American Journal of Kidney Diseases
Volume 50, Issue 4 , Pages 574-584 , October 2007

Randomized Controlled Trial of Intradialytic Resistance Training to Target Muscle Wasting in ESRD: The Progressive Exercise for Anabolism in Kidney Disease (PEAK) Study

  • Bobby Cheema, PhD

      Affiliations

    • School of Exercise and Sport Science, University of Sydney, Sydney, Australia
    • Institute of Food, Nutrition, and Human Health, Massey University, Wellington, New Zealand
    • Corresponding Author InformationAddress correspondence to Bobby Cheema, PhD, Institute of Food, Nutrition and Human Health, Te Kura Hangarua o Kai-oranga-a-tangata, Massey University, Wellington Campus, Private Bag 756, Wellington, New Zealand.
    • ,
  • Haifa Abas, BApplSc

      Affiliations

    • School of Exercise and Sport Science, University of Sydney, Sydney, Australia
    • ,
  • Benjamin Smith, BApplSc

      Affiliations

    • School of Exercise and Sport Science, University of Sydney, Sydney, Australia
    • ,
  • Anthony O’Sullivan, MBBS

      Affiliations

    • Department of Medicine, University of New South Wales, Sydney, Australia
    • ,
  • Maria Chan, MNutrDiet

      Affiliations

    • Department of Nutrition and Dietetics, St George Hospital, Sydney, Australia
    • ,
  • Aditi Patwardhan, MNutrDiet

      Affiliations

    • Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney, Australia
    • ,
  • John Kelly, MBBS

      Affiliations

    • Department of Renal Medicine, St George Hospital, Sydney, Australia
    • ,
  • Adrian Gillin, MBBS

      Affiliations

    • Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
    • ,
  • Glen Pang, MNutrDiet

      Affiliations

    • Department of Nutrition and Dietetics, St George Hospital, Sydney, Australia
    • ,
  • Brad Lloyd, BApplSc

      Affiliations

    • School of Exercise and Sport Science, University of Sydney, Sydney, Australia
    • ,
  • Maria Fiatarone Singh, MD

      Affiliations

    • School of Exercise and Sport Science, University of Sydney, Sydney, Australia
    • Faculty of Medicine, University of Sydney, Sydney, Australia
    • Hebrew SeniorLife and Jean Mayer USDA Human Nutrition Center on Aging, Tufts University, Boston, MA.

Received 28 November 2006 ,Accepted 10 July 2007.

