Michou Vasiliki, Davioti Michaela, Syrakou Niki, Liakopoulos Vasilios, Deligiannis Asterios, Kouidi Evangelia
Sports Medicine Laboratory, School of Physical Education and Sport Science, Aristotle University, PC 57001 Thessaloniki, Greece.
Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University, PC 54636 Thessaloniki, Greece.
J Funct Morphol Kinesiol. 2023 Jan 11;8(1):9. doi: 10.3390/jfmk8010009.
Chronic kidney disease (CKD) leads to gradual muscle mass loss, which is strongly associated with lower functional capacity, which limits a patient’s daily activities. The aim of the present study is to examine the effects of a 4-month intradialytic exercise program on the functional capacity and body composition of kidney transplant (KT) candidates. Twenty-nine male patients on hemodialysis (HD) waiting for a kidney transplant, with a mean age of 53.86 ± 9.56 years old and BMI 27.11 ± 5.55 kg/m2, were randomly assigned into the following two groups: A (nA = 15 HD patients), who followed a 4-month intradialytic exercise program combining aerobic and resistance training, with a supervised, progressively increasing workload, and B (nB = 14 HD patients), who continued to receive usual care. At baseline and the end of the study, the KT candidates underwent a 6-min walking distance (6-MWD), and a 10-repetition sit-to-stand test (10-STS) to access physical function, a handgrip strength (HGS) test to evaluate the muscle strength of the non-fistula hand. Moreover, the bioelectrical impedance analysis (BIA) was performed to assess body composition indices, such as body fat (BF), body fat mass index (BFMI), fat-free mass index (FFMI), body cell mass (BCM), basal metabolic rate (BMR), extracellular water (ECW), intracellular water (ICW), total body water (TBW) and phase angle (PhA). Following the exercise program, group A showed favorable improvements in HGS (from 26.59 ± 9.23 to 28.61 ± 9.58 kg, p < 0.05) and 6-MWD (from 427.07 ± 7.66 to 468.16 ± 11.39 m, p < 0.05). Intergroup results from 6-MWD showed a statistically significant difference (Δp = 0.04), at the end of the study. Moreover, group A results from BIA revealed a significant increase of BMR by 2.4% (p < 0.05), ECW by 3.6% (p = 0.01), ICW by 3.8% (p = 0.01), TBW by 4.1% (p = 0.01), lean mass by 2.7% (p = 0.01), and PhA by 13.3% (p = 0.04), while a reduction in BF by 5.0% (p = 0.01) and BFMI by 6.6% (p = 0.03) was also noticed. At the end of the study, group A showed statistical differences in BMR (Δp = 0.01), BMR/BW (Δp = 0.01), dry lean (Δp = 0.01), and PhA (Δp = 0.03), compared to the group B. Linear regression analysis in group A after training showed positive correlations between HGS and both PhA (r = 0.52, p = 0.04) and FFMI (r = 0.64, p = 0.01), and a strong negative correlation between 6-MWT and BF (r = −0.61, p = 0.01). In conclusion, a 4-month intradialytic exercise program can enhance body composition and some physical parameters in HD patients awaiting kidney transplantation.
慢性肾脏病（CKD）会导致肌肉量逐渐减少，这与功能能力下降密切相关，进而限制患者的日常活动。本研究旨在探讨为期4个月的透析期间运动计划对肾移植（KT）候选者功能能力和身体成分的影响。29名等待肾移植的男性血液透析（HD）患者，平均年龄53.86±9.56岁，体重指数（BMI）为27.11±5.55kg/m²，被随机分为以下两组：A组（nA = 15名HD患者），进行为期4个月的透析期间运动计划，结合有氧训练和抗阻训练，由专人监督，工作量逐渐增加；B组（nB = 14名HD患者），继续接受常规护理。在基线和研究结束时，KT候选者进行6分钟步行距离（6-MWD）测试、10次坐立试验（10-STS）以评估身体功能，进行握力（HGS）测试以评估非造瘘手的肌肉力量。此外，进行生物电阻抗分析（BIA）以评估身体成分指标，如体脂（BF）、体脂质量指数（BFMI）、去脂体重指数（FFMI）、身体细胞质量（BCM）、基础代谢率（BMR）、细胞外液（ECW）、细胞内液（ICW）、总体水（TBW）和相位角（PhA）。经过运动计划后，A组的握力（从26.59±9.23kg提高到28.61±9.58kg，p<0.05）和6-MWD（从427.07±7.66m提高到468.16±11.39m，p<0.05）有显著改善。在研究结束时，6-MWD的组间结果显示出统计学上的显著差异（Δp = 0.04）。此外，A组的BIA结果显示，BMR显著增加2.4%（p<0.05），ECW增加3.6%（p = 0.01），ICW增加3.8%（p = 0.01），TBW增加4.1%（p = 0.01），瘦体重增加2.7%（p = 0.01），PhA增加13.3%（p = 0.04），同时BF减少5.0%（p = 0.01），BFMI减少6.6%（p = 0.03）。在研究结束时，与B组相比，A组在BMR（Δp = 0.01）、BMR/体重（Δp = 0.01）、去脂体重（Δp = 0.01）和PhA（Δp = 0.03）方面存在统计学差异。训练后A组的线性回归分析显示，握力与PhA（r = 0.52，p = 0.04）和FFMI（r = 0.64，p = 0.01）均呈正相关，6-MWT与BF呈强负相关（r = -0.61，p = 0.01）。总之，为期4个月的透析期间运动计划可改善等待肾移植的HD患者的身体成分和一些身体参数。
