Improved Glucose Tolerance after High-Load Strength Training in Patients Undergoing Dialysis

Abstract

Background/Aims: The aim of this controlled study was to investigate the effect of high-load strength training on glucose tolerance in patients undergoing dialysis. Methods: 23 patients treated by dialysis underwent a 16-week control period followed by 16 weeks of strength training three times a week. Muscle fiber size, composition and capillary density were analyzed in biopsies obtained in the vastus lateralis muscle. Glucose tolerance and the insulin response were measured by a 2-hour oral glucose tolerance test. Results: All outcome measures remained unchanged during the control period. After strength training the relative area of type 2X fibers was decreased. Muscle fiber size and capillary density remained unchanged. After the strength training, insulin concentrations were significantly lower in patients with impaired glucose tolerance or type 2 diabetes (n = 14) (fasting insulin from 68 ± 12 (46-96) to 54 ± 10 (37-77) pmol/l, p < 0.05, 2-hour insulin from 533 ± 104 (356-776) to 344 ± 68 (226-510) pmol/l, p < 0.05, total insulin area under the curve from 1,868 ± 334 (1,268-2,536) to 1,465 ± 222 (1,094-1,913), p < 0.05). Insulin concentrations were unchanged in patients with normal glucose tolerance (n = 9). Conclusion: The conducted strength training was associated with a significant improvement in glucose tolerance in patients with impaired glucose tolerance or type 2 diabetes undergoing dialysis. The effect was apparently not associated with muscle hypertrophy, whereas the muscle fiber type composition was changed.

Progressive Resistance Training in End-Stage Renal Disease: Systematic Review

“…Skeletal Muscle and Protein-Energy Malnutrition Nine trials [26,28,30,31,[34][35][36][37][38][39][43][44][45][46][47] , including 7 RCT with a mean quality score of 7.6/10 [26,28,30,31,[34][35][36][37] have investigated the effect of PRT on measures of skeletal muscle hypertrophy. The majority of these studies have shown that PRT prescribed for a minimum of 12 weeks, both during [26,31,34,35,[37][38][39] or outside of dialysis treatment [28,46] can induce statistically significant increases in one or more measures of hypertrophy, including muscle size and quality (attenuation).…”

“…Of the 16 trials, 11 were RCT [26][27][28][29][30][31][32][33][34][35][36][37] , 4 were singletreatment, group-uncontrolled trials [20,[38][39][40][41][42] and one trial by Molsted et al [43][44][45][46][47] involved both a withinsubjects control period and an RCT comparing PRT + protein drink to PRT + placebo drink.…”

“…Greece, Switzerland, Denmark, and Wales), 3 in Brazil, 2 in Asia (Iran, South Korea) and 2 in Australia. All studies enrolled exclusively maintenance HD patients with the exception of one study that also enrolled 5 peritoneal dialysis patients [43][44][45][46][47] . All studies included patients who were adequately dialyzed (Kt/V >1.2) and/ or had received HD treatment for more than 3 months.…”

“…RCT quality ranged from low (4/10) to high (10/10) with a mean quality score of 7.3/10, while 7/11 (64%) RCT had a quality score ≥ 7.5. The trial by Molsted et al [43][44][45][46][47] had a quality score of 9.5/10. The 4 uncontrolled trials had a quality rating ranging from 5/10 to 6/10.…”

“…Seven trials have investigated the effect of PRT on circulating CRP producing mixed results [30,32,34,36,38,42,47] . Three trials [32,34,38] , including 2 RCT [32,34] , have shown reduced CRP after 12 or 24 weeks of PRT, while 3 trials prescribing 16 or 24 weeks of PRT reported no change [30,36,47] . One uncontrolled trial [42] reported a reduction in CRP but did not analyze this change statistically.…”