References 

  1. US Renal Data System. USRDS 2006 Annual Data Report. Bethesda, MD: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2006;
  2. Yach D, Stuckler D, Brownell K. Epidemiological and economic consequences of the global epidemics of obesity and diabetes. Nat Med. 2006;12:62–66
  3. Raj D, Zager P, Shah V, et al. Protein turnover and amino acid transport kinetics in end-stage renal disease. Am J Physiol Endocrinol Metab. 2004;286:E136–E143
  4. Goodpaster B, Thaete F, Simoneau J, Kelley D. Subcutaneous abdominal fat and thigh muscle composition predict insulin sensitivity independently of visceral fat. Diabetes. 1997;46:1579–1585
  5. Roubenoff R. Sarcopenia: Effects on body composition and function. J Gerontol A Biol Sci Med Sci. 2003;58A:1012–1017
  6. Marrades RM, Roca J, Campistol JM, et al. Effects of erythropoietin on muscle o2 transport during exercise in patients with chronic renal failure. J Clin Invest. 1996;97:2092–2100
  7. Desmeules S, Levesque R, Jaussent I, Leray-Moragues H, Chalabi L, Canaud B. Creatine index and lean body mass are excellent predictors of long-term survival in haemodiafiltration patients. Nephrol Dial Transplant. 2004;19:1182–1189
  8. Singh MA. Exercise comes of age: Rationale and recommendations for a geriatric exercise prescription. J Gerontol A Biol Sci Med Sci. 2002;57A:M262–M282
  9. Chan M, Cheema B, Fiatarone Singh M. Progressive resistance training and nutrition in renal failure. J Ren Nutr. 2007;17:84–87
  10. Cheema B, O’Sullivan A, Chan M, et al. Progressive resistance training during hemodialysis: Rationale and method of a randomized controlled trial. Hemodial Int. 2006;10:303–310
  11. Cheema B, Abas H, Smith B, et al. Progressive Exercise for Anabolism in Kidney Disease (PEAK): A randomized controlled trial of resistance training during hemodialysis. J Am Soc Nephrol. 2007;18:1594–1601
  12. Hakkinen K, Alen M, Kallinen M, Newton R, Kraemer W. Neuromuscular adaptation during prolonged strength training, detraining and re-strength-training in middle-aged and elderly people. Eur J Appl Physiol. 2000;83:51–62
  13. Borg G, Linderholm H. Exercise performance and perceived exertion in patients with coronary insufficiency, arterial hypertension and vasoregulatory asthenia. Acta Med Scand. 1970;187:17–26
  14. Goodpaster B, Thaete F, Kelley D. Thigh adipose tissue distribution is associated with insulin resistance in obesity and in type 2 diabetes mellitus. Am J Clin Nutr. 2000;71:885–892
  15. Fiatarone MA, O’Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994;330:1769–1775
  16. Enright PL, McBurnie MA, Bittner V, et al. The 6-min walk test: A quick measure of functional status in elderly adults. Chest. 2003;123:387–398
  17. Guyatt GH, Pugsley SO, Sullivan MJ, et al. Effect of encouragement on walking test performance. Thorax. 1984;39:818–822
  18. Guigoz Y, Vellas B, Garry PJ. Mini-Nutritional Assessment: A practical assessment tool for grading the nutritional state of elderly patients. Facts Res Gerontol. 1994;S2(suppl 2):S15–S59
  19. Price CP, Trull AK, Berry D, Gorman EG. Development and validation of a particle-enhanced turbidimetric immunoassay for C-reactive protein. J Immunol Methods. 1987;99:205–211
  20. Coe R: Effect Size Calculator: A User Guide to Using the Spreadsheet. Available at: http://www.cemcentre.org/renderpage.asp?linkID=30325017. Accessed November 9, 2006
  21. Castaneda C, Gordon P, Uhlin K, et al. Resistance training to counteract the catabolism of a low-protein diet in patients with chronic renal insufficiency (A randomized, controlled trial). Ann Intern Med. 2001;135:965–976
  22. Yesavage J, Brink T, Rose T, Lum OJ. Development and validation of a geriatric depression screening scale: A preliminary report. Psychiat Res. 1983;17:37–49
  23. Cheema B, Lassere M, Shnier R, Fiatarone Singh M. Rotator cuff tear in an elderly woman performing progressive resistance training: Case report from a randomized controlled trial. J Phys Act Health. 2007;4:1–8
  24. Goodpaster B, Park S, Harris T, et al. The loss of skeletal muscle strength, mass, and quality in older adults: The Health, Aging and Body Composition Study. J Gerontol A Biol Sci Med Sci. 2006;61A:1059–1064
  25. Johansen KL, Schubert T, Doyle J, Soher B, Sakkas GK, Kent-Braun JA. Muscle atrophy in patients receiving hemodialysis: Effects on muscle strength, muscle quality, and physical function. Kidney Int. 2003;63:291–297
  26. Macdonald J, Marcora S, Jibani M, Phanish M, Holly J, Lemmey A. Intradialytic exercise as anabolic therapy in haemodialysis. Clin Physiol Funct Imaging. 2005;25:113–118
  27. Kouidi E, Albani M, Natsis K, et al. The effects of exercise training on muscle atrophy in hemodialysis patients. Nephrol Dial Transplant. 1998;13:685–699
  28. Sakkas GK, Sargeant AJ, Mercer TH, et al. Changes in muscle morphology in dialysis patients after 6 months of aerobic exercise training. Nephrol Dial Transplant. 2003;18:1854–1861
  29. Moore GE, Parsons DB, Stray-Gundersen J, Painter PL, Brinker KR, Mitchell JH. Uremic myopathy limits aerobic capacity in hemodialysis patients. Am J Kidney Dis. 1993;22:277–287
  30. Johansen K, Painter P, Sakkas G, et al. Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis: A randomized controlled trial. J Am Soc Nephrol. 2006;17:2307–2314
  31. Castaneda C, Gordon P, Parker R, Uhlin K, Roubenoff R, Levey A. Resistance training to reduce the malnutrition-inflammation complex syndrome of chronic kidney disease. Am J Kidney Dis. 2004;43:607–616
  32. Nindl BC, Headley SA, Tuckow AP, et al. IGF-I system responses during 12 weeks of resistance training in end-stage renal disease patients. Growth Horm IGF Res. 2004;14:245–250
  33. Shlipak M, Fried L, Cushman M, et al. Cardiovascular mortality risk in chronic kidney disease. JAMA. 2005;293:1737–1745
  34. Cheema B, Fiatarone Singh M. Exercise training in patients receiving maintenance hemodialysis: A systematic review of clinical trials. Am J Nephrol. 2005;25:352–364
  35. Cheema B, Smith B, Fiatarone Singh M. A rationale for intradialytic exercise training as standard clinical practice in end-stage renal disease. Am J Kidney Dis. 2005;45:912–916
  36. Painter P. Physical functioning in end-stage renal disease patients: Update 2005. Hemodial Int. 2005;9:218–235
  37. Pupim LB, Flakoll PJ, Levenhagen DK, Ikizler TA. Exercise augments the acute anabolic effects of intradialytic parenteral nutrition in chronic hemodialysis patients. Am J Physiol Endocrinol Metab. 2004;286:E589–E597
  38. Kong C, Tattersall J, Greenwood R, Farrington K. The effect of exercise during hemodialysis on solute removal. Nephrol Dial Transplant. 1999;14:2927–2931
  39. Johansen KL, Sakkas GK, Doyle J, Shubert T, Dudley RA. Exercise counselling practices among nephrologists caring for patients on dialysis. Am J Kidney Dis. 2003;41:171–178

 Trial registration: www.actr.org.au; study number: 12605000101684.

PII: S0272-6386(07)01034-7

doi: 10.1053/j.ajkd.2007.07.005

American Journal of Kidney Diseases
Volume 50, Issue 4 , Pages 574-584 , October 2007

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