The Effect of Nutrition and Exercise on Body Composition, Exercise Capacity, and Physical Functioning in Advanced CKD Patients
Abstract
:1. Introduction
2. Methods
3. Physical Inactivity and Physical Function in CKD Patients
4. Frailty, Protein Energy Wasting and Chronic Kidney Disease
5. Causes of Decreased Physical Activity in CKD Patients
6. Results
Nutrition and Exercise Training
7. Discussion
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Column | Reference, Study Design | No. of Patients | Type of Patients | Methods of Intervention | Duration | Significant Results |
---|---|---|---|---|---|---|
1 | Limwanata et al., 2021 [13], randomized controlled trial | Rx1-26 Rx2-30 Control-24 | Malnourished HD, age range 18–75 years | Rx1: ONS (370 kcal/day, 17 g protein, 42.2 g carbohydrate, 16.4 g lipid) Rx2: ONS (370 kcal/day, 16.6 g protein, 33 g carbohydrate, 19.8 g lipid) Control: dietary counseling | 1 month | Significant changes within each group: Rx1: ↑ dietary intake of energy, protein, fat, fiber, and magnesium, ↑ mid-arm circumference, ↑ body weight, ↑ BMI, ↑ pre-albumin and albumin; ↓ MIS; no change in muscle mass, handgrip strength, percentage body fat, and triceps skinfold thickness Rx2: ↑ dietary intake of energy, protein, fat, fiber, and magnesium, ↑ mid-arm circumference, ↑ handgrip strength, ↑ body weight, ↑ BMI; ↓ MIS; no change in muscle mass, percentage body fat, triceps skinfold thickness, and pre-albumin and albumin Control: no change in any markers Two Rx groups vs. control: ↑ dietary intake of energy, protein, fat, fiber, and magnesium, ↑ albumin; ↓ MIS; no change in muscle mass, mid-arm circumference, handgrip strength, body weight, BMI, percentage body fat, triceps skinfold thickness, and pre-albumin |
2 | Sahathevan et al., 2021 [14], randomized, open-label controlled trial | Rx-29 Control-27 | HD with PEW, age range 18–70 years | Rx: ONS (475 kcal, 21.7 g protein) taken 30 min after initiation of HD and at home on non-HD days combined with nutrition counseling. Control: nutrition counseling alone | 6 months | Significant changes within each group: Rx: ↑ dietary energy or protein intake, ↑ mid-thigh girth, ↑ dry weight, ↑ pre-albumin Control: No change in any markers Rx group vs. control: ↑ rectus femoris thickness and CSA at midpoint, ↑ vastus intermedius thickness at midpoint; ↓ dietary energy intake, ↓ MIS, ↓ PEW; no change in appetite, handgrip strength, physical activity level, BMI, albumin, hsCRP and IL-6 |
3 | Martin-Alemany et al., 2020 [11], randomized parallel controlled trial | Rx1-15 Rx2-15 Rx3-15 | Young HD older than 18 years, mean age 29 ± SD 9.3 years | Rx1: ONS (480 kcal, 20 g protein, 56 g carbohydrate, 20 g lipid) Rx2: ONS + aerobic exercise (consisting of pedaling stationary bike during the first 2 h of the HD session) Rx3: ONS + resistance exercise (four sets of 20 repetitions for 40 min during the first 2 h of the HD sessions) | 3 months | Significant changes within each group: Rx1: ↑ handgrip strength, ↑ 6MWT, ↑ TUG, ↑ body weight, ↑ BMI, ↑ albumin Rx2: ↑ handgrip strength, ↑ 6MWT, ↑ TUG, ↑ STS; ↓ albumin Rx3: ↑ handgrip strength, ↑ 6MWT, ↑ TUG, ↑ STS, ↑ weight, ↑ BMI, ↑ percentage body fat, ↑ triceps skinfold thickness, ↑ albumin Rx1 vs. Rx2 vs. Rx3: No change in mid-arm circumference, arm muscle circumference, arm muscle area, physical activity, body weight, BMI, fat mass, triceps skinfold thickness, albumin, and c-reactive protein |
4 | Gamboa et al., 2020 [15], prospective randomized, open-label, parallel arm trial | Rx1-6 Rx2-6 | HD, older than 18 years | Rx1: ONS during HD (480 kcal, 16.7 g protein, 52.8 g carbohydrate, 22.7 g lipid) Rx2: ONS during HD (480 kcal, 16.7 g protein, 52.8 g carbohydrate, 22.7 g lipid) + resistance exercise (leg press within 30 min before each HD session) | 6 months | Significant changes within each group: Rx1 and Rx2 at 3 months: ↑ markers of mitochondrial content in muscle (mtDNA copy no.); no change in mitochondrial PGC-1 alpha Rx1 and Rx2 at 6 months: ↑ forearm protein net balance, ↑ mid-thigh CSA, ↑ mid-thigh fat area; no change in mid-thigh muscle area Rx1 vs. Rx2 at 3 months: No change in forearm protein net balance, whole body protein metabolism, mtDNA copy no., mitochondrial PGC-1 alpha, mid-thigh CSA, mid-thigh muscle area, and mid-thigh fat area Rx1 vs. Rx2 at 6 months: No change in forearm protein net balance, whole body protein metabolism, mid-thigh CSA, mid-thigh muscle area, and mid-thigh fat area |
