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Febles RM, Miranda DM, Perera CDLCC, Martín LD, Rodríguez-Rodríguez AE, González Martín AR, Sánchez Báez DJ, Porrini E. Therapeutic Exercise on Metabolic and Renal Outcomes in Patients with Chronic Kidney Disease: A Narrative Review. Nephron Clin Pract 2023; 148:85-94. [PMID: 37611542 DOI: 10.1159/000531921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/28/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) affects 11-13% of the world population. The main risk factors for CKD include diabetes, hypertension, and obesity. Metabolic syndrome (MS) is associated with the onset of CKD in the nondiabetic population. Obesity and MS are also risk factors for a worse progression of established CKD. Therapeutic exercise is an effective option to treat and manage obesity, MS, and diabetes in the general population. However, the evidence on the effect of exercise on patients with CKD, obesity, and MS is scarce. SUMMARY We evaluated available evidence on the effect of therapeutic exercise in patients with CKD, excluding dialysis, particularly in improving the metabolic risk factors and main renal outcomes: renal function loss and albuminuria/proteinuria. This review includes prospective studies and clinical trials. A total of 44 studies were analysed in 1,700 subjects with renal disease (2-5), including patients with renal transplantation. Most studies did not prove a major effect of exercise on albuminuria/proteinuria, glomerular filtration rate (GFR), obesity, or MS. These results are intriguing and deserve attention. The exploratory nature of most studies, including a low number of cases and short follow-up, might explain the lack of efficacy of exercise in our analysis. Specific aspects like the type of exercise, frequency, intensity, duration, accommodation during follow-up, individualization, safety, and adherence are crucial to the success of therapeutic exercise. The beneficial role of exercise in patients with CKD remains to be determined. KEY MESSAGES Key messages of this review are as follows. (1) The effect of therapeutic exercise on renal and metabolic outcomes in patients with CKD remains to be determined. (2) According to the evidence selected, therapeutic exercise seems to be safe to treat patients with CKD. (3) Most studies are exploratory by nature, with results that need further investigation. (4) Therapeutic exercise is a complex procedure that must be specifically designed to treat patients with CKD.
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Affiliation(s)
- Raúl Morales Febles
- Faculty of Medicine, University of La Laguna, Tenerife, Spain,
- Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, Tenerife, Spain,
| | - Domingo Marrero Miranda
- Instituto de Tecnologías Biomédicas (ITB), Faculty of Medicine, University of La Laguna, Tenerife, Spain
| | - Coriolano de la Concepción Cruz Perera
- Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, Tenerife, Spain
- Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain
| | - Laura Díaz Martín
- Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, Tenerife, Spain
| | | | | | | | - Esteban Porrini
- Faculty of Medicine, University of La Laguna, Tenerife, Spain
- Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain
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2
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Masschelein E, De Smet S, Denhaerynck K, Ceulemans LJ, Monbaliu D, De Geest S. Patient-reported outcomes evaluation and assessment of facilitators and barriers to physical activity in the Transplantoux aerobic exercise intervention. PLoS One 2022; 17:e0273497. [PMID: 36288368 PMCID: PMC9605336 DOI: 10.1371/journal.pone.0273497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 08/09/2022] [Indexed: 11/06/2022] Open
Abstract
Background Transplantoux’s MVT exercise intervention prepares organ transplant recipients to cycle or hike up France’s Mont Ventoux. We aimed to assess (i) MVT’s effects on patient-reported outcomes (PROs) and (ii) perceived barriers and facilitators to physical activity. Methods Using a hybrid design, a convenience sample of transplant recipients participating in MVT (n = 47 cycling (TxCYC); n = 18 hiking (TxHIK)), matched control transplant recipients (TxCON, n = 213), and healthy MVT participants (HCON, n = 91) completed surveys to assess physical activity (IPAQ), health-related quality of life (HRQOL; SF-36 and EuroQol VAS), mental health (GHQ-12), and depressive symptomatology, anxiety, and stress (DASS-21) at baseline, then after 3, 6 (Mont Ventoux climb), 9, and 12 months. TxCYC and TxHIK participated in a 6-month intervention of individualized home-based cycling/hiking exercise and a series of supervised group training sessions. Barriers and facilitators to physical activity (Barriers and Motivators Questionnaire) were measured at 12 months. Results Regarding PROs, except for reducing TxHIK stress levels, MVT induced no substantial intervention effects. For both TxCYC and TxHIK, between-group comparisons at baseline showed that physical activity, HRQOL, mental health, depressive symptomatology and stress were similar to those of HCON. In contrast, compared to TxCYC, TxHIK, and HCON, physical activity, HRQOL and mental health were lower in TxCON. TxCON also reported greater barriers, lower facilitators, and different priority rankings concerning physical activity barriers and facilitators. Conclusion Barely any of the PROs assessed in the present study responded to Transplantoux’s MVT exercise intervention. TxCON reported distinct and unfavorable profiles regarding PROs and barriers and facilitators to physical activity. These findings can assist tailored physical activity intervention development. Trial registration Clinical trial notation: The study was approved by the University Hospitals Leuven’s Institutional Review Board (B322201523602).
