Effects of exercise training plus normalization of hematocrit on exercise capacity and health-related quality of life

doi:10.1053/ajkd.2002.30544

American Journal of Kidney Diseases

Volume 39, Issue 2, February 2002, Pages 257-265

https://doi.org/10.1053/ajkd.2002.30544 Get rights and content

Abstract

The limitation to exercise capacity in hemodialysis patients has been attributed to anemia. We report the effects of normalization of hematocrit levels by using r-hu-recombinant erythropoietin and exercise training on exercise capacity and self-reported physical functioning in hemodialysis patients. Sixty-five patients were randomized into 1 of 4 groups: usual hematocrit (30%-33%) with no exercise training (UH); usual hematocrit (30%-33%) plus exercise training (UHX); normalized hematocrit (40%-42%) with no exercise training (NH); and normalized hematocrit (40%-42%) plus exercise training (NHX). Treadmill exercise testing was conducted at baseline and at 5 months after the initiation of the interventions. Analysis was performed on the data collapsed for 48 patients who met the criteria for hematocrit and exercise adherence and completed both baseline and post intervention (5.6 ±1.6 months) testing. Significant effects of exercise were found in peak oxygen uptake measurements (P = 0.03) and in self-reported physical functioning as measured by the Short Form-36 questionnaire (P = 0.01). There was a significant effect of hematocrit on the General Health scale on the SF-36 (P = 0.03). The changes in peak oxygen uptake with exercise training were small and levels remained lower than age-predicted values at the end of the study. These results indicate that there are other physiologic limitations to exercise capacity that are not overcome by exercise training or normalization of hematocrit. The effects of exercise training on self-reported physical functioning may be of clinical importance because these scores have been shown to be highly predictive of outcomes such as hospitalizations and mortality in hemodialysis patients. © 2002 by the National Kidney Foundation, Inc.

Section snippets

Study design

This was a randomized controlled trial in which 65 hemodialysis patients were randomized into 1 of 4 groups: usual-care hematocrit (30%-33%) with no exercise training (UH); usual-care hematocrit (30%-33%) plus exercise training (UHX); normalized hematocrit (40%-42%) with no exercise training (NH); and normalized hematocrit (40%-42%) plus exercise training (NHX). Randomization was stratified by age (<50 versus ≥50 years) and sex. The original study design was for baseline testing with repeated

Patients

Sixty-five patients were enrolled in this study. Among them, 10 patients dropped out before they had postbaseline measurements. The intent-to-treat analysis includes all 55 patients who had at least 1 postbaseline measurement.

Forty-eight patients completed pre- and posttesting and were included in the post hoc analysis. Reasons for loss of 17 patients to the analysis included: transplant, changed modality to PD, or moved (8); medical reasons (5); out of hematocrit range at the time of testing

Discussion

The results of this study show that endurance exercise training significantly increases peak Vo₂ in hemodialysis patients. In contrast, there was no significant effect of normalization of hematocrit on peak Vo_2. Peak oxygen uptake at baseline was lower than age- and sex-predicted values (UH: 60.6% ± 19.4%; UHX: 63.8% ± 23.0%; NH: 65.1% ± 20.6%; NHX: 56.8% ± 20.6%). Group UHX averaged 72.8% ± 22.8% of age-predicted values for peak Vo₂ after exercise training. Group NHX averaged 64% ± 19% of age-

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Citation Excerpt :
The duration of exercise protocol was 8 weeks in five groups (13%),12,30,41,46 12 weeks in 13 groups (33%),9,19,21,26,28,29,33,38,39,43,48 16 to 20 weeks in ten groups (26%)10,11,25,27,34,40,42,44 and ≥24 weeks in 11 groups (28%).13,24,31,32,35–37,45,47,49 The exercise training program was prescribed three times a week for most groups (80%).9–13,19,21,24,26,28–38,41,43,44,46,48,49 Only nine studies (27%) reported compliance with the exercise training program,19,21,29,31–33,35,40,47 with compliance being at least 74% in all experimental groups where it was reported.40
Do aerobic, resistance and combined exercise training improve aerobic capacity, arterial blood pressure and haemodialysis efficiency in people requiring haemodialysis for end-stage renal disease? Is one exercise training modality better than the others for improving these outcomes?
Systematic review with network meta-analysis of randomised trials.
Adults requiring haemodialysis for end-stage renal disease.
Aerobic training, resistance training, combined training and control (no exercise or placebo).
Aerobic capacity, arterial blood pressure at rest, and haemodialysis efficiency.
Thirty-three trials involving 1254 participants were included. Direct meta-analyses were conducted first. Aerobic capacity improved significantly more with aerobic training (3.35 ml/kg/min, 95% CI 1.79 to 4.91) and combined training (5.00 ml/kg/min, 95% CI 3.50 to 6.50) than with control. Only combined training significantly reduced systolic (−9 mmHg, 95% CI −13 to −4) and diastolic (−5 mmHg, 95% CI −6 to −3) blood pressure compared to control. Only aerobic training was superior to control for haemodialysis efficiency (Kt/V 0.11, 95% CI 0.02 to 0.20). However, when network meta-analysis was conducted, there were some important different findings. Both aerobic training and combined training again elicited greater improvements in aerobic capacity than control. For systolic blood pressure, combined training was superior to control. For diastolic blood pressure, combined training was superior to aerobic training and control. No modality was superior to control for haemodialysis efficiency. Combined training was ranked as the most effective treatment for aerobic capacity and arterial blood pressure.
Combined training was the most effective modality to increase aerobic capacity and blood pressure control in people who require haemodialysis. This finding helps to fill the gap created by the lack of head-to-head comparisons of different modalities of exercise in people with end-stage renal disease.
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^☆: Supported by Amgen, Inc. Work performed at the Stanford Center for Research in Disease Prevention.

^☆☆: Address reprint requests to Patricia Painter, PhD, UCSF Department of Physiological Nursing, Box 0116, San Francisco, CA 94143. E-mail: [email protected]

^★: 0272-6386/02/3902-0003$35.00/0

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Original InvestigationsEffects of exercise training plus normalization of hematocrit on exercise capacity and health-related quality of life☆,☆☆,★

Abstract

Section snippets

Study design

Patients

Discussion

Adv Ren Replace Ther

Kidney Int

Am J Kidney Dis

Kidney Int

Am J Cardiol

Am J Clin Nutr

Adv Ren Replace Ther

Lancet

Am J Kidney Dis

Am J Kidney Dis

Am J Kidney Dis

Am J Kidney Dis

Adv Ren Replace Ther

A Report of the Surgeon General

Exercise in end stage renal disease. Exer Sport

Sci Rev

Effects of erythropoietin on strength and functional status of patients on hemodialysis

Clin Nephrol

Cardiovascular status in long-term hemodialysis patients: An exercise and echocardiographic study

Nephron

Determinants of VO2peak in patients with end-stage renal disease: On and off dialysis

Med Sci Sports Exerc

Original Investigations
Effects of exercise training plus normalization of hematocrit on exercise capacity and health-related quality of life☆,☆☆,★