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Zang W, Fang M, Xiao N, Zhang X, Lin C, Wang S. Quantifying the dose-response relationship between exercise and health-related quality of life in patients undergoing haemodialysis: A meta-analysis. Prev Med Rep 2024; 42:102737. [PMID: 38707251 PMCID: PMC11066687 DOI: 10.1016/j.pmedr.2024.102737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024] Open
Abstract
Objective This meta-analysis aims to explore the dose-response relationship of aerobic exercise or aerobic combined resistance exercise on cardiopulmonary function in maintenance hemodialysis(MHD), with the goal of aiding in the formulation of precise exercise prescriptions. Methods A literature search up to August 18, 2023, was conducted in databases including Web of Science, among others, focusing on the effects of exercise interventions on cardiopulmonary function in hemodialysis patients.Two researchers independently conducted literature screening, data extraction, and an assessment of study methodology quality. A dose-response meta-analysis was carried out using a one-stage cubic spline mixed-effects model, followed by stratified analyses based on intervention period, intervention method, and exercise environment. Results A nonlinear dose-response relationship was observed between exercise and 6-minute walk test (6WMT) as well as peak oxygen uptake (VO2Peak) in hemodialysis patients. The optimal exercise dose for the 6WMT across the full exposure range was 922 METs-min/week, with VO2Peak increasing with the dose. The effects were influenced by the type of exercise, intervention period, and exercise environment. An exercise dose of 500 METs-min/week and 619 METs-min/week was found sufficient to achieve the minimal clinically important differences (MCID) for 6WMT and VO2Peak, respectively. Conclusion There is a significant association between the dose of exercise and its effects. With appropriate adjustment of variables, even low-dose exercise can lead to clinically significant improvements in cardiopulmonary function.
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Affiliation(s)
- Wanli Zang
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Mingqing Fang
- Xiangya Hospital, Central South University, Changsha, China
| | - Ningkun Xiao
- Department of Immunochemistry, Institution of Chemical Engineering, Ural Federal University, Russia
| | - Xianzuo Zhang
- Department of Orthopedics, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Changchun Lin
- Xiangya Hospital, Central South University, Changsha, China
| | - Su Wang
- Department of Sports Science, University of Harbin Sport, Harbin, China
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Moezy A, Masoudi S, Nazari A, Abasi A. A controlled randomized trial with a 12-week follow-up investigating the effects of medium-frequency neuromuscular electrical stimulation on pain, VMO thickness, and functionality in patients with knee osteoarthritis. BMC Musculoskelet Disord 2024; 25:158. [PMID: 38378564 PMCID: PMC10877797 DOI: 10.1186/s12891-024-07266-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND One of the major contributors to disability in Knee osteoarthritis (KOA) patients is weakness in the Quadriceps Femoris muscle. Neuromuscular electrical stimulation (NMES) has been used in rehabilitation for patients suffering from muscle weakness. Thus, the purpose of the study was to assess the effectiveness of NMES and exercise therapy, for improving pain, muscle weakness and function among patients with KOA. METHODS A randomized controlled trial was conducted with 75 female patients diagnosed with KOA. Participants were divided into three intervention groups: NMES-only, exercise therapy (Exs) alone, and a combination of NMES and exercise (NMES + Exs). All patients underwent 12 supervised treatment sessions, three times a week. Outcome measures included pain intensity measured by visual analog scale (VAS), knee flexion range of motion (FROM), thigh muscle girth (TG), thickness of the Vastus Medialis Oblique (VMO), timed up and go test (TUG), six-minute walk test (6MWT), and WOMAC scores. Statistical analyses (ANOVA and Kruskal-Wallis) methods were done to compare the amounts at the baseline, immediately after treatment and after 12 weeks. RESULTS The NMES group exhibited a significant reduction in pain at the 12-week follow-up compared to the other groups(p = 0.022). The NMES + Exs group showed better outcomes in terms of FROM, TG, and VMO thickness post-intervention (p < 0.0001, p < 0.004, p = 0.003, respectively) and at the 12-week follow-up (p < 0.0001, p < 0.0001, p < 0.0001, respectively). Additionally, NMES was superior in improving TUG and 6MWT post-intervention (p < 0.0001, p = 0.038, respectively) and during the follow-up assessments (p < 0.0001, p = 0.029, respectively). The NMES + Exs group achieved better WOMAC stiffness scores at both post-intervention and follow-up evaluations (p < 0.0001, p < 0.0001, respectively). Furthermore, at the 12-week follow-up, NMES + Exs group outperformed the others in WOMAC pain and function subscales (p = 0.003, p = 0.017, respectively), while the NMES group demonstrated better WOMAC total scores compared to the other groups (p = 0.007). CONCLUSION The combination of NMES and exercise seems to be an efficient approach for managing KOA, as it enhances knee flexion range and TG, increases VMO thickness, and improves WOMAC scores. On the other hand, NMES alone was found to be effective in improving the physical function of KOA patients. TRIAL REGISTRATION IRCT20101228005486N7 (06-02-2020).
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Affiliation(s)
- Azar Moezy
- Department of Sports and Exercise Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Department, School of Medicine, Hazrate Rasoole Akram Hospital, Iran University of Medical Sciences, Sattarkhan Ave, Niayesh St, Tehran, 14455613131, Iran.
| | - Soheila Masoudi
- Department of Sports and Exercise Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Nazari
- Department of Sports and Exercise Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Arezoo Abasi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Davies MD, Hughes F, Sandoo A, Alejmi A, Macdonald JH. The effect of exercise on vascular health in chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials. Am J Physiol Renal Physiol 2023; 325:F638-F655. [PMID: 37733834 PMCID: PMC10881234 DOI: 10.1152/ajprenal.00152.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023] Open
Abstract
Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular disease. This increased risk cannot be fully explained by traditional risk factors such as hypertension. Endothelial dysfunction and arterial stiffness have been suggested as factors that explain some of the increased risk and are independently associated with important cardiovascular outcomes in patients with CKD. Studies in other disease populations have shown the positive effects of exercise on vascular dysfunction. The aim of this review was to determine whether exercise training interventions improve measures of vascular function and morphology in patients across the spectrum of CKD and which exercise training interventions are most efficacious. A systematic search of Medline, Embase, and the Cochrane Central Register identified 25 randomized controlled trials. Only randomized control trials using an exercise intervention with a nonexercising control group and at least one measure of vascular function or morphology were included. Participants were patients with nondialysis CKD or transplant patients or those requiring dialysis therapy. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A meta-analysis was completed for pulse wave velocity, augmentation index, and measures of endothelium-dependent vasodilation. Data from 25 studies with 872 participants showed that exercise training reduced pulse wave velocity and augmentation index but had no effect on endothelium-dependent vasodilation. Subgroup analyses suggested that exercise interventions of at least moderate intensity were more likely to be effective. Limitations included the absence of observational studies or other interventions aimed at increasing habitual physical activity. Further studies are warranted to investigate which are the most effective exercise interventions.NEW & NOTEWORTHY A thorough systematic review and meta-analysis of the effects of exercise training on measures of vascular function in patients with chronic kidney disease, including arterial stiffness and endothelial function, were conducted. Subgroup analyses investigated how differences in exercise training, according to frequency, intensity, type, and timing, have an impact on the efficacy of the intervention.
