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Takahashi R, Yabe H, Ishikawa H, Hibino T, Morishita S, Kono K, Moriyama Y, Yamada T. The impact of malnutrition on the effectiveness of intradialytic exercise in hemodialysis patients: amulticenter cohort study. Int Urol Nephrol 2024; 56:2093-2101. [PMID: 38334912 DOI: 10.1007/s11255-024-03952-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/06/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE Low physical function can be effectively improved via intradialytic exercise. However, the association between the effects of intradialytic exercise on physical function and malnutrition severity has not been studied extensively. This study aimed to investigate the impact of nutritional status severity on physical function in patients undergoing hemodialysis with low physical function to whom intradialytic exercise was prescribed. METHODS The participants were patients with decreased mobility [walking speed < 1.0 m/s and/or Short Physical Performance Battery (SPPB) < 12] who had been undergoing hemodialysis thrice a week for 6 months and performing intradialytic exercise program. Patients were divided into groups based on the Geriatric Nutritional Risk Index (GNRI) [Non-malnutrition group (GNRI > 98), Gentle/slim malnutrition group (GNRI ≤ 98, GNRI ≥ 92), Mild malnutrition group (GNRI < 92, GNRI ≥ 82), Severe malnutrition group (GNRI < 82)]. The primary outcomes were Grip strength, isometric knee extension strength (IKES), SPPB, and 10-m walking speed measured at baseline and at 6 months. Statistical analyses were performed using a linear mixed-effects model with the intention-to-treat analysis, including within-group analysis and between-group comparison. RESULTS A total of 805 participants were included in the study. Within-group comparisons showed significantly improved IKES, 10-m walking speed, and SPPB improved, except in the Severe malnutrition group. Grip strength significantly improved in the Gentle/slim and mild malnutrition groups. Between-group comparison with controls showed that the improvement in Grip strength was significantly bigger in the Gentle/slim malnutrition group [0.98 (0.15 to 1.82) kg] than in the non-malnutrition group. However, IKES in the Severe malnutrition group [- 5.14 (- 9.18 to - 1.10) %] less significantly improve than that in the non-malnutrition group. No significant differences were found in the other indices. CONCLUSION In patients with severe malnutrition, the changes in IKES scores resulting from Intradialytic exercise were significantly smaller than those observed in non-malnourished patients. Therefore, it is necessary to initiate suitable nutritional and exercise therapy based on the severity of malnutrition.
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Affiliation(s)
- Ren Takahashi
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan.
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Shizuoka, Japan.
| | - Hiroki Yabe
- Department of Physical Therapy, School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Shizuka, Japan
| | - Hideaki Ishikawa
- Department of Internal Medicine, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Takashi Hibino
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Sayumi Morishita
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Kenichi Kono
- Department of Physical Therapy, International University of Health and Welfare School of Health Science at Narita, Narita, Chiba, Japan
| | - Yoshifumi Moriyama
- Department of Wellness Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Tetsuya Yamada
- Dialysis Division, Kaikoukai Healthcare Group, Nagoya, Aichi, Japan
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Takahashi R, Yabe H, Ishikawa H, Hibino T, Yamaguchi T, Morishita S, Kono K, Moriyama Y, Yamada T. Age-associated effects of intradialytic exercise on physical function and nutritional status in patients receiving ambulatory hemodialysis: A multicenter cohort study. Hemodial Int 2024; 28:117-124. [PMID: 37935650 DOI: 10.1111/hdi.13128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Intradialytic exercise is essential for improving physical function for older patients. This study aimed to examine the relationship between the effects of exercise therapy and aging. METHODS This multicenter cohort study included 1176 patients aged 40-89 years, who participated in an intradialytic exercise program, comprising stretching and resistance training, three times per week for 12 months. Isometric knee extension strength (IKES), 10-m walking speed, Short Physical Performance Battery (SPPB), and Geriatric Nutritional Risk Index (GNRI) were measured at baseline and after 12 months. The patients were divided according to age as follows: 40-59, 60-69, 70-79, and 80-89 years. A linear mixed-effects model examined the improvement within-group and between-control differences, as the 40-59 age group was the control group. FINDINGS The 40-59, 60-69, 70-79, and 80-89 age groups comprised 180, 317, 466, and 213 participants, respectively. Within-group differences, all the age groups significantly improved IKES and SPPB. The 10-m walking speed [0.02 (0.02) m/s] and GNRI [0.38 (0.33)] did not improved only in the 80-89 age group despite other age groups significantly improved. Between-control differences, IKES of the 70-79 age group [-0.24 (-0.42 to -0.06) %] was significantly lower improvement than control. GNRI of all the older groups were significantly smaller improvement than control (p < 0.05). DISCUSSION The older group demonstrated difficulty in improving walking ability and nutritional status compared with the younger groups. Clinicians need to consider the difference in effectiveness due to age and prescribe intradialytic exercises accordingly.
