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Randomized controlled trial of intradialytic resistance training to target muscle wasting in ESRD: the Progressive Exercise for Anabolism in Kidney Disease (PEAK) study.
Am J Kidney Dis. 2007 Oct; 50(4):574-84.AJ

Abstract

BACKGROUND

To determine whether prolonged (24 weeks) intradialytic progressive resistance training (PRT) could counteract muscle wasting more effectively than short-duration training (12 weeks) in patients with end-stage renal disease.

STUDY DESIGN

Randomized controlled trial.

SETTING & PARTICIPANTS

49 patients (age, 62.6 +/- 14.2 years; 0.3 to 16.7 years on hemodialysis therapy) were randomly assigned to PRT plus usual care for 24 weeks (24WK group) or a crossover control group that received usual care for the first 12 weeks, then PRT plus usual care for the latter 12 weeks (12WK group).

INTERVENTION

Two sets of 10 free-weight PRT exercises were performed at a high intensity during routine thrice-weekly hemodialysis treatment under direct supervision.

OUTCOMES & MEASUREMENTS

Primary outcomes include thigh muscle cross-sectional area by means of computed tomography and intramuscular lipid content estimated through attenuation. Secondary outcomes include muscular strength, exercise capacity, and C-reactive protein level.

RESULTS

The 24WK group increased muscle cross-sectional area (+1.82 +/- 3.25 cm(2)) compared with losses in the 12WK group (-1.37 +/- 6.87 cm(2); relative effect size, 0.59; 95% confidence interval [CI], -0.27 to 6.65; P = 0.04). However, this outcome did not achieve the level of statistical significance required (P = 0.025) after Bonferroni correction for multiple primary outcomes. There was no significant change in intramuscular lipid content between groups (+0.19 +/- 1.32 versus +0.16 +/- 1.69 Hounsfield units in the 24WK and 12WK groups, respectively; P = 0.31). Log C-reactive protein level tended to decrease in the 24WK group compared with the 12WK group (relative effect size, -0.63; 95% CI, -0.27 [-0.54 to 0.00]; P = 0.05). The 24WK group improved muscular strength measures and exercise capacity throughout the trial.

LIMITATIONS

Single geographic site used; no control group without exercise exposure; unblinded assessment of some secondary outcome measures.

CONCLUSIONS

Prolonged intradialytic PRT did not significantly improve muscle cross-sectional area or intramuscular lipid content compared with a shorter duration of exercise. Future trials are required to more thoroughly investigate the clinical importance and magnitude of myogenic adaptations to PRT in this cohort.

Links

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Authors+Show Affiliations

Cheema B
School of Exercise and Sport Science, University of Sydney, Sydney, Australia. b.cheema@massey.ac.nz
Abas H
No affiliation info available
Smith B
No affiliation info available
O'Sullivan A
No affiliation info available
Chan M
No affiliation info available
Patwardhan A
No affiliation info available
Kelly J
No affiliation info available
Gillin A
No affiliation info available
Pang G
No affiliation info available
Lloyd B
No affiliation info available
Fiatarone Singh M
No affiliation info available

MeSH

AdultAgedAged, 80 and overCohort StudiesCross-Over StudiesExerciseExercise TherapyFemaleHumansKidney Failure, ChronicMaleMiddle AgedMuscle StrengthMuscle WeaknessRenal Dialysis

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17900457

Clinical Trial Links

Low-frequency Electrical Muscle Stimulation vs Cycle Training During Haemodialysis