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Affiliation(s)
- Mark D Davies
- Institute for Applied Human Physiology, School of Psychology and Sport Science, Bangor University, Bangor, Gwynedd, United Kingdom
| | - Felicity Hughes
- Department of Emergency Medicine, Ysbyty Gwynedd Hospital, Bangor, Gwynedd, United Kingdom
| | - Aamer Sandoo
- School of Psychology and Sport Science, Department of Sport Science, Bangor University, Bangor, Gwynedd, United Kingdom
| | - Abdulfattah Alejmi
- Renal Department, Ysbyty Gwynedd Hospital, Bangor, Gwynedd, United Kingdom
| | - Jamie Hugo Macdonald
- Institute for Applied Human Physiology, School of Psychology and Sport Science, Bangor University, Bangor, Gwynedd, United Kingdom
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Ferrari F, Andrade FP, Teixeira MS, Ziegelmann PK, Carvalho G, Bittencourt ESS, Barcellos FC, Stein R. Efficacy of six exercise-based interventions for individuals undergoing hemodialysis: a network meta-analysis of randomized clinical trials. Nephrol Dial Transplant 2023; 38:2389-2406. [PMID: 37118876 DOI: 10.1093/ndt/gfad083] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Evidence comparing different exercise modalities in individuals undergoing hemodialysis remains incipient. Our aim was to conduct a systematic review and network meta-analysis of randomized clinical trials to compare and synthesize the efficacy of five different intradialytic exercise modalities and home-based training in this population. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Studies were searched in PubMed/MEDLINE, Cochrane Library, Embase, Cinahl, and Scopus from their inception to 19 September 2022. We used traditional random-effects models and Bayesian network meta-analysis models. The risk of bias was assessed using the RoB v.2.0 tool, and the assessment of confidence in the results through the Confidence in Network Meta-Analysis (CINeMA) tool. RESULTS Seventy-eight studies involving 3326 participants were included. Our network meta-analysis showed that combined training was the intervention with the best performance to increase VO2 peak [mean difference (MD) = 3.94 ml/kg/min; 95% credible interval (CrI), 2.38 to 5.76] and to reduce diastolic blood pressure (MD = -5.19 mmHg; 95%CrI, -9.35 to -0.96) compared to the usual care group. Inspiratory muscle training was the intervention that most improved the 6-minute walk test distance (MD = 70.97 m; 95%CrI, 18.09 to 129.87). C-reactive protein decreased in resistance training (MD = -2.6 mg/l; 95%CrI, -4.97 to -0.33) and aerobic training (MD = -1.4 mg/l; 95%CrI, -3.15 to -0.06). Kt/V improved in aerobic training (MD = 0.11; 95%CrI, 0.02 to 0.18), and SF-36 physical functioning outcomes improved in resistance training (MD = 10.66 points; 95%Crl, 1.91 to 20.22). No intradialytic exercise modality was superior to others or comparable with home-based training in improving the evaluated outcomes. Subgroup analysis revealed that exercise interventions >12 weeks improved functional capacity more than interventions ≤12 weeks, and that combined training reduces diastolic blood pressure only after 12 weeks of follow-up. Furthermore, our results suggest that moderate or moderate-to-vigorous intensity training leads to more pronounced improvements in functional capacity, whereas mild or mild-to-moderate intensity training does not have the same effect. In this review, most of the included studies were assessed as having some concern, which resulted in a low to very low level of confidence in the overall findings. CONCLUSIONS Both intradialytic training and home-based training can promote benefits for individuals undergoing hemodialysis, with no evidence of the superiority of either training modality over the other.
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Affiliation(s)
- Filipe Ferrari
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Exercise Cardiology Research Group (CardioEx), Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Francini P Andrade
- Graduate Program in Pneumological Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, Maia, Portugal
| | - Marcelo S Teixeira
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Exercise Cardiology Research Group (CardioEx), Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Patrícia K Ziegelmann
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Gabriel Carvalho
- Exercise Cardiology Research Group (CardioEx), Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Eduarda S S Bittencourt
- Exercise Cardiology Research Group (CardioEx), Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Ricardo Stein
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Exercise Cardiology Research Group (CardioEx), Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Zang W, Fang M, He H, Mu L, Zheng X, Shu H, Ge N, Wang S. Comparative efficacy of exercise modalities for cardiopulmonary function in hemodialysis patients: A systematic review and network meta-analysis. Front Public Health 2022; 10:1040704. [PMID: 36530731 PMCID: PMC9751492 DOI: 10.3389/fpubh.2022.1040704] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Background To provide reliable evidence to exercise rehabilitation therapists and clinicians, we compared and analyzed the effects of different exercise modalities on cardiopulmonary function in hemodialysis patients using Bayesian network meta-analysis. Methods PubMed, OVID, Web of Science, Cochrane Library, Embase, Scopus, CINAHL, SPORT Discus, SinoMed, CNKI, Wanfang, and VIP were searched from inception to July 20, 2022. We included randomized controlled trials comparing 12 exercise modalities to improve cardiorespiratory fitness in hemodialysis patients. All statistical analysis was performed using STATA and R. Result A total of 82 randomized controlled trials involving 4146 maintenance hemodialysis patients were included in this study. The pair-wise meta-analysis showed that all exercise modalities had a positive effect on all indicators of cardiorespiratory capacity. The network meta-analysis demonstrated that Blood flow restriction training (BFRT), Cycle exercise (CE), Inspiratory muscle training (IMT), Combined aerobic and resistance training (CT), and Aerobic training (AT) were significantly better than usual care for 6-min walkability; Medium intensity continuous training (MICT), CT, CE, and AT were considerably better than usual care for VO2Peak; body and mind training (MBT) and CT significantly improved SBP compared to usual care; and only MBT was significantly better than usual care for DBP. Both the two-dimensional plot and the radar plot demonstrated that CT had the best combined-effect on each index of cardiorespiratory fitness. Subgroup and sensitivity analyses demonstrated the robustness of the results. The evidence was mainly "low" to "very low" for this network meta-analysis. Conclusion There is no one exercise that can achieve the best effect on all of the outcomes. The benefits of MBT in decreasing arterial blood pressure are unsurpassed by other exercise methods. The intervention effect of the CT is better and more stable. Electrical muscle stimulation training (MEST) can be employed in individuals who do not wish to exercise actively but may cause an increase in blood pressure. On the basis of the characteristics of different exercise types, guidelines developers, clinicians, and patients may employ them appropriately. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#recordDetails.
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Affiliation(s)
- Wanli Zang
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Mingqing Fang
- Xiangya Hospital, Central South University, Changsha, China
| | - He He
- Winter Olympic Academy, University of Harbin Sport, Harbin, China
| | - Liang Mu
- Winter Olympic Academy, University of Harbin Sport, Harbin, China,Postdoctoral Research Station, University of Harbin Sport, Harbin, China
| | - Xiaoqin Zheng
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Heng Shu
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Nan Ge
- School of Physical Education, South China Normal University, Guangzhou, China
| | - Su Wang
- Department of Sports Science, University of Harbin Sport, Harbin, China,*Correspondence: Su Wang
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Pella E, Boutou A, Boulmpou A, Papadopoulos CE, Papagianni A, Sarafidis P. Cardiopulmonary exercise testing in patients with end-stage kidney disease: principles, methodology and clinical applications of the optimal tool for exercise tolerance evaluation. Nephrol Dial Transplant 2022; 37:2335-2350. [PMID: 33823012 DOI: 10.1093/ndt/gfab150] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Indexed: 12/31/2022] Open
Abstract
Chronic kidney disease (CKD), especially end-stage kidney disease (ESKD), is associated with an increased risk for cardiovascular events and all-cause mortality. Exercise intolerance as well as reduced cardiovascular reserve is extremely common in patients with CKD. Cardiopulmonary exercise testing (CPET) is a non-invasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, neuropsychological and metabolic function during maximal or submaximal exercise, allowing the evaluation of functional reserves of these systems. This assessment is based on the principle that system failure typically occurs when the system is under stress and thus CPET is currently considered to be the gold standard for identifying exercise limitation and differentiating its causes. It has been widely used in several medical fields for risk stratification, clinical evaluation and other applications, but its use in everyday practice for CKD patients is scarce. This article describes the basic principles and methodology of CPET and provides an overview of important studies that utilized CPET in patients with ESKD, in an effort to increase awareness of CPET capabilities among practicing nephrologists.
