Patients with end-stage renal disease (ESRD) have poor physical performance and reduced exercise capacity due to frequent haemodialysis treatments.
OBJECTIVE:
The aim of the study was to determine the effectiveness of a three-month endurance training programme in patients with ESRD.
METHODS:
In order to improve both functional fitness and skeletal muscle properties, movement therapy-cycle ergometer, was applied in eligible ESRD patients during dialysis. The study included 40 dialysis patients, but only 27 patients completed the full three-month training during each haemodialysis treatment. Before and after training, all patients underwent observations according to the established protocol: functional capacity - Six-Min Walk Test, agility - Timed Up and Go test, and muscle strength testing under isokinetic conditions at 60, 180 and 300°/s.
RESULTS:
Patients covered significantly longer distances in the 6MWT with a higher gait intensity after the 3 months training programme: the 6MWT increased from 360.8 to 390.2 m and metabolic equivalent from 2.74 to 2.85. The TUG significantly decreased in both women and men: from 9.07 to 7.51 s, and from 9.64 s to 7.4 s, respectively. The knee extension peak moment at 60 and 180°/s was significantly higher in women than in men following training. In addition, the women demonstrated more significant changes in flexor muscles at all angular velocities.
CONCLUSIONS:
Three-month endurance training was effective in patients with ESRD in improving both functional fitness and skeletal muscle properties.
RutkowskiB, GrendaR, SuƚowiczW, Dȩbska-ŚlizieńA. Position statement of the Polish Nephrology Consultant's Working Group concerning wider introduction of hemodiafiltration. Forum Nefrol2011; 4: 272-276.
2.
JohansenKL, ChertowGM, NgAV, MulliganK, CareyS, SchoenfeldPY, et al. Physical activity levels in patients on hemodialysis and healthy sedentary controls. Kidney Int2000; 57: 2564-2570.
3.
PainterP, Messer-RahakD, HansonP, ZimmermanSW, GlassNR. Exercise capacity in hemodialysis, CAPD and renal transplant patients. Nephron1986; 42: 47-51.
4.
JohansenKL, DoyleJ, SakkasGK, Kent-BraunJA. Neural and metabolic mechanisms of excessive muscle fatigue in maintenance hemodialysis patients. Am J Physiol Regul Integr Comp Physiol2005; 289: 805-813.
5.
McIntyreCW, SelbyNM, SigristM, PearceLE, MercerTH, NaishPF. Patients receiving maintenance dialysis have more severe functionally significant skeletal muscle wasting than patients with dialysis-independent chronic kidney disease. Nephrol Dial Transplant2006; 21: 2210-2216.
6.
JohansenKL, KaysenGA, YoungBS, HungAM, da SilvaM, ChertowGM. Longitudinal study of nutritional status, body composition, and physical function in hemodialysis patients. Am J Clin Nutr2003; 77: 842-846.
7.
GoƚȩbiowskiT, WeydeW, KusztalM, SzymczakM, MadziarskaK, PenarJ, et al. Physical exercise in the rehabilitation of dialysis patients. Postȩpy Hig Med Dosw2009; 63: 13-22.
8.
KrauseR. Nephrologists' view on exercise training in chronic kidney disease (results of the questionnaire at the WCN 2003). Clin Nephrol2004; 61: 2-4.
9.
SakkasGK, SargeantAJ, MercerTH, BallD, KoufakiP, KaratzaferiC, et al. Changes in muscle morphology in dialysis patients after 6 months of aerobic exercise training. Nephrol Dial Transplant2003; 18: 1854-1861.
10.
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med2002; 166: 111-117.
11.
ConnorsG. Planowanie i stosowanie programów rehabilitacji pulmonologicznej. Ocena wydolności wysiƚkowej i trening. In: Planowanie i stosowanie programów rehabilitacji pulmonologicznej wedƚug zaleceń Amerykańskiego Stowarzyszenia Rehabilitacji Kardiologicznej i Pulmonologicznej. Rehabilitacja Medyczna. Connors GL, Hilling L, eds, 1999, pp. 45-54.
12.
PodsiadloD, RichardsonS. The timed ``Up & Go'': A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc1991; 39: 142-148.
KannusP. Isokinetic evaluation of muscular performance: Implications for muscle testing and rehabilitation. Int J Sports Med1994; 15: 11-18.
15.
MancaA, SolinasG, DragoneD and DeriuF. Isokinetic testing of muscle performance: New concepts for strength assessment. Isokinet Exerc Sci2015; 23: 69-75.