5 | Jeong et al., 2019 [12], randomized controlled trial | Rx1-38 Rx2-29 Control-34 | HD, age range 30–80 years | Rx1: 30 g whey protein at beginning of each HD session Rx2: 30 g whey protein+ supervised exercise training (cycle ergometer up to 45 min) Control: ~150 g of a non-nutritive beverage during HD | 12 months | Significant changes within each group: Rx1: at 6 months: ↑ dietary protein intake, ↑ gait speed; no change in muscle strength (leg maximal flexion force), STS, and TUG at 12 months: ↑ dietary protein intake, ↑ gait speed; no change in muscle strength (leg maximal flexion force), STS, and TUG Rx2: at 6 months: ↑ dietary protein intake, ↑ muscle strength (leg maximal flexion force), ↑ STS, ↑ TUG, ↑ gait speed at 12 months: ↑ dietary protein intake, ↑ muscle strength (leg maximal flexion force), ↑ gait speed; no change in STS and TUG Control at 6 months and at 12 months: ↑ gait speed (only at 6 months); no change in dietary protein intake, muscle strength (leg maximal flexion force), STS, and TUG Two Rx groups vs. control: No change in albumin, IL-6, and CRP |
6 | Ikizler et al., 2018, Aydemir et al. 2020 [16,17], randomized controlled trial | Rx1-30 Rx2-28 Rx3-27 Control-26 | Moderate to severe overweight or obese CKD (stage 3 and 4), age range 18–75 years | Rx1: aerobic exercise+ calorie restriction Rx2: usual activity+ calorie restriction Rx3: aerobic exercise+ usual dietControl: usual activity+ usual diet | 4 months | Significant changes within each group: Rx1: ↓ percentage body fat, ↓ body weight, ↓ F2-isoprostane, ↓ IL-6; no change in VO2 peak Rx2: ↑ plasma adiponectin; ↓ percentage body fat, ↓ body weight, ↓ F2-isoprostane, ↓ IL-6; no change in VO2 peak Rx3: ↓ F2-isoprostane, ↓ IL-6; no change in VO2 peak, percentage body fat, and body weight Rx1 vs. control: ↓ percentage body fat, ↓ body weight |
7 | Zilles et al., 2018 [18], prospective randomized trial | Rx1-7 HIV positive Rx2-16 HIV negative (treatment: 8, control: 8) | HD patients with and without HIV, age range 18–75 years | Rx1: ONS (250 kcal, 9.4 g protein, 25 g carbohydrates, 12.5 g lipid) consumed after HD and on non-HD days Rx2: Treatment: ONS (250 kcal, 9.4 g protein, 25 g carbohydrate, 12.5 g lipid) consumed after HD and on non-HD days Rx2: Control: no nutritional supplement | 6 months | Significant changes within each group: In both Rx1 and Rx2: No change in iliopsoas muscle thickness at CSA, mid-arm circumference, subjective global assessment, BMI, subcutaneous fat thickness, albumin, c-reactive protein, IL-1beta, tumor necrosis factor alpha, and IL-6 Only in Rx1: ↑ body cell mass Significant changes in Rx1 and Rx2 Treatment combined: ↑ BMI; no change in phase angle alpha and albumin Rx1 vs. Rx2: No change in iliopsoas muscle thickness at CSA, mid-arm circumference, body cell mass, phase angle alpha, subjective global assessment, BMI, subcutaneous fat thickness, albumin, c-reactive protein, (IL)-1beta, tumor necrosis factor alpha, and IL-6 |
8 | Martin Alemany et al., 2016 [19], randomized trial | Rx1-19 Rx2-17 | HD patients older than 18 years with no physical activity (86% had a BMI <23 kg/m2, 83% had a serum albumin <3.8 g/dL, and 55.5% were diagnosed with PEW) | Rx1: ONS during HD (434 kcal, 19.2 g protein, 22.8 g lipid) Rx2: ONS during HD (434 kcal, 19.2 g protein, 22.8 g lipid) + resistance exercise | 3 months | Significant changes within each group: In both Rx1 and Rx2: ↑ dietary energy or protein intake, ↑ mid-arm circumference, ↑ mid-arm muscle circumference, ↑ phase angle, ↑ handgrip strength, ↑ body weight, ↑ BMI, ↑ triceps skinfold thickness, ↑ percentage body fat, ↑ albumin Rx1 vs. Rx2: No change in dietary energy or protein intake, mid-arm muscle circumference, mid-arm circumference, phase angle, handgrip strength, PEW, body weight, BMI, triceps skinfold thickness, percentage body fat, and albumin |