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Affiliation(s)
- Eva Pella
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Aristi Boulmpou
- Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Song Y, Chen L, Wang M, He Q, Xue J, Jiang H. The optimal exercise modality and intensity for hemodialysis patients incorporating Bayesian network meta-analysis and systematic review. Front Physiol 2022; 13:945465. [PMID: 36200055 PMCID: PMC9527310 DOI: 10.3389/fphys.2022.945465] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Physical inactivity is highly prevalent in patients with hemodialysis, and a large body of evidence reported the positive effect of different exercise modalities on their health outcomes. However, the effective dosage of exercise for hemodialysis patients still requires verification. Objective: We aimed to determine the most effective exercise intensity and modality for improvements in physical function, blood pressure control, dialysis adequacy, and health-related quality of life for hemodialysis patients. Design: Systematic review with network meta-analysis of randomized trials. Data sources: Five electronic databases (PubMed, EMBASE, Web of Science, Cochrane CENTRAL, and Scopus) were searched for randomized controlled trials. Data extraction and quality appraisal were conducted by two authors independently. Data were analyzed by the R (version.3.6.2) and the Stata (version.15.0). Result: We included 1893 patients involving four exercise modalities and six exercise intensities. Combined training (aerobic exercise plus resistance exercise) has been the top-ranking exercise modality for improving the 6-min walk test (6MWT) (surface under the cumulative ranking curve analysis (SUCRA) score, 90.63), systolic blood pressure control (SUCRA score, 77.35), and diastolic pressure control (SUCRA score, 90.56). Moreover, the top-ranking exercise intensity was moderate–vigorous for 6MWT (SUCRA score, 82.36), systolic blood pressure (SUCRA score, 77.43), and diastolic blood pressure (SUCRA score, 83.75). Regarding dialysis adequacy and health-related quality of life, we found no exercise modality or intensity superior to the placebo. Conclusion: This network meta-analysis indicated that combined training and moderate–vigorous intensity might be the most effective interventions to improve 6MWT and blood pressure control. This finding helps further guide clinical exercise prescriptions for hemodialysis patients. Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021268535].
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Arroyo E, Umukoro PE, Burney HN, Li Y, Li X, Lane KA, Sher SJ, Lu T, Moe SM, Moorthi R, Coggan AR, McGregor G, Hiemstra TF, Zehnder D, Lim K. Initiation of Dialysis Is Associated With Impaired Cardiovascular Functional Capacity. J Am Heart Assoc 2022; 11:e025656. [PMID: 35861826 PMCID: PMC9707847 DOI: 10.1161/jaha.122.025656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022]
Abstract
Background The transition to dialysis period carries a substantial increased cardiovascular risk in patients with chronic kidney disease. Despite this, alterations in cardiovascular functional capacity during this transition are largely unknown. The present study therefore sought to assess ventilatory exercise response measures in patients within 1 year of initiating dialysis. Methods and Results We conducted a cross-sectional study of 241 patients with chronic kidney disease stage 5 from the CAPER (Cardiopulmonary Exercise Testing in Renal Failure) study and from the intradialytic low-frequency electrical muscle stimulation pilot randomized controlled trial cohorts. Patients underwent cardiopulmonary exercise testing and echocardiography. Of the 241 patients (age, 48.9 [15.0] years; 154 [63.9%] men), 42 were predialytic (mean estimated glomerular filtration rate, 14 mL·min-1·1.73 m-2), 54 had a dialysis vintage ≤12 months, and 145 had a dialysis vintage >12 months. Dialysis vintage ≤12 months exhibited a significantly impaired cardiovascular functional capacity, as assessed by oxygen uptake at peak exercise (18.7 [5.8] mL·min-1·kg-1) compared with predialysis (22.7 [5.2] mL·min-1·kg-1; P<0.001). Dialysis vintage ≤12 months also exhibited reduced peak workload, impaired peak heart rate, reduced circulatory power, and increased left ventricular mass index (P<0.05 for all) compared with predialysis. After excluding those with prior kidney transplant, dialysis vintage >12 months exhibited a lower oxygen uptake at peak exercise (17.0 [4.9] mL·min-1·kg-1) compared with dialysis vintage ≤12 months (18.9 [5.9] mL·min-1·kg-1; P=0.033). Conclusions Initiating dialysis is associated with a significant impairment in oxygen uptake at peak exercise and overall decrements in ventilatory and hemodynamic exercise responses that predispose patients to functional dependence. The magnitude of these changes is comparable to the differences between low-risk New York Heart Association class I and higher-risk New York Heart Association class II to IV heart failure.
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Affiliation(s)
- Eliott Arroyo
- Division of Nephrology and HypertensionDepartment of MedicineIndiana University School of MedicineIndianapolisIN
| | - Peter E. Umukoro
- Division of Nephrology and HypertensionDepartment of MedicineIndiana University School of MedicineIndianapolisIN
- Department of NephrologyHendricks Regional HealthDanvilleIN
| | - Heather N. Burney
- Department of Biostatistics and Health Data ScienceIndiana University School of MedicineIndianapolisIN
| | - Yang Li
- Department of Biostatistics and Health Data ScienceIndiana University School of MedicineIndianapolisIN
| | - Xiaochun Li
- Department of Biostatistics and Health Data ScienceIndiana University School of MedicineIndianapolisIN
| | - Kathleen A. Lane
- Department of Biostatistics and Health Data ScienceIndiana University School of MedicineIndianapolisIN
| | - S. Jawad Sher
- Division of Nephrology and HypertensionDepartment of MedicineIndiana University School of MedicineIndianapolisIN
| | - Tzong‐shi Lu
- Renal DivisionDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMA
| | - Sharon M. Moe
- Division of Nephrology and HypertensionDepartment of MedicineIndiana University School of MedicineIndianapolisIN
| | - Ranjani Moorthi
- Division of Nephrology and HypertensionDepartment of MedicineIndiana University School of MedicineIndianapolisIN
| | - Andrew R. Coggan
- Department of KinesiologyIndiana University–Purdue University IndianapolisIndianapolisIN
| | - Gordon McGregor
- Department of NephrologyUniversity Hospital Coventry and Warwickshire National Health Service TrustCoventryUnited Kingdom
- Department of CardiologyUniversity Hospital Coventry and Warwickshire National Health Service TrustCoventryUnited Kingdom
- Centre for Sport, Exercise, and Life SciencesCoventry UniversityCoventryUnited Kingdom
- Warwick Clinical Trials UnitWarwick Medical SchoolUniversity of WarwickCoventryUnited Kingdom
| | - Thomas F. Hiemstra
- Cambridge Clinical Trials UnitCambridge University Hospitals National Health Service Foundation TrustCambridgeUnited Kingdom
- School of Clinical MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Daniel Zehnder
- Department of NephrologyNorth Cumbria University Hospital National Health Service TrustCarlisleUnited Kingdom
- Department of Acute MedicineNorth Cumbria University Hospital National Health Service TrustCarlisleUnited Kingdom
| | - Kenneth Lim
- Division of Nephrology and HypertensionDepartment of MedicineIndiana University School of MedicineIndianapolisIN
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Wang H, Xie D, Wu L, Zhao L. Association of Exercise With Vascular Function in Patients With CKD: A Meta-Analysis of Randomized Controlled Trials. Front Med (Lausanne) 2022; 9:904299. [PMID: 35872793 PMCID: PMC9299368 DOI: 10.3389/fmed.2022.904299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Aim Vascular function is associated with an increased risk of cardiovascular events in patients with chronic kidney disease (CKD). Whether exercise improves vascular function in such patients remains controversial. This study aimed to conduct a meta-analysis on the effect of exercise training on the vascular function of patients with CKD. Methods Embase, the Cochrane Central Register of Controlled Trials, and Medline were searched from inception until November 15, 2021. The terms exercise, CKD, dialysis, kidney transplant, and randomized controlled trial (RCT) were searched alone or in combination. RCTs were included when studies compared exercise with active control, usual care, or no intervention, and the studies reported vascular function on patients with CKD. Results This meta-analysis included 18 RCTs with 817 patients. Exercise training was significantly associated with decreased pulse wave velocity weighted mean difference (WMD), −0.56; 95% confidence interval (CI), −1.02 to −0.09, P = 0.02 and augmentation index (WMD, −3.26; 95% CI, −5.46 to −1.05, P = 0.004). It was also significantly associated with improved peak VO2 (WMD, 2.64; 95% CI, 1.94–3.35, P < 0.00001), general health (WMD, 7.03; 95% CI, 0.65–13.42, P = 0.03), and vitality (WMD, 9.1; 95% CI, 2.50–15.69, P = 0.007). Conclusions The meta-analysis suggested that exercise training improved vascular function in patients with CKD. An exercise program should be considered as one of the management strategies for vascular dysfunction in patients with CKD. Further studies are needed to demonstrate that exercise training improves cardiovascular diseases in patients with CKD.