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Affiliation(s)
- Evi Masschelein
- Laboratory of Exercise and Health, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Stefan De Smet
- Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Transplantoux Foundation, Leuven, Belgium
| | - Kris Denhaerynck
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Laurens J. Ceulemans
- Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Diethard Monbaliu
- Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Transplantoux Foundation, Leuven, Belgium
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- * E-mail:
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3
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Billany RE, Smith AC, Hutchinson GM, Graham-Brown MPM, Nixon DGD, Bishop NC. Feasibility and acceptability of high-intensity interval training and moderate-intensity continuous training in kidney transplant recipients: the PACE-KD study. Pilot Feasibility Stud 2022; 8:106. [PMID: 35597974 PMCID: PMC9123685 DOI: 10.1186/s40814-022-01067-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background Kidney transplant recipients (KTRs) exhibit unique elevated inflammation, impaired immune function, and increased cardiovascular risk. Although exercise reduces cardiovascular risk, there is limited research on this population, particularly surrounding novel high-intensity interval training (HIIT). The purpose of this pilot study was to determine the feasibility and acceptability of HIIT in KTRs. Methods Twenty KTRs (male 14; eGFR 58±19 mL/min/1.73 m2; age 49±11 years) were randomised and completed one of three trials: HIIT A (4-, 2-, and 1-min intervals; 80–90% watts at V̇O2peak), HIITB (4×4 min intervals; 80–90% V̇O2peak) or MICT (~40 min; 50–60% V̇O2peak) for 24 supervised sessions on a stationary bike (approx. 3x/week over 8 weeks) and followed up for 3 months. Feasibility was assessed by recruitment, retention, and intervention acceptability and adherence. Results Twenty participants completed the intervention, and 8 of whom achieved the required intensity based on power output (HIIT A, 0/6 [0%]; HIITB, 3/8 [38%]; MICT, 5/6 [83%]). Participants completed 92% of the 24 sessions with 105 cancelled and rescheduled sessions and an average of 10 weeks to complete the intervention. Pre-intervention versus post-intervention V̇O2peak (mL/kg-1/min-1) was 24.28±4.91 versus 27.06±4.82 in HIITA, 24.65±7.67 versus 27.48±8.23 in HIIT B, and 29.33±9.04 versus 33.05±9.90 in MICT. No adverse events were reported. Conclusions This is the first study to report the feasibility of HIIT in KTRs. Although participants struggled to achieve the required intensity (power), this study highlights the potential that exercise has to reduce cardiovascular risk in KTRs. HIIT and MICT performed on a cycle, with some modification, could be considered safe and feasible in KTRs. Larger scale trials are required to assess the efficacy of HIIT in KTRs and in particular identify the most appropriate intensities, recovery periods, and session duration. Some flexibility in delivery, such as incorporating home-based sessions, may need to be considered to improve recruitment and retention. Trial registration ISRCTN, ISRCTN17122775. Registered on 30 January 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01067-3.
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Affiliation(s)
- Roseanne E Billany
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Alice C Smith
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.,Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Matthew P M Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Daniel G D Nixon
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.,Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nicolette C Bishop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
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Golenia A, Malyszko JS, Malyszko J. Cognitive impairment and kidney transplantation- underestimated, underrecognized but clinically relevant problem. Kidney Blood Press Res 2022; 47:459-466. [PMID: 35447625 DOI: 10.1159/000521907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/10/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) affects the crosstalk between organs in the body and vast majority of studies were devoted to the interactions between the kidneys and the cardiovascular system. As of today, there is more evidence of the kidney and the central nervous system connections. SUMMARY Indeed, CKD and in particular dialysis therapy is linked to the increased prevalence of neurological complications, such as cerebrovascular disorders, movement disorders, cognitive impairment, and depression. Both traditional cardiovascular risk factors (such as diabetes, hypertension, and lipid disorders), non-traditional risk factors (such as uremic toxins, anemia, secondary hyperparathyroidism) may predispose CKD patients to neurological disorders. Likewise, cognitive problems occur more commonly in kidney transplant recipients, regardless of age, than in the general population, but the prevalence is still understudied. Cognitive impairment is associated with a higher risk of hospitalization, mortality, decreased quality of life or health care costs in kidney transplant recipients. Here, we review (i) the potential clinical impact of kidney transplantation on cerebrovascular and neurological complications, (ii) evaluation of patients with cognitive impairment for kidney transplantation (iii) the potential impact cognitive impairment on waitlisted and transplanted patients on patient care, and (iv) unmet medical needs. KEY MESSAGES • Cognitive impairment in kidney transplant recipients is underestimated, underrecognized but clinically relevant problem. • The screening for cognitive declines after kidney transplantation is not yet a routine practice. • Several prospective and cross-sectional studies reported improvement across some of the assessed cognitive domains after transplantation.
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Affiliation(s)
| | - Jacek S Malyszko
- 1st Department of Nephrology and Transplantology, Medical University of Bialystok, Białystok, Poland
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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5
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Hemmati N, Kazemi S, Jamshidian-Tehrani N, Roozbeh J, Koushkie Jahromi M, Salesi M, Abdollahpour-Alitappeh M, Karimi MH. Effects of exercise training on immunological factors in kidney transplant recipients; a randomized controlled trial. Res Sports Med 2022; 30:80-91. [PMID: 33843376 DOI: 10.1080/15438627.2021.1906671] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The purpose of this study was to investigate the effects of a 12 week exercise training on the immune system of kidney transplant recipients. 23 kidney transplant recipients were randomly divided into two groups including control (n = 10) and training (n =13) groups. The training groups participated in the training for 10 weeks (three days a week; each day 60-90 minutes). The control group performed no regular exercise during this time. The blood samples were taken before and after 12 weeks. ELISA and Real-time PCR were used to evaluate cytokine profiles, including TNF-a, IL-6, IL-4, IL-31 and IL-35 as well as T-bet, GATA-3, RORYt and FOXP3, respectively. Finally, the data were analyzed, using paired T-test. ELISA results showed decreased levels of TNF- α, increased levels of IL-6 and no significant differences in the IL-35, IL-31 and IL-4 levels in the training group in comparison to the control group. Gene expression profiles showed significantly increased expression of T-bet and no changes in the GATA-3, RORYt and FOXP3 levels. According to these results, a moderate exercise including aerobic and resistance training could inhibit inflammatory cytokines and have beneficial effects on the immune system, but this issue needs further research.