9 | Hristea et al., 2016 [20], randomized controlled trial | Rx1-10 Rx2-11 | Old HD patients with PEW, mean age 69.7 ± SD 14.2 years | Rx1: ONS or IDPN Rx2: ONS or IDPN+ exercise (moderate intensity cycling at the beginning of HD) | 6 months | Significant changes within each group: Rx2: ↑ total energy intake, ↑ 6MWT Rx1 vs. Rx2: No change in dietary energy or protein intake, quadriceps force, lean-tissue index, PEW, BMI, fat-tissue index, albumin, pre-albumin, and c-reactive protein |
10 | Tomayko et al., 2015 [21], randomized controlled trial | Rx1-11 Rx2-12 Control-15 | HD patients older than 30 years | Rx1: 27 g whey protein beverage (15 min before HD) Rx2: 27 g soy protein beverage (15 min before HD) Control: 2 g non caloric placebo beverage (15 min before HD) | 6 months | Significant changes within each group: In both Rx1 and Rx2: ↑ gait speed, ↑ shuttle walk test; ↓ IL-6 Control: ↓ gait speed Two Rx groups vs. control: ↑ gait speed; no change in whole body lean mass, shuttle walk test, body weight, whole body fat, and albumin |
11 | Molsted et al., 2013 [22], randomized controlled trial | Rx1-16 Rx2-13 Control-29 | Dialysis patients undergoing HD or PD, more than 18 years | Rx1: ONS (251 kcal, 9.4 g protein, 25 g carbohydrate, 12.5 g lipid) + strength training Rx2: non-protein ONS (251 kcal, 2.4 g carbohydrate, 27.3 g lipid) + strength training Control: usual care | 4 months | Rx1 vs. Rx2: No change in energy intake, muscle fiber composition or size, muscle power (leg extension), muscle strength (knee extension), physical performance (chair stand test), body weight, and BMI Two Rx groups vs. control: ↑ energy intake, ↑ muscle power (leg extension), ↑ muscle strength (knee extension), ↑ physical performance (chair stand test), ↑ body weight, ↑ BMI; ↓ type 2x muscle fiber number |
Column | Reference, Study Design | No. of Patients | Type of Participants | Methods of Intervention | Duration | Significant Results |
---|---|---|---|---|---|---|
1 | Sheshadri et al., 2020 [23,24], randomized controlled trial | Rx-30 Control-30 | Undergoing HD or PD; older than 18 years | Rx: Used pedometers with counseling to increase their daily steps by 10% each week. Control: usual care | 3 months intervention and 3 months post-intervention follow-up | Rx vs. control at 3 months: ↑ daily steps, ↑ heart rate variability; no change in total body muscle mass, BMI, fat mass, short physical performance battery score, and endothelial function Rx vs. control at 6 months: ↑ total body muscle mass; ↓ BMI, ↓ fat mass; no change in daily steps, short physical performance battery score, endothelial function, or heart rate variability |
2 | Cooke et al., 2018 [25], open-label randomized controlled trial | Rx-10 Control-10 | HD; mean age 55 ± SD 16 years, mean BMI 26.4 ± SD 5.2 kg/m2 | Rx: pedaling exercise during HD Control: usual care | 4 months | Rx vs. control: ↑ waist:hip ratio; ↓ heart rate-corrected augmentation index, ↓ carotid femoral pulse wave velocity, ↓ heart rate; no change in handgrip strength, gait speed, BMI, albumin, peripheral, and central blood pressure |
3 | Manfredini et al., 2017 [26], randomized controlled trial | Rx-151 Control-145 | HD or CAPD | Rx: low-intensity home-based personalized walking exercise Control: usual care | 6 months | Rx vs. control: ↑ 6MWT; ↓ STS; no change in albumin, heart rate, and blood pressure |
4 | Thompson et al., 2016 [27], randomized controlled trial | Rx1-8 Rx2-7 Rx3-8 Control-8 | HD; older than 18 years | Rx1: aerobic exercise (cycling) during HD Rx2: resistance exercise during HD Rx3: combined exercise (aerobic + resistance) during HD Control: routine stretching during HD | 3 months | Three Rx groups vs. control: No change in 6MWT, STS, and muscle strength (one repetition maximum) |
