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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.

Authors+Show Affiliations

School of Exercise and Sport Science, University of Sydney, Sydney, Australia. b.cheema@massey.ac.nzNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

17900457

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 -