,

Patel²,

Ramachandran³

2017

Transl. Pediatr.

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Individuals suffering from chronic kidney disease (CKD) deal with major morbidity and mortality including poor exercise tolerance. A variety of factors including anemia, poor muscle mass, cardiovascular changes and limited physical activity contribute to exercise intolerance. Studies suggest that early initiation of aerobic and resistance training improves the muscle function, ability to tolerate exercise and quality of life in CKD patients. A thorough medical examination and exercise testing are recommended before initiating an exercise regimen in individuals with CKD. Though current recommendations suggest a qualified approval to contact sports in patients with solitary kidney, a proper risk assessment and counselling must be provided detailing all the risks involved. Special care must be taken to avoid infection or damage to the peritoneal dialysis catheter and hemodialysis vascular access sites. Collision sports should be avoided in individuals with kidney transplant, ectopic kidney or with other urological abnormalities (severe hydronephrosis or ureteropelvic junction obstruction) with high risk of injury.

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Exercise Training in Hemodialysis Patients: A Systematic Review and Meta-Analysis

Abstract: Exercise training is safe and imparts large improvements in peak VO(2) , and heart rate variability.

Cited by 100 publications

References 24 publications

Akt1-Mediated Fast/Glycolytic Skeletal Muscle Growth Attenuates Renal Damage in Experimental Kidney Disease

Akt1-Mediated Fast/Glycolytic Skeletal Muscle Growth Attenuates Renal Damage in Experimental Kidney Disease

Questionnaire survey on nutritional supplement therapy and exercise training at hemodialysis facilities in Japan

Chronic kidney disease and sports participation by children and adolescents

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