Efficacy of physical exercise on sleep quality in patients with chronic kidney disease: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

To revise and critically summarize the available scientific evidence regarding the effect of exercise on sleep quality in patients with chronic kidney disease (CKD).

METHODS

A systematic review of randomized controlled trials (RCTs) and comparative studies was conducted, searching MEDLINE/PubMed, SPORTDiscus, and Scopus using keywords "Exercise", "Physical Activity", "Chronic Kidney Disease," and "Sleep". The methodological quality of included studies was assessed using the PEDRo and MINORS scales.

RESULTS

A total of 8 RCTs and 3 comparative studies were included, showing a low (n = 1), fair (n = 7), and good (n = 3) methodological quality. Most of the studies included patients undergoing hemodialysis (HD) (n = 8). Self-reported sleep quality (n = 9), sleepiness (n = 2), and objective sleep status (n = 2) were the main outcomes analyzed. The most frequent exercise interventions included aerobic training (n = 7), resistance training (n = 2), or a combination of both (n = 4). Generally, exercise induced positive effects on the reported outcomes. Data synthesis indicated that participants who exercised obtained significant improvements on their self-reported sleep quality in comparison with those included in the control groups, with a mean difference in the Pittsburgh Sleep Quality Index of - 5.27 points (95% CI - 7.76, - 2.77; p < 0.001).

CONCLUSION

Preliminary scientific evidence indicates that patients with CKD, especially those undergoing HD, report improvements in self-reported sleep quality after taking part in aerobic exercise programs, while combined training interventions yielded diverse findings. The effects of exercise on sleepiness and objective sleep status were backed by few studies with mixed results.

Initial Maximum Push-Rim Propulsion and Sprint Performance in Elite Men's Wheelchair Basketball

OBJECTIVES

This study sought to report the reliability (intrasession) values of initial maximum push-rim propulsion (IMPRP) and sprint performance in elite wheelchair basketball (WB) players and to assess the involvement of strength in sprint capacity.

METHODS

Fifteen Spanish international WB male players participated in this study. The maximum single wheelchair push from a stationary position (IMPRP) and the sprint performance (ie, 3, 5, and 12 m) of WB players were measured in this study.

RESULTS

IMPRP mechanical outputs V, Vmax, P, Rel. P, F, and Rel. F variables presented high reliability values (intraclass correlation coefficient [ICC] ≥ .92; coefficient of variation [CV] ≤ 8.04 ± 7.37; standard error of measurement [SEM] ≤ 29.92), but the maximum strength variables Pmax, Rel. Pmax, Fmax, and Rel. Fmax (ICC ≥ .63; CV ≤ 13.19 ± 16.63; SEM ≤ 203.76) showed lower ICC values and by contrast higher CV and SEM values. The most substantial correlations were identified between maximum IMPRP values (ie, V, Vmax, P, Rel. P, F, and Rel. F) and sprint performance in 3 m (r ± confidence limits ≥ -0.74 ± 0.22, very large; R2 ≥ .55), 5 m (r ± confidence limits ≥ -0.72 ± 0.24, very large; R2 ≥ .51), and 12 m (r ± confidence limits ≥ -0.67 ± 0.27, large; R2 ≥ .44).

CONCLUSIONS

The IMPRP test and sprint tests (3, 5, and 12 m) are practical and reliable for measuring strength and speed in WB players. In addition, there were large to very large associations among strength variables (ie, P, Rel. P, F, and Rel. F) and all sprint variables. This could indicate a need to implement specific strength exercises in WB players to improve sprint capacity.

The Relationship between Resistance Exercise Performance and Ventilatory Efficiency after Beetroot Juice Intake in Well-Trained Athletes

The assessment of ventilatory efficiency is critical to understanding the matching of ventilation (VE) and perfusion in the lungs during exercise. This study aimed to establish a causal physiological relationship between ventilatory efficiency and resistance exercise performance after beetroot juice (BJ) intake. Eleven well-trained males performed a resistance exercise test after drinking 140 mL of BJ (~12.8 mmol NO₃^-) or a placebo (PL). Ventilatory efficiency was assessed by the VE•VCO₂^-1 slope, the oxygen uptake efficiency slope and the partial pressure of end-tidal carbon dioxide (PetCO₂). The two experimental conditions were controlled using a randomized, double-blind crossover design. The resistance exercise test involved repeating the same routine twice, which consisted of wall ball shots plus a full squat (FS) with a 3 min rest or without a rest between the two exercises. A higher weight lifted was detected in the FS exercise after BJ intake compared with the PL during the first routine (p = 0.004). BJ improved the VE•VCO₂^-1 slope and the PetCO₂ during the FS exercise in the first routine and at rest (p < 0.05). BJ intake improved the VE•VCO₂^-1 slope and the PetCO₂ coinciding with the resistance exercise performance. The ergogenic effect of BJ could be induced under aerobic conditions at rest.