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Affiliation(s)
- Nazi Hemmati
- Department of Sport Sciences, Shiraz University, Shiraz, Iran
| | - Sohrab Kazemi
- Department of Sport Sciences, Shiraz University, Shiraz, Iran
| | | | - Jamshid Roozbeh
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohsen Salesi
- Department of Sport Sciences, Shiraz University, Shiraz, Iran
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6
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Billany RE, Vadaszy N, Bishop NC, Wilkinson TJ, Adenwalla SF, Robinson KA, Croker K, Brady EM, Wormleighton JV, Parke KS, Cooper NJ, Webster AC, Barratt J, McCann GP, Burton JO, Smith AC, Graham-Brown MP. A pilot randomised controlled trial of a structured, home-based exercise programme on cardiovascular structure and function in kidney transplant recipients: the ECSERT study design and methods. BMJ Open 2021; 11:e046945. [PMID: 34610929 PMCID: PMC8493915 DOI: 10.1136/bmjopen-2020-046945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a major cause of morbidity and mortality in kidney transplant recipients (KTRs). CVD risk scores underestimate risk in this population as CVD is driven by clustering of traditional and non-traditional risk factors, which lead to prognostic pathological changes in cardiovascular structure and function. While exercise may mitigate CVD in this population, evidence is limited, and physical activity levels and patient activation towards exercise and self-management are low. This pilot study will assess the feasibility of delivering a structured, home-based exercise intervention in a population of KTRs at increased cardiometabolic risk and evaluate the putative effects on cardiovascular structural and functional changes, cardiorespiratory fitness, quality of life, patient activation, healthcare utilisation and engagement with the prescribed exercise programme. METHODS AND ANALYSIS Fifty KTRs will be randomised 1:1 to: (1) the intervention; a 12week, home-based combined resistance and aerobic exercise intervention; or (2) the control; usual care. Intervention participants will have one introductory session for instruction and practice of the recommended exercises prior to receiving an exercise diary, dumbbells, resistance bands and access to instructional videos. The study will evaluate the feasibility of recruitment, randomisation, retention, assessment procedures and the intervention implementation. Outcomes, to be assessed prior to randomisation and postintervention, include: cardiac structure and function with stress perfusion cardiac MRI, cardiorespiratory fitness, physical function, blood biomarkers of cardiometabolic health, quality of life and patient activation. These data will be used to inform the power calculations for future definitive trials. ETHICS AND DISSEMINATION The protocol was reviewed and given favourable opinion by the East Midlands-Nottingham 2 Research Ethics Committee (reference: 19/EM/0209; 14 October 2019). Results will be published in peer-reviewed academic journals and will be disseminated to the patient and public community via social media, newsletter articles and presentations at conferences. TRIAL REGISTRATION NUMBER NCT04123951.
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Affiliation(s)
- Roseanne E Billany
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Noemi Vadaszy
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nicolette C Bishop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Sherna F Adenwalla
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Kathryn Croker
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Kelly S Parke
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Nicola J Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Angela C Webster
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Renal and Transplant Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - Jonathan Barratt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Alice C Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Matthew Pm Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
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7
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The care of kidney transplant recipients during a global pandemic: Challenges and strategies for success. Transplant Rev (Orlando) 2020; 34:100567. [PMID: 32690437 PMCID: PMC7354264 DOI: 10.1016/j.trre.2020.100567] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/22/2022]
Abstract
The global pandemic of severe acute respiratory coronavirus 2 (SARS-CoV-2), which causes the novel beta coronavirus 2019 disease (COVID-19), has become an unprecedented medical, economic, and psychosocial crisis. The pandemic and its management strategies have resulted in immense challenges for health systems, not only in caring for those with COVID-19 but also in the ongoing management of chronic medical conditions. Kidney transplant recipients present a unique challenge given their need for ongoing monitoring and management as well as their higher risk of COVID-19 infection. In the absence of clear guidelines, it is unclear how to best provide routine care to this unique patient population during the pandemic. Rigorous medical and psychosocial patient-centered risk stratification strategies are needed to avoid adverse outcomes in stable solid organ transplant recipients. This review will focus on the challenges faced by kidney transplant recipients and health care providers and provides strategies to address these issues.
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Lima PS, de Campos AS, de Faria Neto O, Ferreira TCA, Amorim CEN, Stone WJ, Prestes J, Garcia AMC, Urtado CB. Effects of Combined Resistance Plus Aerobic Training on Body Composition, Muscle Strength, Aerobic Capacity, and Renal Function in Kidney Transplantation Subjects. J Strength Cond Res 2019; 35:3243-3250. [PMID: 31714457 DOI: 10.1519/jsc.0000000000003274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lima, PS, de Campos, AS, de Faria Neto, O, Ferreira, TCA, Amorim, CEN, Stone, WJ, Prestes, J, Garcia, AMC, and Urtado, CB. Effects of combined resistance plus aerobic training on body composition, muscle strength, aerobic capacity, and renal function in kidney transplantation subjects. J Strength Cond Res XX(X): 000-000, 2019-Immunosuppression and a sedentary lifestyle may exacerbate complications such as early graft dysfunction and muscle loss, and reduce patient survival after kidney transplantation (KT). Therefore, the purpose of this study was to evaluate changes in body composition (BC), muscular strength, aerobic, and renal function in KT subjects submitted to combined resistance plus aerobic training. Twelve KT subjects were randomly assigned into groups: (G1) 12 weeks of combined training (3 males and 4 females, 54 ± 3 years); or (G2) nonexercise control (5 females, 43 ± 18 years). The subjects were evaluated for BC (dual-energy X-ray absorptiometry), estimated V[Combining Dot Above]O2peak, right-hand maximal grip strength (RHMGS) and left-hand maximal grip strength (LHMGS), and renal function. Post-training revealed that G1 reduced body fat percentage (p = 0.046), uric acid (Δ = -0.87; p = 0.023), urea (Δ = -9.43; p = 0.032), and creatinine (Δ = -0.15; p = 0.045), increased fat-free mass, estimated V[Combining Dot Above]O2peak, RHMGS, LHMGS (p < 0.05), and estimated glomerular filtration rate (eGFR) (Δ = 11.64; p = 0.017). G2 increased urea (Δ = 8.20; p = 0.017), creatinine (Δ = 0.37; p = 0.028), and decreased eGFR (Δ = -16.10; p = 0.038). After 12 weeks, urea (Δ = 24.94; p = 0.013), uric acid (Δ = 1.64; p = 0.044), and creatinine (Δ = 0.9; p = 0.011) were lower, whereas eGFR (Δ = 36.51; p = 0.009) was higher in G1. These data indicate that combined training instigates positive changes in BC, muscular strength, aerobic capacity, and renal function after KT.