5 | Bennett et al., 2016 [28], prospective stepped intradialytic resistance training randomized controlled trial | Rx1-80 Rx2-80 Rx3-68 | HD; older than 18 years | Rx1, Rx2, Rx3: resistance exercise during HD. The time of commencement of the resistance training program in each HD unit was determined randomly. | Rx1: 9 months Rx2: 6 months Rx3: 3 months | With intradialytic resistance training: ↑ STS; ↓ 8-ft timed up-and-go |
6 | Olvera-Soto et al., 2016 [9], randomized controlled trial | Rx-30 Control-31 | HD; older than 18 years, (83% with some grade of malnutrition) | Rx: resistance exercise during HD Control: usual care | 3 months | Significant changes within each group: Rx: ↑ percentage body fat, ↑ arm muscle circumference, ↑ arm muscle area, ↑ handgrip strength Control: ↓ handgrip strength Rx vs. control: ↑ handgrip strength; no change in dietary protein or energy intake, percentage body fat, arm muscle circumference, and arm muscle area |
7 | Lewis et al., 2015 [29], randomized controlled trial | Rx1-15 Rx2-13 Rx3-17 Rx4-14 Control-22 | HD; mean age 42.1 ± SD 1.5 years; healthy matched controls mean age 40.9 ± SD 2.6 years | Rx1: HD, no training Rx2: HD, endurance training Rx3: HD, strength training RX4: HD, a combination of endurance and strength training Control: normal sedentary people with no exercise training | 22 weeks | Significant changes within each group: Rx2: ↑ number of capillaries in type I and IIA fibers of vastus lateralis, ↑ capillary density of vastus lateralis, ↑ capillary-to-fiber ratio Rx3: No change in the number of capillaries in any type of fibers of vastus lateralis, capillary density of vastus lateralis, and capillary-to-fiber ratio. Rx4: ↓ thickness of type I and IIA fiber CSA in vastus lateralis; ↑ capillary number in type I, IIA, and IIX fibers of vastus lateralis; ↑ capillary density of vastus lateralis, ↑ capillary-to-fiber ratio With any type of training (Rx2, Rx3, and Rx4) vs. no training (Rx1): No change in the proportion of type I, IIA, and IIX fibers in vastus lateralis muscle and succinate dehydrogenase activity in type I, IIA, and IIX fibers in vastus lateralis |
8 | Matsufuji et al., 2015 [30], prospective randomized parallel controlled trial | Rx-12 Control-15 | HD; age range 61–79 years | Rx: chair stand exercise before HD Control: stretching exercise before HD | 3 months | Rx vs. control: ↑ functional independence measure; no change in thigh circumference, knee extensor strength, 6MWT, and albumin |
9 | Bohm et al., 2014 [10], prospective randomized trial | Rx1-30 Rx2-30 | HD; older than 18 years | Rx1: ergometer cycling during HD Rx2: pedometer home-based walking | 6 months | Significant changes within each group: Rx1: ↑ STS, ↑ SR; no change in VO2 peak, 6MWT, and PAL Rx2: ↑ STS, ↑ SR; no change in VO2 peak, 6MWT, and PAL Rx1 vs. Rx2: No change in VO2 peak, 6MWT, STS, SR, and PAL |
10 | Kirkman et al., 2014 [31], randomized controlled trial | Rx1-12 Rx2-5 Control1: 11 Control2: 4 | HD; older than 18 years; normal sedentary individuals | Rx1: progressive resistance training during HD Rx2: progressive resistance training in normal individuals Control1: low-intensity lower body stretching during HD Control2: low-intensity lower body stretching in normal individuals | 3 months | Rx1 vs. control1: ↑ thigh muscle volume, ↑ knee extensor strength; no change in STS, 6MWT, and 8-ft get-up-and-go test Rx2 vs. control2: ↑ STS, ↑ 6MWT; no change in thigh muscle volume, knee extensor strength, and 8-ft get-up-and-go test Rx1 vs Rx2: ↑ STS (greater increase in normal group); no change in thigh muscle volume, knee extensor strength, 6MWT, and 8-ft get-up-and-go test |
11 | De lima et al., 2013 [32], randomized controlled trial | Rx1-11 Rx2-10 Control-11 | HD; age range 18–75 years | Rx1: strength training during HD Rx2: aerobic training during HD Control: usual care | 2 months | Two Rx groups vs. control: ↑ respiratory muscular strength, ↑ number of steps achieved |
