The Effect of Interdialytic Combined Resistance and Aerobic Exercise Training on Health Related Outcomes in Chronic Hemodialysis Patients: The Tunisian Randomized Controlled Study

Frih, Bechir; Jaafar, Hamdi; Mkacher, Wajdi; Salah, Z. Ben; Hammami, Mohamed; Frih, A.

doi:10.3389/fphys.2017.00288

Cited by 56 publications

(81 citation statements)

References 63 publications

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“…Combined [35,37,[39][40][41][42][43][44][45][46] and resistance exercise [33,34,36,38,47,48] were the next most common. Three times per week was the most popular exercise frequency, followed by two times per week [37] and four [44] times per week. In the majority of cases, the intervention was performed during the dialysis procedure.…”

Section: Study Characteristicsmentioning

confidence: 99%

Exercise-Based Interventions in Hemodialysis Patients: A Systematic Review with a Meta-Analysis of Randomized Controlled Trials

Bogataj

Pajek

et al. 2019

JCM

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There is a lack of agreement on the efficacy of different exercise interventions in hemodialysis patients. We analyzed which exercise type is the most beneficial in terms of functional fitness and inflammation. A literature search of seven databases yielded 33 studies that met the inclusion criteria. Compared with an inactive control, the intervention group showed moderate effects (ES = 0.74; 95% CI 0.35 to 1.14; p < 0.001; and ES = 0.70; 95% CI 0.39 to 1.01; p < 0.001; respectively) on functional capacity (six-minute walk test) and oxygen consumption. Small nonsignificant effects were observed for aerobic (ES = −0.36; 95% CI −0.85 to 0.13; p = 0.154) and resistance (ES = −0.44; 95% CI −1.07 to 0.19; p = 0.169) training types, whereas moderate effects were found for combined (ES = −0.69; 95% CI −1.47 to 0.10; p = 0.088) training type based on a 10-repetition sit-to-stand test. Further, large and small effects were observed for aerobic (ES = −1.21; 95% CI −1.94 to −0.49; p = 0.001) and resistance training (ES = −0.54; 95% CI −0.90 to −0.17; p = 0.004) types on C-reactive protein. Overall, the results showed the numerically largest effect sizes for combined types compared to solely aerobic or resistance training types, with the differences between training types not reaching statistical significance. There was a significant modifying impact of age, training frequency, and session duration on performance and inflammatory outcomes.

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Section: Study Characteristicsmentioning

confidence: 99%

Exercise-Based Interventions in Hemodialysis Patients: A Systematic Review with a Meta-Analysis of Randomized Controlled Trials

Bogataj

Pajek

et al. 2019

JCM

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“…Improvements in both systolic and diastolic BP (measured by 24‐hour ambulatory BP monitoring) were demonstrated by a randomized controlled trial of 50 patients on hemodialysis undertaking inter‐dialytic aerobic and resistance training, although a larger study by Manfredini et al found that 6‐months home‐based walking exercise had no significant effect on blood pressure. It should be noted that this study was of moderate intensity walking and included both hemodialysis (n = 192) and peritoneal dialysis patients (n = 35).…”

Section: Effects Of Exercise On Blood Pressurementioning

confidence: 99%

“…Several small studies have reported the effects of exercise on these traditional risk factors, but given that traditional risk factors do not explain the excess cardiovascular morbidity and mortality in patients on hemodialysis, the relative importance on possible reductions in these variables needs to be questioned. Small, noncontrolled studies of inter and intra dialytic aerobic training have suggested that structured programs of exercise improve triglyceride control and promote favorable alterations in lipid profile . Supporting this, a pilot randomized trial by Wilund et al suggested that IDC led to a reduction in the atherogenic index of plasma and epicardial fat thickness (proposed as a determinant of CVD and implicated in pathogenesis) …”

Section: Effects Of Exercise On Traditional and Non‐traditional Cardimentioning

confidence: 99%

“…| 363 lipid profile. 28,46,47 There are no strong randomized clinical trial data to suggest exercise improves the lipid profiles of patients on hemodialysis.…”

Section: Future Researchmentioning

confidence: 99%

“…Certain studies have implemented combined aerobic and resistance exercise programs, 28,29 others have assessed the effects of exercise programs in combination with lifestyle or dietary interventions. 30 In health and disease states, aerobic and resistance exercise training have distinct physiological effects, so an appreciation of these differences is essential when interpreting cardiorespiratory adaptations to exercise programs in hemodialysis patients.…”

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confidence: 99%

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Cardiovascular adaptations associated with exercise in patients on hemodialysis

Graham-Brown

Jardine

Burton

2019

Seminars in Dialysis

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Patients on hemodialysis are physically inactive. Less than 50% of hemodialysis patients undertake exercise once a week and such patients have increased mortality compared to patients who undertake regular exercise. The reasons for physical inactivity and reduced functional capacity are complex and inter‐related, with skeletal muscle catabolism, chronic inflammation, anemia, malnutrition, uremia, the burden of co‐morbid diseases, and “enforced” sedentary time during hemodialysis all contributing. Many of these factors drive cardiovascular disease (CVD) processes in this cohort of patients and in the general population, exercise interventions have been shown to modify many of these risk factors. Whilst there is increasing evidence about the beneficial effects of exercise interventions on quality of life, functional capacity, aerobic fitness, and muscular strength, there are few compelling data on the effects of such programs on cardiovascular outcome measures. The reasons for this are manifold and include: limitations in study size; inconsistencies in study design; the heterogeneous nature of exercise interventions; assessment of nonstandardized outcome measures and; a lack of understanding of what changes in certain traditional measures of CVD (such as blood pressure or lipid profile) mean for patients on hemodialysis. This review summarizes the current evidence base for the effects of exercise on traditional and nontraditional cardiovascular risk factors and the effects of exercise interventions on cardiovascular structure and function, including a review of study limitations and future research priorities.

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