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Affiliation(s)
- Paulo S Lima
- Graduate Program on Physical Education, Department of Physical Education, Federal University of Maranhao (UFMA), São Luis, Brazil
| | - Alexandre S de Campos
- Multiprofessional Program of Internship in Health, Kidney Health Care Unit, University Hospital of the Federal University of Maranhao (HU-UFMA), São Luis, Brazil
| | - Omar de Faria Neto
- Graduate Program on Physical Education, Department of Physical Education, Catholic University of Brasilia, Brasilia, Federal District, Brazil
| | - Teresa C A Ferreira
- Kidney Transplant Unit, University Hospital of the Federal University of Maranhao (HU-UFMA), São Luis, Brazil.,Department of Medicine, Federal University of Maranhão (UFMA), Pinheiro, Brazil
| | - Carlos E N Amorim
- Department of Physical Education, Federal University of Maranhao (UFMA), São Luis, Brazil
| | - Whitley J Stone
- School of Nutrition, Kinesiology, and Psychological Sciences, University of Central Missouri, Missouri
| | - Jonato Prestes
- Graduation Program on Physical Education, Department of Physical Education, Catholic University of Brasilia, Brasilia, Federal District, Brazil
| | - Alessandra M C Garcia
- Department of Physical Education, Federal University of Maranhao (UFMA), São Luis, Brazil
| | - Christiano B Urtado
- Department of Physical Education, Federal University of Maranhao (UFMA), São Luis, Brazil
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9
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Calella P, Hernández-Sánchez S, Garofalo C, Ruiz JR, Carrero JJ, Bellizzi V. Exercise training in kidney transplant recipients: a systematic review. J Nephrol 2019; 32:567-579. [DOI: 10.1007/s40620-019-00583-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 01/04/2019] [Indexed: 12/20/2022]
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10
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Lima P, Campos A, Corrêa C, Dias C, Mostarda C, Amorim C, Garcia A. Effects of Chronic Physical Activity on Glomerular Filtration Rate, Creatinine, and the Markers of Anemia of Kidney Transplantation Patients. Transplant Proc 2018; 50:746-749. [DOI: 10.1016/j.transproceed.2018.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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11
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Roi GS, Mosconi G, Totti V, Angelini ML, Brugin E, Sarto P, Merlo L, Sgarzi S, Stancari M, Todeschini P, La Manna G, Ermolao A, Tripi F, Andreoli L, Sella G, Anedda A, Stefani L, Galanti G, Di Michele R, Merni F, Trerotola M, Storani D, Nanni Costa A. Renal function and physical fitness after 12-mo supervised training in kidney transplant recipients. World J Transplant 2018; 8:13-22. [PMID: 29507858 PMCID: PMC5829451 DOI: 10.5500/wjt.v8.i1.13] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/06/2017] [Accepted: 12/28/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations.
METHODS Ninety-nine kidney transplant recipients (KTRs) were assigned to interventional exercise (Group A; n = 52) and a usual care cohort (Group B; n = 47). Blood and urine chemistry, exercise capacity, muscular strength, anthropometric measures and health-related quality of life (HRQoL) were assessed at baseline, and after 6 and 12 mo. Group A underwent a supervised training three times per week for 12 mo. Group B received only general recommendations about home-based physical activities.
RESULTS Eighty-five KTRs completed the study (Group A, n = 44; Group B, n = 41). After 12 mo, renal function remained stable in both groups. Group A significantly increased maximum workload (+13 W, P = 0.0003), V’O2 peak (+3.1 mL/kg per minute, P = 0.0099), muscular strength in plantar flexor (+12 kg, P = 0.0368), height in the countermovement jump (+1.9 cm, P = 0.0293) and decreased in Body Mass Index (-0.5 kg/m2, P = 0.0013). HRQoL significantly improved in physical function (P = 0.0019), physical-role limitations (P = 0.0321) and social functioning scales (P = 0.0346). No improvements were found in Group B.
CONCLUSION Twelve-month of supervised aerobic and resistance training improves the physiological variables related to physical fitness and cardiovascular risks without consequences on renal function. Recommendations alone are not sufficient to induce changes in exercise capacity of KTRs. Our study is an example of collaborative working between transplant centres, sports medicine and exercise facilities.