Citation

Cheema, Bobby, et al. "Randomized Controlled Trial of Intradialytic Resistance Training to Target Muscle Wasting in ESRD: the Progressive Exercise for Anabolism in Kidney Disease (PEAK) Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 50, no. 4, 2007, pp. 574-84.
Cheema B, Abas H, Smith B, et al. Randomized controlled trial of intradialytic resistance training to target muscle wasting in ESRD: the Progressive Exercise for Anabolism in Kidney Disease (PEAK) study. Am J Kidney Dis. 2007;50(4):574-84.
Cheema, B., Abas, H., Smith, B., O'Sullivan, A., Chan, M., Patwardhan, A., Kelly, J., Gillin, A., Pang, G., Lloyd, B., & Fiatarone Singh, M. (2007). Randomized controlled trial of intradialytic resistance training to target muscle wasting in ESRD: the Progressive Exercise for Anabolism in Kidney Disease (PEAK) study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 50(4), 574-84.
Cheema B, et al. Randomized Controlled Trial of Intradialytic Resistance Training to Target Muscle Wasting in ESRD: the Progressive Exercise for Anabolism in Kidney Disease (PEAK) Study. Am J Kidney Dis. 2007;50(4):574-84. PubMed PMID: 17900457.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomized controlled trial of intradialytic resistance training to target muscle wasting in ESRD: the Progressive Exercise for Anabolism in Kidney Disease (PEAK) study. AU - Cheema,Bobby, AU - Abas,Haifa, AU - Smith,Benjamin, AU - O'Sullivan,Anthony, AU - Chan,Maria, AU - Patwardhan,Aditi, AU - Kelly,John, AU - Gillin,Adrian, AU - Pang,Glen, AU - Lloyd,Brad, AU - Fiatarone Singh,Maria, PY - 2006/11/28/received PY - 2007/07/10/accepted PY - 2007/9/29/pubmed PY - 2007/10/16/medline PY - 2007/9/29/entrez SP - 574 EP - 84 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 50 IS - 4 N2 - BACKGROUND: To determine whether prolonged (24 weeks) intradialytic progressive resistance training (PRT) could counteract muscle wasting more effectively than short-duration training (12 weeks) in patients with end-stage renal disease. STUDY DESIGN: Randomized controlled trial. SETTING & PARTICIPANTS: 49 patients (age, 62.6 +/- 14.2 years; 0.3 to 16.7 years on hemodialysis therapy) were randomly assigned to PRT plus usual care for 24 weeks (24WK group) or a crossover control group that received usual care for the first 12 weeks, then PRT plus usual care for the latter 12 weeks (12WK group). INTERVENTION: Two sets of 10 free-weight PRT exercises were performed at a high intensity during routine thrice-weekly hemodialysis treatment under direct supervision. OUTCOMES & MEASUREMENTS: Primary outcomes include thigh muscle cross-sectional area by means of computed tomography and intramuscular lipid content estimated through attenuation. Secondary outcomes include muscular strength, exercise capacity, and C-reactive protein level. RESULTS: The 24WK group increased muscle cross-sectional area (+1.82 +/- 3.25 cm(2)) compared with losses in the 12WK group (-1.37 +/- 6.87 cm(2); relative effect size, 0.59; 95% confidence interval [CI], -0.27 to 6.65; P = 0.04). However, this outcome did not achieve the level of statistical significance required (P = 0.025) after Bonferroni correction for multiple primary outcomes. There was no significant change in intramuscular lipid content between groups (+0.19 +/- 1.32 versus +0.16 +/- 1.69 Hounsfield units in the 24WK and 12WK groups, respectively; P = 0.31). Log C-reactive protein level tended to decrease in the 24WK group compared with the 12WK group (relative effect size, -0.63; 95% CI, -0.27 [-0.54 to 0.00]; P = 0.05). The 24WK group improved muscular strength measures and exercise capacity throughout the trial. LIMITATIONS: Single geographic site used; no control group without exercise exposure; unblinded assessment of some secondary outcome measures. CONCLUSIONS: Prolonged intradialytic PRT did not significantly improve muscle cross-sectional area or intramuscular lipid content compared with a shorter duration of exercise. Future trials are required to more thoroughly investigate the clinical importance and magnitude of myogenic adaptations to PRT in this cohort. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/17900457/Randomized_controlled_trial_of_intradialytic_resistance_training_to_target_muscle_wasting_in_ESRD:_the_Progressive_Exercise_for_Anabolism_in_Kidney_Disease__PEAK__study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(07)01034-7 DB - PRIME DP - Unbound Medicine ER -