Graduate Program in Physical Education, Catholic University of Brasília, Brasília, Brazil.
Department of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
J Appl Physiol (1985). 2021 Feb 1;130(2):508-516. doi: 10.1152/japplphysiol.00416.2020. Epub 2020 Nov 26.
This study compared the effectiveness of dynamic resistance training (DRT) versus isometric RT (IRT) on osteogenesis and hormonal mechanisms involved in maintenance hemodialysis (MHD) patients. One hundred and ninety-three MHD patients were randomized into three groups: control (CTL) ( = 60), DRT ( = 66), and IRT ( = 67). A first visit was required for an anamnesis to evaluate the number of medications, biochemical, and anthropometric measurements (dialysis adequacy, creatinine, urea, body mass, height, and body mass index). Grip strength, bone mineral density (BMD), and renal-bone markers were assessed pre- and postprotocol. The DRT and IRT training was 6 mo with a frequency of three times per week, on alternate days. Each training session consisted of three sets of 8 to 12 repetitions at lower and moderate intensities. Both training sessions were prescribed approximately 1 h prior to dialysis. Statistical significances were adopted with < 0.05. There was a greater dropout in the IRT group (24%) as compared with the DRT group (14%), which in turn had less adverse clinical effects (67%, 24%, and 61% for CTL, DRT, and IRT, respectively). DRT promoted gains in BMD in different body locations, in addition to increasing pro-osteogenic factors (Klotho and calcitriol) and reducing those related to bone loss, such as sclerostin, FGF23, and PTH. There was an improvement in Ca × PO for DRT, whereas these benefits did not occur in the IRT group ( < 0.05). These novel findings suggest that the DRT generates biopositive adaptations in bone tissue in MHD and can be used as a nonpharmacological strategy to improve BMD. This study shows, for the first time, the effect of dynamic and isometric resistance training on bone mineral density in hemodialysis patients, providing a new understanding of the possible participation of the sclerostin/FGF23/Klotho axis, vitD, PTH, and calcium × phosphate product in this process. However, isometric resistance training may not be sufficient to induce these benefits. Therefore, this study supports the potential therapeutic role of dynamic resistance training counteracting chronic kidney disease-mineral and bone disorder.
这项研究比较了动态抗阻训练（DRT）与等长抗阻训练（IRT）对维持性血液透析（MHD）患者成骨和激素机制的影响。193 名 MHD 患者被随机分为三组：对照组（CTL）（n=60）、DRT 组（n=66）和 IRT 组（n=67）。第一次就诊需要进行病史回顾，以评估药物数量、生化和人体测量学测量值（透析充分性、肌酐、尿素、体重、身高和体重指数）。在方案前后评估握力、骨密度（BMD）和肾骨标志物。DRT 和 IRT 训练持续 6 个月，每周 3 次，隔日进行。每次训练包括 3 组 8-12 次重复，强度较低且中等。两次训练均在透析前约 1 小时进行。统计学意义为 < 0.05。与 DRT 组（14%）相比，IRT 组的退出率更高（24%），后者的不良反应发生率更低（分别为 67%、24%和 61%，CTL、DRT 和 IRT）。DRT 促进了不同身体部位的 BMD 增加，同时增加了促成骨因子（Klotho 和骨化三醇），减少了与骨丢失相关的因子，如 Sclerostin、FGF23 和 PTH。DRT 改善了 Ca × PO，而 IRT 组则没有发生这种情况（ < 0.05）。这些新发现表明，DRT 可使 MHD 患者的骨组织产生生物正向适应，可作为改善 BMD 的非药物策略。这项研究首次表明，动态和等长抗阻训练对血液透析患者的骨密度有影响，为 Sclerostin/FGF23/Klotho 轴、VitD、PTH 和 Ca × PO 产物在这一过程中的可能参与提供了新的认识。然而，等长抗阻训练可能不足以产生这些益处。因此，这项研究支持动态抗阻训练在对抗慢性肾脏病-矿物质和骨异常方面的潜在治疗作用。