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Affiliation(s)
- Ren Takahashi
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Shizuoka, Japan
| | - Hiroki Yabe
- Department of Physical Therapy, Seirei Christopher University, School of Rehabilitation, Hamamatsu, Shizuoka, Japan
| | - Hideaki Ishikawa
- Department of Internal medicine, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Takashi Hibino
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Tomoya Yamaguchi
- Department of Rehabilitation, Hamamatsu University Hospital, Hamamatsu, Shizuoka, Japan
| | - Sayumi Morishita
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Kenichi Kono
- Department of Physical Therapy, International University of Health and Welfare, School of Health Sciences at Narita, Kozunomori, Narita, Chiba, Japan
| | - Yoshifumi Moriyama
- Department of Wellness Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Tetsuya Yamada
- Department of Dialysis Division, Kaikoukai Healthcare Group, Nagoya, Aichi, Japan
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Takahashi R, Yabe H, Hibino T, Yamaguchi T, Morishita S, Kono K, Moriyama Y, Yamada T. Influence of Malnutrition on the Improvement of Physical Function by Intradialytic Resistance Exercise in Patients Undergoing Hemodialysis. J Ren Nutr 2023; 33:346-354. [PMID: 36179956 DOI: 10.1053/j.jrn.2022.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/20/2022] [Accepted: 09/18/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Intradialytic exercise improves physical function. However, malnutrition may be an essential factor affecting the effectiveness of exercise to improve physical function. Few studies of the relationship between malnutrition and the effectiveness of intradialytic exercise to improve physical function exist. Therefore, this study investigated malnutrition at the beginning of intradialytic exercise and how it affects the subsequent improvement in physical function. METHODS Patients who performed intradialytic exercise for 12 months were enrolled in this study. A Geriatric Nutritional Risk Index of 91.2 was defined as malnutrition. Patients were assigned to 2 groups using propensity score matching to adjust for confounding factors. Physical function outcomes were handgrip strength, isometric knee extension strength, short physical performance battery, and 10-m walking speed; these were compared at baseline, 3 months, 6 months, and 12 months. The 2 groups were further divided into another 2 groups as per whether the nutritional status had improved after 12 months; therefore, a total of 4 groups were analyzed. RESULTS After matching, the data of 154 patients in each group were analyzed. During the intragroup comparison, isometric knee extension strength, short physical performance battery, and 10-m walking speed improved significantly in both groups after intradialytic exercise was started compared with before intradialytic exercise was started. However, there was no significant improvement in handgrip strength in the malnutrition group. There were no significant differences in any of the physical function measurements or changes from the baseline values among the 4 groups divided as per subsequent recovery of the nutritional status. CONCLUSION Malnutrition may not impact the effectiveness of intradialytic exercise to improve lower-leg physical function. Its effect on the improvement of handgrip strength requires further investigation.
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Affiliation(s)
- Ren Takahashi
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan.
| | - Hiroki Yabe
- Department of Physical Therapy, School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Shizuka, Japan
| | - Takashi Hibino
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Tomoya Yamaguchi
- Department of Rehabilitation, Hamamatsu University Hospital, Hamamatsu, Shizuoka, Japan
| | - Sayumi Morishita
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Kenichi Kono
- Department of Physical Therapy, International University of Health and Welfare School of Health Science at Narita, Narita, Chiba, Japan
| | - Yoshifumi Moriyama
- Department of Wellness Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Tetsuya Yamada
- Dialysis division, Kaikoukai Healthcare Group, Nagoya, Aichi, Japan
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Pavlin L, Rodriguez A, Ohresser I, Larivière M, Portal C, Cristol JP, Bernardi H, Turc-Baron C, Candau R. Does the interference phenomenon affect strength development during same-session combined rehabilitation program in hemodialysis patients? Semin Dial 2021; 35:154-164. [PMID: 34751456 DOI: 10.1111/sdi.13033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/07/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study aimed to assess if an interference effect could blunt the neuromuscular gains induced by a same-session combined rehabilitation in hemodialysis (HD) patients. METHODS Patients exercised twice a week, for 16 weeks, over their HD sessions. They were either always trained with resistance and endurance exercises (continuous training, "CONT") or alternatively with 1 week of resistance alternated with 1 week of endurance (discontinuous training, "DISC"). Adherence and workload were continuously recorded. Short Physical Performance Battery (SPPB) score, one-leg balance test, and handgrip and quadriceps strength were evaluated before and after training intervention. RESULTS Adherence to both programs was high (>90%). SPPB score had significantly improved (CONT: +1.5 point, DISC: +1.2 pt, p < 0.001), like one-leg balance test (CONT: +3.7 s, DISC: +5.5 s, p < 0.05), handgrip strength of exercised (CONT: +5.5 kg, DISC: +5.6 kg, p < 0.001) and of nonexercised arm (CONT: +4.4 kg, DISC: +2.8 kg, p < 0.01) as well as maximal quadriceps strength (+22 N·m for dominant and +29 N·m for nondominant leg in both groups, p < 0.001) bearing no difference between the trainings. CONCLUSION Same-session combined training does not induce an interference effect in HD patients and temporal separation of exercises does not optimize strength gains. These practical data may be relevant for clinicians and practitioners to alternate endurance and resistance exercises.
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Affiliation(s)
- Laura Pavlin
- DMEM, UMR866, INRAE, University of Montpellier, Montpellier, France.,Fondation Charles Mion - AIDER Santé, AIDER Santé, Montpellier, France
| | - Annie Rodriguez
- Fondation Charles Mion - AIDER Santé, AIDER Santé, Montpellier, France.,Department of Biochemistry, University Hospital of Montpellier, University of Montpellier, Montpellier, France
| | - Isabelle Ohresser
- Fondation Charles Mion - AIDER Santé, AIDER Santé, Montpellier, France
| | - Martin Larivière
- Fondation Charles Mion - AIDER Santé, AIDER Santé, Montpellier, France
| | - Cyril Portal
- Fondation Charles Mion - AIDER Santé, AIDER Santé, Montpellier, France
| | - Jean-Paul Cristol
- Department of Biochemistry, University Hospital of Montpellier, University of Montpellier, Montpellier, France
| | - Henri Bernardi
- DMEM, UMR866, INRAE, University of Montpellier, Montpellier, France
| | - Cécile Turc-Baron
- Fondation Charles Mion - AIDER Santé, AIDER Santé, Montpellier, France
| | - Robin Candau
- DMEM, UMR866, INRAE, University of Montpellier, Montpellier, France
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