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Affiliation(s)
- Huan Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dengpiao Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Dengpiao Xie
| | - Lisheng Wu
- Southern Medical University, Guangzhou, China
| | - Liangbin Zhao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Liangbin Zhao
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Arazi H, Mohabbat M, Saidie P, Falahati A, Suzuki K. Effects of Different Types of Exercise on Kidney Diseases. Sports (Basel) 2022; 10:sports10030042. [PMID: 35324651 PMCID: PMC8952011 DOI: 10.3390/sports10030042] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/26/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
The effects of exercise on kidney function have been studied for more than three decades. One of the most common health issues among patients with chronic kidney disease (CKD) is a lack of physical activity, which leads to a low exercise capacity in these patients. The majority of maintenance hemodialysis (MHD) patients do not exercise at all. At each stage of dialysis, patients lose 10–12 g of their amino acids through blood sampling. Dialysis also leads to increased cortisol and circadian rhythm sleep disorders in hemodialysis (HD) patients. Studies have also reported higher C-reactive protein levels in HD patients, which causes arterial stiffness. Exercise has a variety of health benefits in these patients, including improved blood pressure control, better sleep, higher physical function, and reduced anxiety and depression. On the other hand, it should be noted that intense exercise has the potential to progress KD, especially when conducted in hot weather with dehydration. This review aimed to investigate the effects of different types of exercise on kidney disease and provide exercise guidelines. In conclusion, moderate-intensity and long-term exercise (for at least a 6-month period), with consideration of the principles of exercise (individualization, intensity, time, etc.), can be used as an adjunctive treatment strategy in patients undergoing dialysis or kidney transplantation.
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Affiliation(s)
- Hamid Arazi
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran; (M.M.); (P.S.); (A.F.)
- Correspondence: (H.A.); (K.S.); Tel.: +98-911-139-9207 (H.A.)
| | - Majid Mohabbat
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran; (M.M.); (P.S.); (A.F.)
| | - Payam Saidie
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran; (M.M.); (P.S.); (A.F.)
| | - Akram Falahati
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran; (M.M.); (P.S.); (A.F.)
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan
- Correspondence: (H.A.); (K.S.); Tel.: +98-911-139-9207 (H.A.)
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11
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Cha RH, Lee GS. Steady exercise improves hand grip and leg muscle strength in hemodialysis patients. J Exerc Rehabil 2022; 17:435-443. [PMID: 35036393 PMCID: PMC8743601 DOI: 10.12965/jer.2142616.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/21/2021] [Indexed: 11/22/2022] Open
Abstract
Sarcopenia due to chronic inflammation and biochemical disturbances in chronic kidney disease is severer and more prevalent in hemodialysis (HD) patients. We longitudinally evaluated the hand grip strength (HGS) and leg muscle strength (LMS) and evaluated the role of exercise in muscle strength in HD patients. We screened (January, n=127) and followed up (June, n=110 and December 2020, n=104). HGS and LMS at single center by using digital hand and leg dynamometer. HGS (24.2 kg vs. 15.5 kg) and LMS (32.8 kg vs. 22.5 kg) were better in men (P<0.001 and P<0.001, respectively). Older patients (≥60 years) showed decreased LMS than others in women (P=0.01). Patients who performed steady home- or hospital-based exercise showed marginally higher HGS (23.1 kg vs. 19.8 kg, P=0.07) and significantly higher LMS (33.7 kg vs. 25.9 kg, P=0.004). Steady exercise improved LMS throughout the study period (30.3 kg vs. 33.2 kg from Jan to Jun 2020, P=0.004; 30.3 kg vs. 34.2 kg from Jan to Dec 2020, P=0.014). Multiple linear regression analysis proved steady exercise was independently associated with better HGS and LMS. Steady exercise showed greater impact on LMS in male patients with longer HD vintage (≥44 months) and on HGS in younger male patients with shorter HD vintage (<44 months). Steady exercise was an important determinant of muscle strength in HD patients. We need to encourage patients to steadily perform regular home- or group-exercise before sarcopenia develops.