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Affiliation(s)
- Giulio Sergio Roi
- Department of Education and Research, Isokinetic Medical Group, Bologna 40123, Italy
| | - Giovanni Mosconi
- Department of Nephrology and Dialysis, Morgagni-Pierantoni Hospital, Forlì 47121, Italy
| | - Valentina Totti
- Department of Biomedical & Neuromotor Sciences, University of Bologna, Bologna 40121, Italy
- Associazione Nazionale Emodializzati, Dialisi e Trapianto, Milano 20121, Italy
| | - Maria Laura Angelini
- Department of Nephrology and Dialysis, Morgagni-Pierantoni Hospital, Forlì 47121, Italy
| | - Erica Brugin
- Department of Cardiovascular, Sports Medicine, Noale 30033, Italy
| | | | - Laura Merlo
- Sports Medicine, ULSS Company 9, Treviso 31100, Italy
| | - Sergio Sgarzi
- Sports Medicine, Regional Hospital of Bologna, Bologna 40121, Italy
| | - Michele Stancari
- Sports Medicine, Regional Hospital of Bologna, Bologna 40121, Italy
| | - Paola Todeschini
- Department of Nephrology and Dialysis, S. Orsola Hospital, Bologna 40121, Italy
| | - Gaetano La Manna
- Department of Nephrology and Dialysis, S. Orsola Hospital, Bologna 40121, Italy
| | - Andrea Ermolao
- Sports Medicine Unit DIMED, Department of Medicine, University of Padua, Padua 35100, Italy
| | - Ferdinando Tripi
- Sports Medicine, Regional Hospital of Modena, Modena 41100, Italy
| | - Lucia Andreoli
- Sports Medicine, Regional Hospital of Modena, Modena 41100, Italy
| | - Gianluigi Sella
- Sports Medicine, Regional Hospital of Ravenna, Ravenna 48121, Italy
| | - Alberto Anedda
- Sports Medicine, Regional Hospital of Parma, Parma 43121, Italy
| | - Laura Stefani
- Department of Experimental and Clinical Medicine, School of Sports Medicine, University of Florence, Sports Medicine Centre, Florence 50100, Italy
| | - Giorgio Galanti
- Department of Experimental and Clinical Medicine, School of Sports Medicine, University of Florence, Sports Medicine Centre, Florence 50100, Italy
| | - Rocco Di Michele
- Department of Biomedical & Neuromotor Sciences, University of Bologna, Bologna 40121, Italy
| | - Franco Merni
- Department of Biomedical & Neuromotor Sciences, University of Bologna, Bologna 40121, Italy
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12
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Takahashi A, Hu SL, Bostom A. Physical Activity in Kidney Transplant Recipients: A Review. Am J Kidney Dis 2018; 72:433-443. [PMID: 29482935 DOI: 10.1053/j.ajkd.2017.12.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 12/09/2017] [Indexed: 12/11/2022]
Abstract
Physical activity has known health benefits and is associated with reduced cardiovascular risk in the general population. Relatively few data are available for physical activity in kidney transplant recipients. Compared to the general population, physical activity levels are lower overall in kidney recipients, although somewhat higher compared to the dialysis population. Recipient comorbid condition, psychosocial and socioeconomic factors, and long-term immunosuppression use negatively affect physical activity. Physical inactivity in kidney recipients may be associated with reduced quality of life, as well as increased mortality. Interventions such as exercise training appear to be safe in kidney transplant recipients and are associated with improved quality of life and exercise capacity. Additional studies are required to evaluate long-term effects on cardiovascular risk factors and ultimately cardiovascular disease outcomes and patient survival. Currently available data are characterized by wide variability in the interventions and outcome measures investigated in studies, as well as use of small sample-sized cohorts. These limitations highlight the need for larger studies using objective and standardized measures of physical activity and physical fitness in kidney transplant recipients.
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Affiliation(s)
- Ashley Takahashi
- Warren Alpert Medical School of Brown University, Department of Medicine, Rhode Island Hospital, Providence, RI
| | - Susie L Hu
- Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Providence, RI.
| | - Andrew Bostom
- Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Providence, RI
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13
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Abstract
Solid organ transplantation is the criterion standard treatment for many with end-organ failure and can offer a new independence from the burden of disease. However solid organ transplant recipients (SOTRs) remain at high risk of cardiovascular (CV) disease, and poor quality of life and physical functioning. Increasing physical activity and exercise can improve the health of the general population; however, the effects on those with a transplant remain unclear. Intensive exercise and sporting activity has the potential to be beneficial, although there remain concerns particularly around the effects on immune function and the CV system. This review summarizes what is known about the effects of exercise on determinants of health in SOTRs and then collates the available literature investigating the consequences of intensive exercise and sport on the health of SOTR. There is a paucity of high-quality research, with most evidence being case studies or anecdotal; this is understandable given the relatively few numbers of SOTRs who are performing sport and exercise at a high level. However, if suitable evidence-based guidelines are to be formed and SOTRs are to be given reassurances that their activity levels are not detrimental to their transplanted organ and overall health, then more high-quality studies are required.
