Isolated Effects of Renal Failure, Anthropometric Indices, and Serum Total Iron-Binding Capacity as Determinants of Muscle Performance in Hemodialysis Patients

Ponikvar

et al. 2020

Sci Rep

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Intradialytic cycling is a widely used workout mode, whereas added benefit of other exercise modalities remains unknown. This is the first randomised controlled trial on the effects and sustainability of functional training and counselling in addition to intradialytic cycling. patients were randomly assigned to a kinesiologist-guided functional training in addition to intradialytic cycling (n = 20, experimental group) or intradialytic cycling only (n = 20, control group) over 16 weeks. The experimental group attended predialysis functional exercise in the first eight weeks and afterward performed functional training at home for the next eight weeks. The primary study endpoint was 10-repetition-sit-to-stand test time at eight weeks: at this test, the experimental group improved significantly better than controls (−4.5 ± 1.9 s, 95%CI −8.4 to −0.7; P = 0.021), which was maintained at week 16 (−4.7 ± 2.1 s, 95%CI −9.0 to −0.3; P = 0.037). At week 8, the experimental group significantly outperformed controls also at handgrip strength (P = 0.004), lower body flexibility test (P < 0.001), balance test (P < 0.001), and upper body flexibility test (P = 0.003). At week 16, superior results of the experimental group in secondary end-points remained preserved for handgrip strength, balance, and upper body flexibility tests. Functional training with exercise counselling meaningfully improves physical performance and successfully prepares patients for sustainable home exercise. Intradialytic exercise on a customized ergometer (cycling) is currently the most common mode of in-centre exercise among haemodialysis (HD) patients 1,2. This exercise mode is well feasible, time-efficient, can be easily supervised 1 and has shown numerous improvements in aerobic capacity 3-6 , functional performance 7-9 , HD efficiency (improved Kt/V) 1 , and quality of life 1,5,7. It could be perceived as the current standard of physical training in the HD population. However, the comparative data on the efficiency and sustainability of various types of exercise modes are lacking. With the previous studies showing a minimal efficacy of intradialytic cycling on the functional performance of HD patients 7,9-12 , we need innovative strategies to improve the outcome and sustainability of dialysis exercise programs. Functional training simulates activities of daily living 13 and targets the neuromuscular system to train movements that activate both the nervous system and the muscle groups 14. Functional training is performed as a combination of lower and upper body movements including various multi-joint activities 15. A systematic review among older adults, including 13 trials with 1139 participants, demonstrated positive effects of functional training on muscle strength, physical functioning, and activities of daily living 16. The authors stated that functional training, which imitates specific performance, confers the best performance gains. HD patients have largest functional deficits in flexibility, balance, and lower extremity functions 17. These are...

Section: Methodsmentioning

confidence: 99%

Kinesiologist-guided functional exercise in addition to intradialytic cycling program in end-stage kidney disease patients: a randomised controlled trial

Bogataj

Ponikvar

et al. 2020

Sci Rep

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“…We have previously shown that age, body height, and lean tissue index (LTI) predict 10-repetition sit-to-stand (STS-10) test performance [ 11 ]. Therefore, we adjusted for these factors in the models incorporating individual uremic toxins and other markers as predictors of STS-10 results.…”

Section: Resultsmentioning

confidence: 99%

“…The exact description of the research protocol and measurements was given previously [ 4 , 11 , 32 ]. In short, physical performance tests were performed in the afternoon hours on non-dialysis days (mean time lag from the last dialysis session was 25 ± 6 h).…”

Section: Methodsmentioning

confidence: 99%

“…For each uremic toxin, a separate model—including selected demographic and non-modifiable anthropometric variables (such as height)—was calculated. We only adjusted for those case-mix and non-modifiable anthropometric variables that we previously showed to be significantly associated with physical performance test results analyzed here (1st model) [ 3 , 4 , 11 ]. The body composition indices LTI and FTI were considered to be modifiable parameters that may lie in the causal pathway from uremic toxin level to the physical performance measurement.…”

Section: Methodsmentioning

confidence: 99%

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Association of Uremic Toxins and Inflammatory Markers with Physical Performance in Dialysis Patients

Jerman

Osredkar

et al. 2018

Toxins

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Association of higher serum levels of uremic toxins and inflammatory markers with poorer physical performance is understudied. We measured the six-minute walk test (6MWT), 10 repetition sit-to-stand test (STS-10), handgrip strength (HGS), and Human Activity Profile (HAP) questionnaire score in 90 prevalent hemodialysis patents, with low comorbidity to reduce the potential confounding of concomitant disease. Midweek pre-dialysis serum levels of asymmetric dimethyl-arginine (ADMA), β2-microglobulin (B2M), high-sensitivity C-reactive protein (hs-CRP), indoxyl sulfate (IS), insulin-like growth factor 1 (IGF-1), interleukin 6 (IL-6), myostatin, and urea were analyzed as predictor parameters of physical performance measures in adjusted models. Serum levels of most measured toxins were not significantly related to performance, except for ADMA, which was significantly related to poorer performance in the STS-10 test (B = 0.11 ± 0.03 s, p < 0.01). Higher hs-CRP was associated with poorer results in the 6MWT (B = −2.6 ± 0.97 m, p < 0.01) and a lower HAP score (B = −0.36 ± 0.14, p = 0.01). There were no other significant associations found. We conclude that inflammation may be a more important pathway to physical impediment than uremic toxemia. This suggests that there is a large physical rehabilitation potential in non-inflamed uremic patients.

“…Chronic kidney disease (CKD) has become a public health problem that affects 8%-16% of the population worldwide [1]. CKD patients typically lead very sedentary lifestyles [2], which contributes to increased risk of cardiovascular disease [3], decreased physical function [4][5][6], muscle wasting [7], and overall reduced quality of life [8]. Hemodialysis (HD) is one of the main methods of renal replacement therapies that are employed to treat advanced kidney disease [9].…”

Section: Introductionmentioning

confidence: 99%

Outcome Expectations for Exercise and Decisional Balance Questionnaires Predict Adherence and Efficacy of Exercise Programs in Dialysis Patients

Bogataj

Ponikvar

et al. 2020

IJERPH

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The purpose of this study was to define if Outcomes Expectations for Exercise (OEE) and Decisional Balance (DB) scales predict adherence to guided exercise programs and associate with the improvement in physical performance in the dialysis population. Participants (n = 40; age 63.6 ± 12.5 years) completed OEE and DB questionnaires before randomization to the experimental group (n = 20) and control group (n = 20) of a two-phased exercise program—the experimental group received eight weeks of supervised functional exercise and exercise counseling (1st phase) before commencing eight weeks of home-based exercise on non-dialysis days (2nd phase). Both groups performed intradialytic cycling on dialysis days during both study phases. Patients with above-median OEE and DB scores (>3.15 and >1.3, respectively) expressed significantly better adherence to intradialytic cycling (89% vs. 76%, 89% vs. 77%, respectively, p < 0.05). Experimental group patients with an above-median OEE (but not DB) score had significantly better adherence to supervised and home-based functional exercise (93% vs. 81% and 85% vs. 60%, respectively, p < 0.05). Baseline DB score predicted the final result in the hand-grip test and 6-min walk test. Low OEE and, to a lesser degree, low DB questionnaire scores associate with inferior adherence to dialysis bundled and home-based exercise programs and may help define patient subsets in need of intensified motivational input by exercise caregivers.