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Affiliation(s)
- Ran-Hui Cha
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Geum Sil Lee
- Department of Internal Medicine, National Medical Center, Seoul, Korea
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12
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Bernier-Jean A, Beruni NA, Bondonno NP, Williams G, Teixeira-Pinto A, Craig JC, Wong G. Exercise training for adults undergoing maintenance dialysis. Cochrane Database Syst Rev 2022; 1:CD014653. [PMID: 35018639 PMCID: PMC8752366 DOI: 10.1002/14651858.cd014653] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Dialysis treatments weigh heavily on patients' physical and psychosocial health. Multiple studies have assessed the potential for exercise training to improve outcomes in adults undergoing dialysis. However, uncertainties exist in its relevance and sustainable benefits for patient-important outcomes. This is an update of a review first published in 2011. OBJECTIVES To assess the benefits and safety of regular structured exercise training in adults undergoing dialysis on patient-important outcomes including death, cardiovascular events, fatigue, functional capacity, pain, and depression. We also aimed to define the optimal prescription of exercise in adults undergoing dialysis. SEARCH METHODS In this update, we conducted a systematic search of the Cochrane Kidney and Transplant Register of Studies up to 23 December 2020. The Register includes studies identified from CENTRAL, MEDLINE, EMBASE, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov as well as kidney-related journals and the proceedings of major kidney conferences. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs of any structured exercise programs of eight weeks or more in adults undergoing maintenance dialysis compared to no exercise or sham exercise. DATA COLLECTION AND ANALYSIS Two authors independently assessed the search results for eligibility, extracted the data and assessed the risk of bias using the Cochrane risk of bias tool. Whenever appropriate, we performed random-effects meta-analyses of the mean difference in outcomes. The primary outcomes were death (any cause), cardiovascular events and fatigue. Secondary outcomes were health-related quality of life (HRQoL), depression, pain, functional capacity, blood pressure, adherence to the exercise program, and intervention-related adverse events. MAIN RESULTS We identified 89 studies involving 4291 randomised participants, of which 77 studies (3846 participants) contributed to the meta-analyses. Seven studies included adults undergoing peritoneal dialysis. Fifty-six studies reported aerobic exercise interventions, 21 resistance exercise interventions and 19 combined aerobic and resistance training within the same study arm. The interventions lasted from eight weeks to two years and most often took place thrice weekly during dialysis treatments. A single study reported death and no study reported long-term cardiovascular events. Five studies directly assessed fatigue, 46 reported HRQoL and 16 reported fatigue or pain through their assessment of HRQoL. Thirty-five studies assessed functional capacity, and 21 reported resting peripheral blood pressure. Twelve studies reported adherence to exercise sessions, and nine reported exercise-related adverse events. Overall, the quality of the included studies was low and blinding of the participants was generally not feasible due to the nature of the intervention. Exercise had uncertain effects on death, cardiovascular events, and the mental component of HRQoL due to the very low certainty of evidence. Compared with sham or no exercise, exercise training for two to 12 months may improve fatigue in adults undergoing dialysis, however, a meta-analysis could not be conducted. Any exercise training for two to 12 months may improve the physical component of HRQoL (17 studies, 656 participants: MD 4.12, 95% CI 1.88 to 6.37 points on 100 points-scale; I² = 49%; low certainty evidence). Any exercise training for two to 12 months probably improves depressive symptoms (10 studies, 441 participants: SMD -0.65, 95% CI -1.07 to -0.22; I² = 77%; moderate certainty evidence) and the magnitude of the effect may be greater when maintaining the exercise beyond four months (6 studies, 311 participants: SMD -0.30, 95% CI 0.14 to -0.74; I² = 71%). Any exercise training for three to 12 months may improve pain (15 studies, 872 participants: MD 5.28 95% CI -0.12 to 10.69 points on 100 points-scale; I² = 63%: low certainty evidence) however, the 95% CI indicates that exercise training may make little or no difference in the level of pain. Any exercise training for two to six months probably improves functional capacity as it increased the distance reached during six minutes of walking (19 studies, 827 participants: MD 49.91 metres, 95% CI 37.22 to 62.59; I² = 34%; moderate certainty evidence) and the number of sit-to-stand cycles performed in 30 seconds (MD 2.33 cycles, 95% CI 1.71 to 2.96; moderate certainty evidence). There was insufficient evidence to assess the safety of exercise training for adults undergoing maintenance dialysis. The results were similar for aerobic exercise, resistance exercise, and a combination of both aerobic and resistance exercise. AUTHORS' CONCLUSIONS It is uncertain whether exercise training improves death, cardiovascular events, or the mental component of HRQoL in adults undergoing maintenance dialysis. Exercise training probably improves depressive symptoms, particularly when the intervention is maintained beyond four months. Exercise training is also likely to improve functional capacity. Low certainty evidence suggested that exercise training may improve fatigue, the physical component of quality of life, and pain. The safety of exercise training for adults undergoing dialysis remains uncertain.
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Affiliation(s)
- Amelie Bernier-Jean
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Nadim A Beruni
- Resident Support Unit, Western Sydney Local Health District, Westmead, Australia
| | - Nicola P Bondonno
- School of Biomedical Sciences, The University of Western Australia, Royal Perth Hospital, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Gabrielle Williams
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | | | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
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13
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Yu MY, Park JH, Kim YC, Park JY, Cha RH. Comparison of intradialytic neuromuscular electrical stimulation and oral nutritional supplements in hemodialysis patients: study protocol for a multicenter, parallel-group, randomized controlled trial in Korea. Trials 2021; 22:942. [PMID: 34930408 PMCID: PMC8686339 DOI: 10.1186/s13063-021-05918-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background The prevalence of sarcopenia increases as renal function decreases, and a considerable number of hemodialysis (HD) patients have sarcopenia. Exercise and nutritional support are established interventions to prevent and treat sarcopenia. Recently, many studies evaluating intradialytic neuromuscular electrical stimulation (NMES) showed improvement of muscular strength and mass, functional capacity, and quality of life (QOL). However, there has been no research about the effect of simultaneous nutritional support and NMES in HD patients. Methods This is a 12-week, randomized controlled, parallel-group, multicenter trial of intradialytic NMES and protein supplementation for HD patients. Seventy-two patients receiving HD will be randomly assigned in a 1:1:1:1 ratio to control, intradialytic NMES only, protein supplementation only, and intradialytic NMES combined with protein supplementation groups. NMES will be delivered to a total of four areas of the bilateral vastus medialis and vastus lateralis using a 4-channel NMES instrument. A total of 25 g of protein supplements will be provided at the beginning of every dialysis session or after the NMES. The primary endpoint is the difference of hand grip and leg muscle strength at 12 weeks among 4 treatment groups. Secondary endpoints include muscle mass, physical performances, and questionnaires about QOL and physical activity. Discussion In this study, we will evaluate the differential effectiveness of nutritional support and NMES during HD on muscle strength, muscle mass, physical function, and QOL. We expect that this study can provide guidelines for a new therapeutic option for HD patients who are unable or hesitant to exercise. Furthermore, this option can offer an opportunity to improve the physical function, QOL, and prognosis of HD patients. Trial registration Clinical Research Information Service (CRIS), Korea, KCT0005573. Retrospectively registered on 03 November 2020
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Affiliation(s)
- Mi-Yeon Yu
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Gyeonggi-do, Republic of Korea
| | - Jae Hyeon Park
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, Guri, Gyeonggi-do, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Ilsan, Gyeonggi-do, Republic of Korea
| | - Ran-Hui Cha
- Department of Internal Medicine, National Medical Center, 245, Eulji-ro, Jung-gu, Seoul, 04564, Republic of Korea.
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14
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Andrade FP, Borba GC, da Silva KC, Ferreira TDS, de Oliveira SG, Antunes VVH, Veronese FV, Rovedder PME. Intradialytic periodized exercise improves cardiopulmonary fitness and respiratory function: A randomized controlled trial. Semin Dial 2021; 35:181-189. [PMID: 34536050 DOI: 10.1111/sdi.13020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/06/2021] [Accepted: 08/14/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a factor that predisposes to gradual physical deconditioning from its early stages leading to cardiorespiratory fitness and musculoskeletal system impairment. We evaluated the effects of combined and periodized intradialytic exercise training on cardiopulmonary fitness and respiratory function in HD subjects. METHODS A randomized controlled trial with HD subjects was allocated into two groups: exercise group (EXG) and usual care group (UCG). EXG performed a 12-week combined and periodized intradialytic training. UCG maintained the HD routine. RESULTS Thirty-nine HD subjects were analyzed (EXG = 20; UCG = 19). The EXG in comparison with the UCG showed improvements in peak oxygen consumption (Δ3.1[0.4-5.5] vs. -0.2[-2.0-1.5] ml/kg/min; p = 0.003), forced expiratory volume in the first second (Δ0.1[-0.0-0.1] vs. -0.0[-0.1-0.0] L; p = 0.022), forced vital capacity (Δ0.1[0.0-0.2] vs. -0.1[-0.2-0.0] L; p = 0.005), peak expiratory flow (Δ0.4[-0.7-1.2] vs. -0.1[-0.5-0.2] L; p = 0.046), and maximal inspiratory pressure (Δ7.35[-8.5-17.5] vs. -4.0[-18.0-12.0] cmH2 O; p = 0.028). The EXG, different from the UCG, did not worsen the maximal expiratory pressure (Δ0.1[-8.8-7.5] vs. -2.5[-15.0-9.0] cmH2 O; p = 0.036). Besides, EXG showed a significant improvement in quadriceps strength (32.05 ± 10.61 vs. 33.35 ± 11.62 kg; p = 0.042). CONCLUSIONS The combined and periodized intradialytic exercise training improved cardiopulmonary fitness, respiratory function, inspiratory muscle strength, and quadriceps strength, beyond maintaining the expiratory muscle strength in HD subjects.