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Barroso R, Silva-Filho AC, Dias CJ, Soares N, Mostarda A, Azoubel LA, Melo L, Garcia ADMC, Rodrigues B, Mostarda CT. Effect of exercise training in heart rate variability, anxiety, depression, and sleep quality in kidney recipients: A preliminary study. J Health Psychol 2016; 24:299-308. [DOI: 10.1177/1359105316676329] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Rodrigo Barroso
- Federal University of Maranhão, Brazil
- Laboratory of Cardiovascular Adaptations to Exercise (LACORE), Brazil
| | - Antonio C Silva-Filho
- Federal University of Maranhão, Brazil
- Laboratory of Cardiovascular Adaptations to Exercise (LACORE), Brazil
| | - Carlos José Dias
- Federal University of Maranhão, Brazil
- Laboratory of Cardiovascular Adaptations to Exercise (LACORE), Brazil
| | - Nivaldo Soares
- Federal University of Maranhão, Brazil
- Laboratory of Cardiovascular Adaptations to Exercise (LACORE), Brazil
| | - Alessandra Mostarda
- Laboratory of Cardiovascular Adaptations to Exercise (LACORE), Brazil
- UNOPAR, Brazil
| | - Luana Anaisse Azoubel
- Federal University of Maranhão, Brazil
- Laboratory of Cardiovascular Adaptations to Exercise (LACORE), Brazil
| | - Leandro Melo
- Federal University of Maranhão, Brazil
- Laboratory of Cardiovascular Adaptations to Exercise (LACORE), Brazil
| | | | | | - Cristiano Texeira Mostarda
- Federal University of Maranhão, Brazil
- Laboratory of Cardiovascular Adaptations to Exercise (LACORE), Brazil
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15
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Bossola M, Pepe G, Vulpio C. Fatigue in kidney transplant recipients. Clin Transplant 2016; 30:1387-1393. [DOI: 10.1111/ctr.12846] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Maurizio Bossola
- Hemodialysis Service; Department of Surgery; Catholic University of the Sacred Heart; Rome Italy
| | - Gilda Pepe
- Department of Emergency; Catholic University of the Sacred Heart; Rome Italy
| | - Carlo Vulpio
- Hemodialysis Service; Department of Surgery; Catholic University of the Sacred Heart; Rome Italy
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16
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Hernández Sánchez S, Carrero JJ, García López D, Herrero Alonso JA, Menéndez Alegre H, Ruiz JR. [Fitness and quality of life in kidney transplant recipients: case-control study]. Med Clin (Barc) 2016; 146:335-8. [PMID: 26969426 DOI: 10.1016/j.medcli.2016.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/19/2016] [Accepted: 01/21/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES We analyzed the levels of fitness, muscle structure and quality of life of adults after kidney transplant and healthy adults. PATIENTS AND METHODS A total of 16 kidney transplant patients and 21 healthy controls performed several fitness test, isokinetic evaluation of knee flexion and extension and ultrasonography muscle thickness assessment. They also completed the quality of life questionnaire SF-36. RESULTS Physical fitness, muscle structure and quality of life of the kidney transplant recipients were significantly poorer than the controls. The transplant patients performed less well in the "get up and go" and "sit to stand" test (p<.001) as well as in assessments of muscle structure, strength and power. The patients had a poorer score in their quality of life assessments, differing from the controls in domains of physical function, physical role, general health and social function (p<.001). DISCUSSION Fitness, strength and muscle mass are diminished in kidney transplant patients, resulting in a poorer quality of life which might entail an increased risk to their health.
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Affiliation(s)
- Sonsoles Hernández Sánchez
- Grupo de Investigación PROmoting FITness and Health through physical activity (PROFITH), Departamento de Educación Física y Deportiva, Facultad de Ciencias del Deporte, Universidad de Granada, Granada, España.
| | - Juan J Carrero
- Renal Medicine and Baxter Novum, CLINTEC, Karolinska Institutet, Estocolmo, Suecia
| | - David García López
- Laboratorio de Fisiología, Facultad de Ciencias de la Salud, Universidad Europea Miguel de Cervantes, Valladolid, España
| | - Juan Azael Herrero Alonso
- Laboratorio de Fisiología, Facultad de Ciencias de la Salud, Universidad Europea Miguel de Cervantes, Valladolid, España; Centro de Investigación en Discapacidad Física, Valladolid, España
| | - Héctor Menéndez Alegre
- Laboratorio de Fisiología, Facultad de Ciencias de la Salud, Universidad Europea Miguel de Cervantes, Valladolid, España; Centro de Investigación en Discapacidad Física, Valladolid, España
| | - Jonatan R Ruiz
- Grupo de Investigación PROmoting FITness and Health through physical activity (PROFITH), Departamento de Educación Física y Deportiva, Facultad de Ciencias del Deporte, Universidad de Granada, Granada, España
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17
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A Novel and Personalized Rehabilitation Program for Obese Kidney Transplant Recipients. Transplant Proc 2014; 46:3431-7. [DOI: 10.1016/j.transproceed.2014.05.085] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/27/2014] [Indexed: 11/15/2022]
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18
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Wang DWY, Sills LL, MacDonald SB, Maianski Z, Alwayn I. Active video gaming in patients with renal transplant: a pilot study. Transplant Res 2014; 3:15. [PMID: 25114788 PMCID: PMC4128824 DOI: 10.1186/2047-1440-3-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/16/2014] [Indexed: 01/15/2023] Open
Abstract
Background Patients with renal transplant are at higher risk of mortality from cardiovascular disease (CVD) compared with the general population. Physical activity has been shown to reduce the risk of CVD mortality in these patients. Unfortunately, barriers such as the harsh Canadian climate prevent patients from engaging in and harvesting the health benefits of physical activity. This pilot study explored active video gaming (AVG) as a way for patients with renal transplant to obtain physical activity and examined its effect on their functional status and quality of life (QOL). Main text We recruited nine patients for an 8-week prospective pilot study. All patients received a Microsoft Xbox 360™ video gaming console, a Microsoft Kinect™ sensor, and the video game Your Shape Fitness Evolved 2012. Assessment of each participant before and after the intervention included blood pressure measures, a 6-minute walk test, and the Godin Leisure Time Questionnaire (GLTQ). We analyzed all nine patients at the end of the 8-week study period, and found no changes in blood pressure or GLTQ scores. However, there was a significant increase in the 6-minute walk distance (P = 0.022), which represented a consistent increase for most patients (correlation = 0.977). In addition, participants over the age of 45 years (n = 4) were more likely to use the AVG system (P = 0.042). Conclusion AVG has the potential to improve the functional status in patients with renal transplant. Further research is required to corroborate the full health benefits of AVG in this patient population.