12 | Song et al., 2012 [33], randomized controlled trial | Rx-20 Control-20 | HD; older than 18 years | Rx: resistance training during HD Control: usual care | 3 months | Rx vs. control: ↑ skeletal muscle mass, ↑ leg muscle strength; ↓ body fat rate; no change in visceral far area, waist circumference, arm muscle circumference, and handgrip strength |
13 | Chen et al., 2010 [34], randomized controlled trial | Rx-25 Control-25 | HD; older than 30 years; serum albumin < 4.2 g/dL | Rx: low-intensity strength training during HD Control: stretching exercise | 6 months (48 exercise sessions) | Rx vs. control: ↑ lean whole-body mass, ↑ leg lean mass, ↑ knee extensor strength, ↑ short physical performance battery score, ↑ self-reported physical function, ↑ leisure-time physical activity; ↓ whole-body fat mass |
14 | Kopple et al., 2007 [35], randomized controlled trial | Rx1-10 Rx2-15 Rx3-12 Control1-14 non-exercising HD Control2-20 normal people | HD; age range 25–65 years; healthy matched controls | Rx1: endurance training during HD Rx2: strength training before HD Rx3: endurance + strength training before and during HD Control1: usual care HD Control2: non-exercising normal | 22 weeks | Significant changes within each group: Rx1: ↑ muscle mRNA in IGF-1 and IGFBP-2 Rx2: ↑ muscle mRNA in IGF-IEa and IGF-1 Rx3: In muscle, ↑ IGF-IEa mRNA, ↑ IGF-IEc mRNA, ↑ IGF-II mRNA Significant changes in Rx1, Rx2, and Rx3 combined: ↑ vastus lateralis muscle mRNA in IGF-IEa, IGF-IEc, IGF-IR, IGF-II, IGFBP-2, and IGFBP-3, ↑ muscle IGF-1, ↑ anthropometry derived fat-free mass; ↓ muscle mRNA of myostatin, ↓ skinfold thickness, ↓ anthropometry-derived percentage body fat and total body fat; no change in dietary protein or energy intake, c-reactive protein, tumor necrosis factor alpha, and IL-6 |
15 | Cheema et al., 2007 [36], randomized controlled trial | Rx-24 Control-25 | HD; older than 18 years | Rx: high-intensity resistance training during HD Control: usual care | 3 months | Rx vs. control: ↓ thigh muscle lipid infiltration, ↓ c-reactive protein; ↑ total strength, ↑ mid-arm circumference, ↑ mid-thigh circumference, ↑ body weight, ↑ BMI; no change in dietary energy or protein intake, total or subcutaneous fat of the mid-thigh, muscle CSA, 6MWT, and habitual physical activity |
16 | Storer et al., 2005 [37] † | Rx-12 HD Control1-12 non-exercising MHD Control2-12 normal people | HD; Normal matched controls | Rx: stationary-cycle endurance training during HD Control1: non-exercising HD patients Control2: non-exercising normal | 9 weeks | Significant changes within each group: Rx: ↑ quadriceps strength, ↑ leg-press fatigability, ↑ stair-climb time, ↑ 10 m walk, ↑ timed up-and-go, ↑ VO2 peak, ↑ endurance time Non-exercise HD and normal subjects: no changes. |
17 | Vilsteren et al., 2005 [38], randomized controlled trial | Rx-53 Control-43 | HD; older than 18 years | Rx: strength training (before HD) plus cycling (during HD) Control: usual care | 3 months | Rx vs. control: ↑ reaction time, ↑ lower extremity muscle strength; no change in VO2 peak |
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Ekramzadeh, M.; Santoro, D.; Kopple, J.D. The Effect of Nutrition and Exercise on Body Composition, Exercise Capacity, and Physical Functioning in Advanced CKD Patients. Nutrients 2022, 14, 2129. https://doi.org/10.3390/nu14102129
Ekramzadeh M, Santoro D, Kopple JD. The Effect of Nutrition and Exercise on Body Composition, Exercise Capacity, and Physical Functioning in Advanced CKD Patients. Nutrients. 2022; 14(10):2129. https://doi.org/10.3390/nu14102129
Chicago/Turabian StyleEkramzadeh, Maryam, Domenico Santoro, and Joel D. Kopple. 2022. "The Effect of Nutrition and Exercise on Body Composition, Exercise Capacity, and Physical Functioning in Advanced CKD Patients" Nutrients 14, no. 10: 2129. https://doi.org/10.3390/nu14102129