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Affiliation(s)
- Francini Porcher Andrade
- Ciências Pneumológicas Post-Graduation Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Gabrielle Costa Borba
- Ciências Pneumológicas Post-Graduation Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Kacylen Costa da Silva
- Ciências Pneumológicas Post-Graduation Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Tatiane de Souza Ferreira
- Ciências Pneumológicas Post-Graduation Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | | | | | - Paula Maria Eidt Rovedder
- Ciências Pneumológicas Post-Graduation Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Physiotherapy School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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15
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Cha RH, Lee GS, Yoo JY, Rhee OB, Jeon YD. Hand Grip and Leg Muscle Strength in Hemodialysis Patients and Its Determinants. J Korean Med Sci 2021; 36:e76. [PMID: 33754509 PMCID: PMC7985287 DOI: 10.3346/jkms.2021.36.e76] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/10/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Chronic kidney disease is associated with chronic inflammation and progressive loss of peripheral muscle strength and the ability to exercise, and these changes are highly pronounced in patients receiving hemodialysis (HD). We evaluated hand grip strength (HGS) and leg muscle strength (LMS) in patients receiving HD and attempted to identify factors associated with muscle strength. METHODS We screened HGS (opposite the fistula side) and LMS (both sides) in HD patients at a single center (n = 112) by using digital hand and leg dynamometers (T.K.K. 5401 and 5710e/5715, Takei Scientific Instruments Co. Ltd., Niigata, Japan). RESULTS The mean age of patients was 62.6 years, and 73.2% of the patients were male. Diabetes was the cause of kidney failure in 50% of the patients, and the median HD vintage was 34 months. A total of 77.7% of patients reported that they participated in regular home-based exercise, and 29.5% of patients regularly participated in hospital-based resistance exercise. HGS and LMS showed good correlation (r = 0.715, P < 0.001). HGS (25.1 vs. 17.0 kg) and LMS (30.1 vs. 20.4 kg) were greater in males (P < 0.001 and P < 0.001, respectively) than in females. Older patients (≥ 60 years) showed less LMS than younger patients in both males and females (P = 0.012 and P = 0.037, respectively), but HGS did not differ according to age. Patients performing regular home- or hospital-based exercise showed higher HGS than those who did not exercise (24.2 vs. 18.6 kg, P = 0.011), but LMS was not significantly different (29.3 vs. 23.6 kg, P = 0.185). Multiple linear regression analysis proved that male sex, younger age, and any type of exercise were factors associated with improved HGS and LMS. Groups of older age (≥ 60 years), male sex, and shorter duration of HD (< median) benefitted more from exercise. CONCLUSION Sex, age, and exercise were the most important determinants of muscle strength in HD patients. We need to encourage patients to engage in regular home or group exercise from the beginning of dialysis and introduce new feasible forms of exercise for HD patients.
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Affiliation(s)
- Ran Hui Cha
- Department of Internal Medicine, National Medical Center, Seoul, Korea.
| | - Geum Sil Lee
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Ju Yeon Yoo
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Oe Bog Rhee
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Yong Duk Jeon
- Department of Internal Medicine, National Medical Center, Seoul, Korea
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16
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Lim K, Ting SMS, Hamborg T, McGregor G, Oxborough D, Tomkins C, Xu D, Thadhani R, Lewis G, Bland R, Banerjee P, Fletcher S, Krishnan NS, Higgins R, Zehnder D, Hiemstra TF. Cardiovascular Functional Reserve Before and After Kidney Transplant. JAMA Cardiol 2021; 5:420-429. [PMID: 32022839 DOI: 10.1001/jamacardio.2019.5738] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Importance Restitution of kidney function by transplant confers a survival benefit in patients with end-stage renal disease. Investigations of mechanisms involved in improved cardiovascular survival have relied heavily on static measures from echocardiography or cardiac magnetic resonance imaging and have provided conflicting results to date. Objectives To evaluate cardiovascular functional reserve in patients with end-stage renal disease before and after kidney transplant and to assess functional and morphologic alterations of structural-functional dynamics in this population. Design, Setting, and Participants This prospective, nonrandomized, single-center, 3-arm, controlled cohort study, the Cardiopulmonary Exercise Testing in Renal Failure and After Kidney Transplantation (CAPER) study, included patients with stage 5 chronic kidney disease (CKD) who underwent kidney transplant (KTR group), patients with stage 5 CKD who were wait-listed and had not undergone transplant (NTWC group), and patients with hypertension only (HTC group) seen at a single center from April 1, 2010, to January 1, 2013. Patients were followed up longitudinally for up to 1 year after kidney transplant. Clinical data collection was completed February 2014. Data analysis was performed from June 1, 2014, to March 5, 2015. Further analysis on baseline and prospective data was performed from June 1, 2017, to July 31, 2019. Main Outcomes and Measures Cardiovascular functional reserve was objectively quantified using state-of-the-art cardiopulmonary exercise testing in parallel with transthoracic echocardiography. Results Of the 253 study participants (mean [SD] age, 48.5 [12.7] years; 141 [55.7%] male), 81 were in the KTR group, 85 in the NTWC group, and 87 in the HTC group. At baseline, mean (SD) maximum oxygen consumption (V̇O2max) was significantly lower in the CKD groups (KTR, 20.7 [5.8] mL · min-1 · kg-1; NTWC, 18.9 [4.7] mL · min-1 · kg-1) compared with the HTC group (24.9 [7.1] mL · min-1 · kg-1) (P < .001). Mean (SD) cardiac left ventricular mass index was higher in patients with CKD (KTR group, 104.9 [36.1] g/m2; NTWC group, 113.8 [37.7] g/m2) compared with the HTC group (87.8 [16.9] g/m2), (P < .001). Mean (SD) left ventricular ejection fraction was significantly lower in the patients with CKD (KTR group, 60.1% [8.6%]; NTWC group, 61.4% [8.9%]) compared with the HTC group (66.1% [5.9%]) (P < .001). Kidney transplant was associated with a significant improvement in V̇O2max in the KTR group at 12 months (22.5 [6.3] mL · min-1 · kg-1; P < .001), but the value did not reach the V̇O2max in the HTC group (26.0 [7.1] mL · min-1 · kg-1) at 12 months. V̇O2max decreased in the NTWC group at 12 months compared with baseline (17.7 [4.1] mL · min-1 · kg-1, P < .001). Compared with the KTR group (63.2% [6.8%], P = .02) or the NTWC group (59.3% [7.6%], P = .003) at baseline, transplant was significantly associated with improved left ventricular ejection fraction at 12 months but not with left ventricular mass index. Conclusions and Relevance The findings suggest that kidney transplant is associated with improved cardiovascular functional reserve after 1 year. In addition, cardiopulmonary exercise testing was sensitive enough to detect a decline in cardiovascular functional reserve in wait-listed patients with CKD. Improved V̇O2max may in part be independent from structural alterations of the heart and depend more on ultrastructural changes after reversal of uremia.