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Affiliation(s)
- Dorothy Wei Yun Wang
- Department of Surgery, Multi-Organ Transplant Program, Dalhousie University, Halifax, Canada
| | - Laura L Sills
- Department of Surgery, Multi-Organ Transplant Program, Dalhousie University, Halifax, Canada
| | - Sara B MacDonald
- Department of Physiotherapy, Dalhousie University, Halifax, Canada
| | - Ziv Maianski
- Department of Surgery, Multi-Organ Transplant Program, Dalhousie University, Halifax, Canada
| | - Ian Alwayn
- Department of Surgery, Multi-Organ Transplant Program, Dalhousie University, Halifax, Canada ; QEII Health Sciences Center, Office 6-291 Victoria Building, 1276 South Park Street, B3H 2Y9 Halifax, NS, Canada
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19
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Haidinger M, Werzowa J, Hecking M, Antlanger M, Stemer G, Pleiner J, Kopecky C, Kovarik JJ, Döller D, Pacini G, Säemann MD. Efficacy and safety of vildagliptin in new-onset diabetes after kidney transplantation--a randomized, double-blind, placebo-controlled trial. Am J Transplant 2014; 14:115-23. [PMID: 24279801 DOI: 10.1111/ajt.12518] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/04/2013] [Accepted: 09/17/2013] [Indexed: 01/25/2023]
Abstract
New-onset diabetes after transplantation (NODAT) is a serious complication after kidney transplantation, but therapeutic strategies remain underexplored. Dipeptidyl peptidase-4 (DPP-4) inhibitors selectively foster insulin secretion without inducing hypoglycemia, which might be advantageous in kidney transplant recipients (KTRs) with NODAT. We conducted a randomized, double-blind, placebo-controlled, phase II trial to assess safety and efficacy of the DPP-4 inhibitor vildagliptin. Intraindividual differences in oral glucose tolerance test (OGTT)-derived 2-h plasma glucose (2HPG) from baseline to 3 months after treatment served as primary endpoint. Among secondary outcomes, we evaluated HbA1c, metabolic and safety parameters, as well as OGTTs at 1 month after drug discontinuation. Of 509 stable KTRs who were screened in our outpatient clinic, 63 (12.4%) had 2HPG ≥ 200 mg/dL, 33 of them were randomized and 32 completed the study. In the vildagliptin group 2HPG and HbA1c were profoundly reduced in comparison to placebo (vildagliptin: 2HPG = 182.7 mg/dL, HbA1c = 6.1%; placebo: 2HPG = 231.2 mg/dL, HbA1c = 6.5%; both p ≤ 0.05), and statistical significance was achieved for the primary endpoint (vildagliptin: 2HPG-difference -73.7 ± 51.3 mg/dL; placebo: -5.7 ± 41.4 mg/dL; p < 0.01). Adverse events were generally mild and occurred at similar rates in both groups. In conclusion, DPP-4 inhibition in KTRs with overt NODAT was safe and efficient, providing a novel treatment alternative for this specific form of diabetes.
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Affiliation(s)
- M Haidinger
- Clinical Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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20
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Abstract
Organ transplantation is one of the medical miracles or the 20th century. It has the capacity to substantially improve exercise performance and quality of life in patients who are severely limited with chronic organ failure. We focus on the most commonly performed solid-organ transplants and describe peak exercise performance following recovery from transplantation. Across all of the common transplants, evaluated significant reduction in VO2peak is seen (typically renal and liver 65%-80% with heart and/or lung 50%-60% of predicted). Those with the lowest VO2peak pretransplant have the lowest VO2peak posttransplant. Overall very few patients have a VO2peak in the normal range. Investigation of the cause of the reduction of VO2peak has identified many factors pre- and posttransplant that may contribute. These include organ-specific factors in the otherwise well-functioning allograft (e.g., chronotropic incompetence in heart transplantation) as well as allograft dysfunction itself (e.g., chronic lung allograft dysfunction). However, looking across all transplants, a pattern emerges. A low muscle mass with qualitative change in large exercising skeletal muscle groups is seen pretransplant. Many factor posttransplant aggravate these changes or prevent them recovering, especially calcineurin antagonist drugs which are key immunosuppressing agents. This results in the reduction of VO2peak despite restoration of near normal function of the initially failing organ system. As such organ transplantation has provided an experiment of nature that has focused our attention on an important confounder of chronic organ failure-skeletal muscle dysfunction.
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Affiliation(s)
- Trevor J Williams
- Department of Allergy, Immunology, and Respiratory Medicine Alfred Hospital and Monash University, Melbourne, Australia.
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21
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Riess KJ, Haykowsky M, Lawrance R, Tomczak CR, Welsh R, Lewanczuk R, Tymchak W, Haennel RG, Gourishankar S. Exercise training improves aerobic capacity, muscle strength, and quality of life in renal transplant recipients. Appl Physiol Nutr Metab 2013; 39:566-71. [PMID: 24766239 DOI: 10.1139/apnm-2013-0449] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Renal transplant recipients (RTR) have reduced peak aerobic capacity, muscle strength, arterial function and an unfavorable cardiovascular disease risk (CVD) profile. This study compared the effects of 12 weeks of supervised endurance and strength training (EST, n = 16) versus usual care (UC, n = 15) on peak aerobic capicity, cardiovascular and skeletal muscle function, CVD risk profile, and quality of life (QOL) in RTR (55 ± 13 years). Peak aerobic capacity and exercise hemodynamics, arterial compliance, 24-h blood pressure, muscle strength, lean body mass, CVD risk score, and QOL were assessed before and after 12 weeks. The change in peak aerobic capacity (EST: 2.6 ± 3.1 vs. UC: -0.5 ± 2.5 mL/(kg·min)), cardiac output (EST: 1.7 ± 2.6 vs. UC: -0.01 ± 0.8 L/min), leg press (EST: 48.7 ± 34.1 vs. UC: -10.5 ± 37.7 kg) and leg extension strength (EST: 9.5 ± 10.3 vs. UC: 0.65 ± 5.5 kg) improved significantly after EST compared with UC. The overall change in QOL improved significantly after 12 weeks of EST compared with UC. No significant difference was found between groups for lean body mass, arterial compliance, 24-h blood pressure or CVD risk score. Supervised EST is an effective intervention to improve peak exercise aerobic capacity and cardiac output, muscle strength and QOL in clinically stable RTR.
