Progressive resistance training during maintenance hemodialysis in patients with end stage renal disease

Abstract

Background: The global incidence of end-stage renal disease (ESRD) continues to rise annually. Accompanying this rise is an increase in the number of patients on hemodialysis. These trends are being driven by an unprecedented burden of hypokinetic, non-communicable diseases, and particularly the type 2 diabetes-obesity pandemic. The progression of kidney disease is associated with an exponential increase in atherosclerotic cardiovascular disease (CVD) and associated mortality. CVD is the leading cause of hospitalization and death in this cohort. As the ESRD patient population continues to grow, greater efforts must be directed toward improving patient outcomes in this cohort, including morbidity, mortality and healthrelated quality of life (HRQoL). Aims: This thesis addresses several gaps related to the investigation and application of progressive resistance training (PRT) in the hemodialysis setting. The specific aims were: (i) to systematically review the extant literature on PRT in patients with ESRD, and to outline recommendations for robust clinical trials; (ii) to assess the feasibility and efficacy of including a novel customized resistance training device within a comprehensive intradialytic PRT intervention in a conventional hemodialysis unit; (iii) to investigate the effect of a 12-week intradialytic PRT intervention on measures of CVD risk, specifically, arterial stiffness (i.e. pulse wave velocity; PWV) and associated outcomes (i.e. hemodynamic, anthropometric, and hematologic). Research Program: The research program was undertaken from March 2011 to March 2015 and culminated in a clinical trial enrolling 22 participants conducted across four dialysis centers in Adelaide, South Australia. Conclusions: Chapter 7 presents general conclusions to the thesis, as follows: (i) According to the systematic review of the extance literature (Chapter 4) clinical trials are required to investigate a range of novel research questions related to the benefits and application of PRT in this cohort and its patient subgroups (e.g. diabetes, depression, dyslipidemia, etc.). Future studies must be of high methodological quality to inform clinical practice guidelines. (ii) According to the study presented in Chapter 5, PRT using the novel training device was feasible and improved measures of physical and psychological health and HRQoL. This device can be utilized in most dialysis centers. Future studies are required to evaluate dose-response effects of PRT prescriptions in subpopulations, and the application of PRT in standard dialysis practice. (iii) According to the study presented in Chapter 6, 12 weeks of low-to-moderate intensity intradialytic PRT did not change PWV, hemodynamic, anthropometric or hematologic measures in patients with ESRD. More research is needed to determine whether different intensities or durations of PRT can affect vascular health or other outcomes related to survival in this patient group.

Date of Award	2016
Original language	English