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Affiliation(s)
- Kenneth Lim
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Stephen M S Ting
- Department of Medicine, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Thomas Hamborg
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Queen Mary, University of London, London, United Kingdom
| | - Gordon McGregor
- Department of Nephrology, University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom.,Department of Cardiology, University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom
| | - David Oxborough
- Research Institutes of Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Claudia Tomkins
- Department of Pathology Service, University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom
| | - Dihua Xu
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Ravi Thadhani
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Gregory Lewis
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Rosemary Bland
- Division of Biomedical Sciences, University of Warwick, Coventry, United Kingdom
| | - Prithwish Banerjee
- Department of Cardiology, University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom.,Centre for Innovative Research Across the Life Course, Coventry University, Coventry, United Kingdom
| | - Simon Fletcher
- Department of Nephrology, University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom
| | - Nithya S Krishnan
- Department of Nephrology, University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom
| | - Robert Higgins
- Department of Nephrology, University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom
| | - Daniel Zehnder
- Department of Nephrology, North Cumbria University Hospital National Health Service Trust, Carlisle, United Kingdom.,Department of Acute Medicine, North Cumbria University Hospital National Health Service Trust, Carlisle, United Kingdom
| | - Thomas F Hiemstra
- Cambridge Clinical Trials Unit and School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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17
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Lim K, McGregor G, Coggan AR, Lewis GD, Moe SM. Cardiovascular Functional Changes in Chronic Kidney Disease: Integrative Physiology, Pathophysiology and Applications of Cardiopulmonary Exercise Testing. Front Physiol 2020; 11:572355. [PMID: 33041870 PMCID: PMC7522507 DOI: 10.3389/fphys.2020.572355] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022] Open
Abstract
The development of cardiovascular disease during renal impairment involves striking multi-tiered, multi-dimensional complex alterations encompassing the entire oxygen transport system. Complex interactions between target organ systems involving alterations of the heart, vascular, musculoskeletal and respiratory systems occur in Chronic Kidney Disease (CKD) and collectively contribute to impairment of cardiovascular function. These systemic changes have challenged our diagnostic and therapeutic efforts, particularly given that imaging cardiac structure at rest, rather than ascertainment under the stress of exercise, may not accurately reflect the risk of premature death in CKD. The multi-systemic nature of cardiovascular disease in CKD patients provides strong rationale for an integrated approach to the assessment of cardiovascular alterations in this population. State-of-the-art cardiopulmonary exercise testing (CPET) is a powerful, dynamic technology that enables the global assessment of cardiovascular functional alterations and reflects the integrative exercise response and complex machinery that form the oxygen transport system. CPET provides a wealth of data from a single assessment with mechanistic, physiological and prognostic utility. It is an underutilized technology in the care of patients with kidney disease with the potential to help advance the field of cardio-nephrology. This article reviews the integrative physiology and pathophysiology of cardio-renal impairment, critical new insights derived from CPET technology, and contemporary evidence for potential applications of CPET technology in patients with kidney disease.
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Affiliation(s)
- Kenneth Lim
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Gordon McGregor
- Coventry University Hospital, Coventry and Warwickshire NHS Trust, Coventry, United Kingdom.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Andrew R Coggan
- Department of Kinesiology, Indiana University - Purdue University, Indianapolis, IN, United States
| | - Gregory D Lewis
- Division of Cardiology, The Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Sharon M Moe
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, United States
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18
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Valenzuela PL, Morales JS, Ruilope LM, de la Villa P, Santos-Lozano A, Lucia A. Intradialytic neuromuscular electrical stimulation improves functional capacity and muscle strength in people receiving haemodialysis: a systematic review. J Physiother 2020; 66:89-96. [PMID: 32291224 DOI: 10.1016/j.jphys.2020.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/26/2019] [Accepted: 03/13/2020] [Indexed: 12/18/2022] Open
Abstract
QUESTIONS Does neuromuscular electrical stimulation (NMES) applied during haemodialysis sessions improve functional capacity in people with end-stage renal disease? Does NMES used in this way also improve muscle strength, muscle mass/architecture, psychological outcomes, cardiovascular outcomes and biochemical variables? Does it have any adverse effects? DESIGN Systematic review of randomised controlled trials with meta-analysis. PubMed, Web of Science, Scopus and SPORTDiscus were searched from inception to 15 October 2019. PARTICIPANTS Patients receiving haemodialysis for end-stage renal disease. INTERVENTION NMES administered during haemodialysis sessions versus control. OUTCOMES MEASURES Functional capacity, muscle strength, muscle mass, psychological outcomes, cardiovascular outcomes, biochemical variables and adverse events. DATA ANALYSIS Data were meta-analysed where possible and results were expressed as the pooled mean difference between groups with a 95% confidence interval. RESULTS Eight studies (221 patients) were included in the analysis. Overall, the methodological quality of the studies was fair to good. NMES improved functional capacity as assessed by the 6-minute walk distance test (MD 31 m, 95% CI 13 to 49) and peak workload attained in incremental exercise (MD 12.5 W, 95% CI 3.2 to 21.9). NMES increased knee extensor muscle strength (MD 3.5 kg, 95% CI 2.3 to 4.7) and handgrip strength (MD 2.4 kg, 95% CI 0.4 to 4.4). Muscle mass/architecture was not substantially affected. NMES was estimated to be beneficial for several domains of quality of life in several studies, although most of these estimates were imprecise. No benefits were found for cardiovascular outcomes. The available data did not establish any clear effects on cardiovascular outcomes or biochemical variables (dialysis efficiency, urea and creatinine). No major NMES-related adverse events were observed. CONCLUSIONS NMES is safe, practical and effective for improving functional capacity and muscle strength in haemodialysis patients. Further research is needed to confirm the clinical relevance of these findings. REGISTRATION PROSPERO CRD42018107323.
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Affiliation(s)
- Pedro L Valenzuela
- Department of Systems Biology, University of Alcalá, Madrid, Spain; Department of Sport and Health, Spanish Agency for Health Protection in Sport (AEPSAD), Madrid, Spain
| | - Javier S Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Luis M Ruilope
- Hypertension Unit and Cardiorenal Translational Laboratory, Research Institute of the Hospital 12 de Octubre ("imas12"), Madrid, Spain
| | - Pedro de la Villa
- Department of Systems Biology, University of Alcalá, Madrid, Spain; i+HeALTH, Department of Health Sciences, European University Miguel de Cervantes, Valladolid, Spain
| | - Alejandro Santos-Lozano
- Hypertension Unit and Cardiorenal Translational Laboratory, Research Institute of the Hospital 12 de Octubre ("imas12"), Madrid, Spain; Ramón y Cajal Health Research Institute (IRYCIS), Madrid
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain; Hypertension Unit and Cardiorenal Translational Laboratory, Research Institute of the Hospital 12 de Octubre ("imas12"), Madrid, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
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Neuromuscular Electrical Stimulation in Chronic Kidney Failure: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2020; 101:700-711. [DOI: 10.1016/j.apmr.2019.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 10/06/2019] [Accepted: 11/14/2019] [Indexed: 11/23/2022]
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Ferrari F, Helal L, Dipp T, Soares D, Soldatelli Â, Mills AL, Paz C, Tenório MCC, Motta MT, Barcellos FC, Stein R. Intradialytic training in patients with end-stage renal disease: a systematic review and meta-analysis of randomized clinical trials assessing the effects of five different training interventions. J Nephrol 2019; 33:251-266. [PMID: 31865607 DOI: 10.1007/s40620-019-00687-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/15/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Patients with end-stage renal disease (ESRD) undergoing hemodialysis may have reduced dialysis adequacy (Kt/V), low cardiorespiratory fitness, and worse prognosis. Different types of intradialytic training (IDT) may serve as an adjunct therapy for the management of the ESRD. This systematic review and meta-analysis aimed to assess the impact of different types of IDT on clinical outcomes and functional parameters in ESRD. METHODS PubMed, Embase, CINAHL, Cochrane CENTRAL, Scopus, SPORTDiscus, and Google Scholar were searched for randomized clinical trials in adult patients with ESRD which compared IDT with usual care (UC), without language restrictions and published up to July 2019; a handsearch of references was also performed. Certainty of evidence was assessed using GRADE, and risk of bias in primary studies with the RoB 1.0 tool. RESULTS Fifty studies were included (n = 1757). Compared to UC, aerobic IDT improved Kt/V (WMD = 0.08), VO2peak (WMD = 2.07 mL/kg/min), 6-minute walk test (6MWT) distance (64.98 m), reduced systolic blood pressure (- 10.07 mmHg) and C-reactive protein (- 3.28 mg/L). Resistance training increased 6MWT distance (68.50 m). Combined training increased VO2peak (5.41 mL/kg/min) and reduced diastolic blood pressure (- 5.76 mmHg). Functional electrostimulation (FES) and inspiratory muscle training (IMT) improved 6MWT distance (54.14 m and 117.62 m, respectively). There was no impact on total cholesterol, interleukin-6, or hemoglobin levels. There was no difference in incidence of adverse events between the IDT and control groups. The certainty of evidence was variable according to the GRADE scale, with most outcomes rated very low certainty. The risk of bias assessment of primary studies showed unclear risk in most. CONCLUSIONS Aerobic, resistance, and combined training during hemodialysis, as well as FES and IMT, demonstrated to be effective for the treatment of the patient with ESRD. Our data should be interpreted in light of the unclear risk of bias of most evaluated articles and the low to very low certainty of evidence for evaluated outcomes. PROSPERO REGISTRATION ID CRD42017081338. DATA SHARING REPOSITORY: https://osf.io/fpj54/.
