Influence of Intradialytic Aerobic Training in Cerebral Blood Flow and Cognitive Function in Patients with Chronic Kidney Disease: A Pilot Randomized Controlled Trial

Belik, Fernanda Stringuetta; Silva, Viviana Rugolo Oliveira e; Braga, Gabriel Pereira; Bazan, Rodrigo; Vogt, Barbara; Júnior, João Garcia Caramori; Barretti, Pasqual; Gonçalves, Renato de Souza; Bôas, Paulo José Fortes Villas; Hueb, João Carlos; Martin, Luís Cuadrado; Franco, Roberto Jorge da Silva

doi:10.1159/000490005

Cited by 32 publications

(29 citation statements)

References 40 publications

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“…To date, there have been only two trials that have explored exercise as an intervention with secondary outcomes of cognitive function among patients undergoing dialysis [ 71 , 72 ]. The first trial was the Exercise Introduction to Enhance Performance in Dialysis (EXCITE) trial, a 6-month randomized, controlled, multicenter trial of adult patients of all ages undergoing dialysis [ 72 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the EXCITE trial, the second trial was a pilot randomized controlled trial studying intradialytic exercise as an intervention to preserve cognitive function [ 71 ]. This first pilot RCT of 30 adult (aged ≥18 years) patients undergoing hemodialysis evaluated the impact of a 4-month exercise intervention of intradialytic cycling and tested whether this aerobic exercise affected cerebral blood flow and cognitive function.…”

Section: Discussionmentioning

confidence: 99%

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Interventions Made to Preserve Cognitive Function Trial (IMPCT) study protocol: a multi-dialysis center 2x2 factorial randomized controlled trial of intradialytic cognitive and exercise training to preserve cognitive function

et al. 2020

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Background: Kidney disease and dialysis significantly impact cognitive function across the age spectrum. Cognitive training (CT) and/or exercise training (ET) are promising approaches to preserve cognitive function among communitydwelling older adults, but have not been tested for cognition preservation in hemodialysis patients of all ages. In this manuscript, we summarize the protocol for the Interventions Made to Preserve Cognitive Function Trial (IMPCT). Methods: We will perform a 2 × 2 factorial randomized controlled trial (RCT) of eligible adult (≥18 years) hemodialysis initiates (n = 200) to test whether intradialytic CT (brain games on a tablet PC), ET (foot peddlers) and combined CT + ET while undergoing hemodialysis preserves executive function compared to standard of care (SC). Participants will engage in the interventions to which they are randomized for 6 months. The primary objective is to compare, among interventions, the 3-month change in executive function measured using the Trail Making Test A (TMTA) and B (TMTB); specifically, executive function is calculated as TMTB-TMTA to account for psychomotor speed. This primary outcome was selected based on findings from our pilot study. The secondary objectives are to compare the risk of secondary cognitive outcomes, ESKD-specific clinical outcomes, and patient-centered outcomes at 3-months and 6-months. All data collection and interventions are conducted in the dialysis center. Discussion: We hypothesize that receiving intradialytic CT or ET will better preserve executive function than SC but receiving combined CT + ET, will be the most effective intervention. The current trial will be an important step in understanding how intradialytic interventions might preserve cognitive health.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Interventions Made to Preserve Cognitive Function Trial (IMPCT) study protocol: a multi-dialysis center 2x2 factorial randomized controlled trial of intradialytic cognitive and exercise training to preserve cognitive function

et al. 2020

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“…One pilot randomized controlled trail of 30 adult HD patients aged 18 years and older assessed the impact of 4 months of intradialytic cycling for aerobic exercise on cerebral blood flow and cognitive function. The study found that the ET group (N = 15) demonstrated improvement in cognitive function and basilar maximum blood flow velocity compared to a control group (N = 15), as well as a greater proportion of arteries with increased flow velocity …”

Section: Introductionmentioning

confidence: 95%

“…Exercise training (ET), is an effective nonpharmacological intervention to preserve global cognitive function, with the greatest observed impact on executive function in community‐dwelling older adults . Even prior to improving physical function and strength, ET in older adults improves executive function through increased: (a) cerebral blood flow; (b) brain volume in the prefrontal cortex and hippocampus; (c) brain‐derived neurotrophic factor; and (d) engagement of neural structures. ET reduces inflammatory markers, including C‐reactive protein, tumor necrosis factor alpha, and IL‐6, resulting in improved brain plasticity and executive function .…”

Section: Introductionmentioning

confidence: 99%

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Exercise and cognitive function in patients with end‐stage kidney disease

Chu

McAdams‐DeMarco

2019

Seminars in Dialysis

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In this review we summarize the research pertaining to the role of exercise in preventing cognitive decline in patients with end‐stage kidney disease (ESKD). Impairment in cognitive function, especially in executive function, is common in patients with ESKD, and may worsen with maintenance dialysis as a result of retention of uremic toxins, recurrent cerebral ischemia, and high burden of inactivity. Cognitive impairment may lead to long‐term adverse consequences, including dementia and death. Home‐based and intradialytic exercise training (ET) are among the nonpharmacologic interventions identified to preserve cognitive function in ESKD. Additionally, cognitive training (CT) is an effective approach recently identified in this population. While short‐term benefits of ET and CT on cognitive function were consistently observed in patients undergoing dialysis, more studies are needed to replicate these findings in diverse populations including kidney transplant recipients with long‐term follow‐up to better understand the health and quality of life consequences of these promising interventions. ET as well as CT are feasible interventions that may preserve or even improve cognitive function for patients with ESKD. Whether these interventions translate to improvements in quality of life and long‐term health outcomes, including dementia prevention and better survival, are yet to be determined.

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