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Affiliation(s)
- Kenneth James Riess
- a Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada
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22
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Abstract
This review summarizes the extant evidence of the effects of exercise training on anxiety among healthy adults, adults with a chronic illness, and individuals diagnosed with an anxiety disorder. A brief discussion of selected proposed mechanisms that may underlie relations of exercise and anxiety is also provided. The weight of the available empirical evidence indicates that exercise training reduces symptoms of anxiety among healthy adults, chronically ill patients, and patients with panic disorder. Preliminary data suggest that exercise training can serve as an alternative therapy for patients with social anxiety disorder, generalized anxiety disorder, and obsessive–compulsive disorder. Anxiety reductions appear to be comparable to empirically supported treatments for panic and generalized anxiety disorders. Large trials aimed at more precisely determining the magnitude and generalizability of exercise training effects appear to be warranted for panic and generalized anxiety disorders. Future well-designed randomized controlled trials should (a) examine the therapeutic effects of exercise training among understudied anxiety disorders, including specific phobias, social anxiety disorder and posttraumatic stress disorder; (b) focus on understudied exercise modalities, including resistance exercise training and programs that combine exercise with cognitive-behavioral therapies; and (c) elucidate putative mechanisms of the anxiolytic effects of exercise training.
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Affiliation(s)
- Matthew P. Herring
- Department of Epidemiology, University of Alabama at Birmingham, Alabama (MPH)
- Department of Kinesiology, The University of Georgia, Athens, Georgia (JBL, PJO)
| | - Jacob B. Lindheimer
- Department of Epidemiology, University of Alabama at Birmingham, Alabama (MPH)
- Department of Kinesiology, The University of Georgia, Athens, Georgia (JBL, PJO)
| | - Patrick J. O’Connor
- Department of Epidemiology, University of Alabama at Birmingham, Alabama (MPH)
- Department of Kinesiology, The University of Georgia, Athens, Georgia (JBL, PJO)
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23
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Dungey M, Hull KL, Smith AC, Burton JO, Bishop NC. Inflammatory factors and exercise in chronic kidney disease. Int J Endocrinol 2013; 2013:569831. [PMID: 23737775 PMCID: PMC3666228 DOI: 10.1155/2013/569831] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 04/19/2013] [Accepted: 04/19/2013] [Indexed: 01/03/2023] Open
Abstract
Patients with chronic kidney disease frequently present with chronic elevations in markers of inflammation, a condition that appears to be exacerbated by disease progression and onset of haemodialysis. Systemic inflammation is interlinked with malnutrition and muscle protein wasting and is implicated in a number of morbidities including cardiovascular disease: the most common cause of mortality in this population. Research in the general population and other chronic disease cohorts suggests that an increase in habitual activity levels over a prolonged period may help redress basal increases in systemic inflammation. Furthermore, those populations with the highest baseline levels of systemic inflammation appear to have the greatest improvements from training. On the whole, the activity levels of the chronic kidney disease population reflect a sedentary lifestyle, indicating the potential for increasing physical activity and observing health benefits. This review explores the current literature investigating exercise and inflammatory factors in the chronic kidney disease population and then attempts to explain the contradictory findings and suggests where future research is required.
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Affiliation(s)
- Maurice Dungey
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire LE11 3TU, UK
- Leicester Kidney Exercise Team, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Katherine L. Hull
- Leicester Kidney Exercise Team, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
- Department of Infection, Immunity and Inflammation, Maurice Shock Medical Sciences Building, University Road, Leicester LE1 9HN, UK
| | - Alice C. Smith
- Leicester Kidney Exercise Team, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
- Department of Infection, Immunity and Inflammation, Maurice Shock Medical Sciences Building, University Road, Leicester LE1 9HN, UK
| | - James O. Burton
- Leicester Kidney Exercise Team, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
- Department of Infection, Immunity and Inflammation, Maurice Shock Medical Sciences Building, University Road, Leicester LE1 9HN, UK
| | - Nicolette C. Bishop
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire LE11 3TU, UK
- Leicester Kidney Exercise Team, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
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Romano G, Lorenzon E, Montanaro D. Effects of exercise in renal transplant recipients. World J Transplant 2012; 2:46-50. [PMID: 24175196 PMCID: PMC3782234 DOI: 10.5500/wjt.v2.i4.46] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 04/02/2012] [Accepted: 06/30/2012] [Indexed: 02/05/2023] Open
Abstract
Even after a successful renal transplantation, the renal transplant recipients (RTRs) keeps on suffering the consequences of the uremic sickness. Cardiovascular risk, work capacity, and quality of life do not improve according to expectations since biological and psychological problems are not completely solved by pharmacological treatment. Furthermore, post-transplant treatment, per se, induces additional problems (i.e., side effects of drugs). It becomes, indeed, very important to insert “non-pharmacological” therapies able to reverse this trend. Exercise may represent an important contribution in the solution of this problem. In fact, many studies have demonstrated, in the last two decades, that physical training is able both, to improve graft function, work capacity and quality of life, and to reduce cardiovascular risk. In conclusion, if the analysis of the available data suggests that an appropriate dose of physical training represent a useful, safe and non-pharmacologic contribution to RTR treatment, it becomes a kidney transplantologist responsibility to introduce exercise in the current therapy of RTRs.
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Affiliation(s)
- Giulio Romano
- Giulio Romano, Eric Lorenzon, Domenico Montanaro, Department of Nephrology, S.M. Misericordia University Hospital, DISM, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
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25
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Prehabilitation to enhance postoperative recovery for an octogenarian following robotic-assisted hysterectomy with endometrial cancer. Can J Anaesth 2012; 59:779-84. [DOI: 10.1007/s12630-012-9734-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 05/08/2012] [Indexed: 12/28/2022] Open
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