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Affiliation(s)
- Filipe Ferrari
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350-Santa Cecília, Porto Alegre, RS, 90035-003, Brazil.,Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Helal
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350-Santa Cecília, Porto Alegre, RS, 90035-003, Brazil.,Exercise Pathophysiology Laboratory (LaFiEx), Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Thiago Dipp
- School of Physical Therapy, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil
| | - Douglas Soares
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350-Santa Cecília, Porto Alegre, RS, 90035-003, Brazil.,Experimental and Molecular Cardiovascular Laboratory and Heart Failure Unit, Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ângela Soldatelli
- Exact Sciences and Engineering, Universidade de Caxias do Sul, Caxias do Sul, Brazil
| | - Andrew Lee Mills
- Center for Workplace Health, American Heart Association, Houston, TX, USA
| | | | | | - Marcelo Trotte Motta
- Department of Biotechnology, Universidade Estadual de Feira de Santana, Feira de Santana, Brazil
| | | | - Ricardo Stein
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350-Santa Cecília, Porto Alegre, RS, 90035-003, Brazil. .,Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Vitta Centro de Bem-Estar Físico, Porto Alegre, Brazil. .,Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Taylor MJ, Schils S, Ruys AJ. Home FES: An Exploratory Review. Eur J Transl Myol 2019; 29:8285. [PMID: 31969976 PMCID: PMC6974778 DOI: 10.4081/ejtm.2019.8285] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/31/2019] [Indexed: 12/28/2022] Open
Abstract
This review of literature focuses on the multiple uses of Functional Electrical Stimulation (FES) and how this modality may be a valuable home-based therapy. Papers pertaining to home FES exercise were collected using the Web of Science, Google Scholar databases and collegial hints. In our opinion, the following statements summarize the results. FES may be used to induce health benefits in populations with paralysis, and in persons with musculoskeletal, cardiorespiratory and renal pathology. The EU Project Rise showed how FES could have a variety of encouraging outcomes for patients with denervated muscles following traumatic injuries. As suggested by recent literature, FES has proven to be a viable form of exercise for elderly individuals. Thus, Home FES may be an option for patients looking for an additional form of muscle and cardiopulmonary physical therapy.
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Affiliation(s)
- Matthew J. Taylor
- Faculty of Engineering and IT, The University of Sydney, Camperdown, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia
- Discipline of Anatomy and Histology, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Sheila Schils
- EquiNew, River Falls, Wisconsin, United States of America
| | - Andrew J. Ruys
- Faculty of Engineering and IT, The University of Sydney, Camperdown, Australia
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Jacobson J, Ju A, Baumgart A, Unruh M, O’Donoghue D, Obrador G, Craig JC, Dapueto JM, Dew MA, Germain M, Fluck R, Davison SN, Jassal SV, Manera K, Smith AC, Tong A. Patient Perspectives on the Meaning and Impact of Fatigue in Hemodialysis: A Systematic Review and Thematic Analysis of Qualitative Studies. Am J Kidney Dis 2019; 74:179-192. [DOI: 10.1053/j.ajkd.2019.01.034] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/30/2019] [Indexed: 11/11/2022]
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Palanova P, Mrkvicova V, Nedbalkova M, Sosikova M, Konecny P, Jarkovsky J, Marques E, Novakova M, Pohanka M, Soucek M, Dobsak P. Home‐based training using neuromuscular electrical stimulation in patients on continuous ambulatory peritoneal dialysis: A pilot study. Artif Organs 2019; 43:796-805. [DOI: 10.1111/aor.13421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/17/2018] [Accepted: 12/28/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Petra Palanova
- Institute of Public Health, Faculty of Medicine, Masaryk University Brno Czech Republic
| | - Veronika Mrkvicova
- Institute of Public Health, Faculty of Medicine, Masaryk University Brno Czech Republic
| | - Marta Nedbalkova
- 2nd Department of Internal Medicine, St. Anne´s Faculty Hospital Brno Czech Republic
| | - Michaela Sosikova
- Department of Sports Medicine and Rehabilitation, St. Anne´s Faculty Hospital Brno Czech Republic
| | - Petr Konecny
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University Brno Czech Republic
| | - Jiri Jarkovsky
- Institute of Biological Analyses, Faculty of Medicine, Masaryk University Brno Czech Republic
| | - Emanuel Marques
- Department of Dermatovenerology, Hospital na Bulovce Prague Czech Republic
| | - Marie Novakova
- Institute of Physiology, Faculty of Medicine, Masaryk University Brno Czech Republic
| | - Michal Pohanka
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University Brno Czech Republic
| | - Miroslav Soucek
- 2nd Department of Internal Medicine, St. Anne´s Faculty Hospital Brno Czech Republic
| | - Petr Dobsak
- Department of Sports Medicine and Rehabilitation, St. Anne´s Faculty Hospital Brno Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University Brno Czech Republic
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Taylor MJ, Fornusek C, Ruys AJ. The duty cycle in Functional Electrical Stimulation research. Part II: Duty cycle multiplicity and domain reporting. Eur J Transl Myol 2018; 28:7733. [PMID: 30662696 PMCID: PMC6317134 DOI: 10.4081/ejtm.2018.7733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/21/2018] [Indexed: 12/17/2022] Open
Abstract
In part I of this review, we introduced the duty cycle as a fundamental parameter in controlling the effect of electrical stimulation pulse trains on muscle structural and functional properties with special emphasis on fatigue. Following on from a survey of the literature, we discuss here the relative ability of intermittent and continuous stimulation to fatigue muscle. In addition, pertinent literature is explored on a more deeper level, highlighting contentions regarding the duty cycle across studies. In response to literature inconsistencies, we propose frameworks upon which the duty cycle parameter may be specified. We present the idea of domain reporting for the duty cycle, and illustrate with practical examples. In addition we dig further into the literature and present a set of notations that have been used by different researchers to report the duty cycle. We also propose the idea of the duty cycle multiple, which together with domain reporting, will help researchers understand more precisely duty cycles of electrical stimulation. As a case study, we also show how the duty cycle has been looked at by researchers in the context of pressure sore attenuation in patients. Together with part I, it is hoped that the frameworks suggested provide a complete picture of how duty cycle has been discussed across the literature, and gives researchers a more trans-theoretical basis upon which they may report the duty cycle in their studies. This may also lead to a more precise specification of electrical stimulation protocols used in patients.
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Affiliation(s)
- Matthew J. Taylor
- Faculty of Engineering and IT, University of Sydney, Camperdown, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, Australia
| | - Ché Fornusek
- Faculty of Medicine and Health, University of Sydney, Lidcombe, Australia
| | - Andrew J. Ruys
- Faculty of Engineering and IT, University of Sydney, Camperdown, Australia
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