16.
CheemaBSB, Fiatarone SinghMA. Exercise training in patients receiving maintenance hemodialysis: A systematic review of clinical trials. Am J Nephrol2005; 25: 352-364.
17.
DayML, McGuiganMR, BriceG, FosterC. Monitoring exercise intensity during resistance training using the session RPE Scale. J Strength Con Res2004; 18: 353-358.
18.
Segura-OrtíE. Exercise in haemodyalisis patients: A literature systematic review. Nefrologia2010; 30: 236-246.
19.
MagnardJ, DeschampsT, CornuC, ParisA, HristeaD. Effects of a six-month intradialytic physical ACTIvity program and adequate NUTritional support on protein-energy wasting, physical functioning and quality of life in chronic hemodialysis patients: Actinut study protocol for a randomised controlled trial. BMC Nephrol2013; 14: 259-267.
20.
DePaulV, MorelandJ, EagerT, ClaseCM. The effectiveness of aerobic and muscle strength training in patients receiving hemodialysis and EPO: A randomized controlled trial. Am J Kidney Dis2002; 40: 1219-1229.
GoƚȩbiowskiT, KusztalM, WeydeW, DziubekW, WoźniewskiM, MadziarskaK, et al. A program of physical rehabilitation during hemodialysis sessions improves the fitness of dialysis patients. Kidney Blood Press Res2012; 35: 290-296.
23.
KonstantinidouE, KoukouvouG, KouidiE, DeligiannisA, TourkantonisA. Exercise training in patients with end-stage renal disease on hemodialysis: comparison of three rehabilitation programs. J Rehabil Med2002; 34: 40-45.
24.
KouidiE, AlbaniM, NatsisK, MegalopoulosA, GigisP, Guiba-TziampiriO, et al. The effects of exercise training on muscle atrophy in haemodialysis patients. Nephrol Dial Transplant1998; 13: 685-699.
25.
KouidiE, GrekasD, DeligiannisA, TourkantonisA. Outcomes of long-term exercise training in dialysis patients: Comparison of two training methods. Clin Nephrol2004; 61: 31-38.
26.
PainterP, CarlsonL, CareyS, PaulSM, MyllJ. Physical functioning and health-related quality-of-life changes with exercise training in hemodialysis patients. Am J Kidney Dis2000; 35: 482-492.
27.
ParsonsTL, ToffelmireEB, King-VanVlackCE. Exercise Training During Hemodialysis Improves Dialysis Efficacy and Physical Performance. Arch Phys Med Rehabil2006; 87: 680-687.
28.
StorerTW, CasaburiR, SawelsonS, KoppleJD. Endurance exercise training during haemodialysis improves strength, power, fatigability and physical performance in maintenance haemodialysis patients. Nephrol Dial Transplant2005; 20: 1429-1437.
29.
van VilsterenMC, de GreefMH, HuismanRM. The effects of a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counseling for sedentary haemodialysis patients in The Netherlands: Results of a randomized clinical trial. Nephrol Dial Transplant2005; 20: 141-146.
30.
Chojak-FijaƚkaK, SmoleńskiO. Rehabilitacja chorych przewlekle dializowanych - wyniki badań wƚasnych. Problemy Lekarskie2006; 45: 247-256.
31.
DieselW, EmmsM, KnightBK, NoakesTD, SwanepoelCR, van Zyl SmitR, et al. Morphologic features of the myopathy associated with chronic renal failure. Am J Kidney Dis1993; 22: 677-684.
32.
da FonsecaST, VazDV, de AquinoCF, BricioRS. Muscular co-contraction during walking and landing from a jump: Comparison between genders and influence of activity level. J Electromyogr Kinesiol2006; 16: 273-280.
33.
MagnardJ, HristeaD, LefrancoisG, TestaA, ParisA, DeschampsT. Implicit postural control strategies in older hemodialysis patients: An objective hallmark feature for clinical balance assessment. Gait Posture2014; 40: 723-726.
34.
DziubekW, BulińskaK, RogowskiȽ, GoƚȩbiowskiT, KusztalM, GrocholaM, MarkowskaD, Zembroń-ȽacnyA, WeydeM, KlingerM, WoźniewskiM. The effect of aquatic exercises on physical fitness and muscle function in dialysis patients, Biomed Research International, 2015; vol. 2015; art. ID 912980 [9 s.].
