The Functional, Metabolic, and Anabolic Responses to Exercise Training in Renal Transplant and Hemodialysis Patients

Background. Exercise intolerance is common in hemodialysis (HD) and renal transplant (RTx) patients and is related to muscle weakness. Its pathogenesis may vary between these groups leading to a different response to exercise. The aim of the study was to compare intrinsic muscular parameters between HD and RTx patients and controls, and to assess the response to exercise training on exercise capacity and muscular structure and function in these groups. Methods. Quadriceps function (isokinetic dynamometry), body composition (dual-energy x-ray absorptiometry), and vastus lateralis muscle biopsies were analyzed before and after a 12-week lasting training-program in 35 RTx patients, 16 HD patients, and 21 healthy controls. Results. At baseline, myosin heavy chain (MyHC) isoform composition and enzyme activities were not different between the groups. VO2peak and muscle strength improved significantly and comparably over the training-period in RTx, HD patients and controls (ptime<0.05). The proportion of MyHC type I isoforms decreased (ptime<0.001) and type IIa MyHC isoforms increased (ptime<0.05). The 3-hydroxyacyl-CoA-dehydrogenase activity increased (ptime=0.052). Intrinsic muscular changes were not significantly different between groups. In the HD group, changes in lean body mass were significantly related to changes in muscle insulin-like growth factor (IGF)-II and IGF binding protein-3. Conclusions. Abnormalities in metabolic enzyme activities or muscle fiber redistribution do not appear to be involved in muscle dysfunction in RTx and HD patients. Exercise training has comparable beneficial effects on functional and intrinsic muscular parameters in RTx patients, HD patients, and controls. In HD patients, the anabolic response to exercise training is related to changes in the muscle IGF system.

[1]  D. Fliser,et al.  Insulin resistance and renal disease. , 2006, Contributions to nephrology.

[2]  E. Wouters,et al.  Exercise training restores uncoupling protein-3 content in limb muscles of patients with chronic obstructive pulmonary disease. , 2006, American journal of physiology. Endocrinology and metabolism.

[3]  F. Franssen,et al.  Similarities in Skeletal Muscle Strength and Exercise Capacity Between Renal Transplant and Hemodialysis Patients , 2005, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[4]  P. Painter.  Physical functioning in end‐stage renal disease patients: Update 2005 , 2005, Hemodialysis international. International Symposium on Home Hemodialysis.

[5]  R. Casaburi,et al.  Skeletal muscle mRNA for IGF-IEa, IGF-II, and IGF-I receptor is decreased in sedentary chronic hemodialysis patients. , 2005, Kidney international.

[6]  Samuele M. Marcora,et al.  Intradialytic exercise as anabolic therapy in haemodialysis patients – a pilot study , 2005, Clinical physiology and functional imaging.

[7]  R. Huisman,et al.  The effects of a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counselling for sedentary haemodialysis patients in The Netherlands: results of a randomized clinical trial. , 2005, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[8]  N. Okudan,et al.  A twelve week exercise program improves the psychological status, quality of life and work capacity in hemodialysis patients. , 2004, Journal of nephrology.

[9]  Jamie H Macdonald,et al.  Muscle insulin-like growth factor status, body composition, and functional capacity in hemodialysis patients. , 2004, Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation.

[10]  E. Kouidi,et al.  Outcomes of long-term exercise training in dialysis patients: comparison of two training programs. , 2004, Clinical nephrology.

[11]  P. Painter,et al.  Alterations in skeletal muscle structure are minimized with steroid withdrawal after renal transplantation1 , 2003, Transplantation.

[12]  M. Drent,et al.  Evaluation of two new high-sensitivity methods for C-reactive protein , 2003, Annals of clinical biochemistry.

[13]  E. Lowrie,et al.  Medical outcomes study short form-36: a consistent and powerful predictor of morbidity and mortality in dialysis patients. , 2003, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[14]  G. Curhan,et al.  The association between mental health, physical function, and hemodialysis mortality. , 2003, Kidney international.

[15]  J. Kent‐Braun,et al.  Muscle atrophy in patients receiving hemodialysis: effects on muscle strength, muscle quality, and physical function. , 2003, Kidney international.

[16]  J. Moreland,et al.  The effectiveness of aerobic and muscle strength training in patients receiving hemodialysis and EPO: a randomized controlled trial. , 2002, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[17]  G. Adams.  Invited Review: Autocrine/paracrine IGF-I and skeletal muscle adaptation. , 2002, Journal of applied physiology.

[18]  B. Brewer,et al.  Resistance training improves strength and functional measures in patients with end-stage renal disease. , 2002, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[19]  P. Painter,et al.  A randomized trial of exercise training after renal transplantation , 2002, Transplantation.

[20]  J. Holly,et al.  What is the role of the insulin‐like growth factor system in the pathophysiology of cancer cachexia, and how is it regulated? , 2002, Clinical endocrinology.

[21]  Ò. Miró,et al.  Skeletal muscle mitochondrial function is preserved in young patients with chronic renal failure. , 2002, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[22]  T. Mercer,et al.  Effects of exercise training on aerobic and functional capacity of end‐stage renal disease patients , 2002, Clinical physiology and functional imaging.

[23]  E. Wouters,et al.  The contribution of starvation, deconditioning and ageing to the observed alterations in peripheral skeletal muscle in chronic organ diseases. , 2002, Clinical nutrition.

[24]  A. Levey,et al.  Resistance Training To Counteract the Catabolism of a Low-Protein Diet in Patients with Chronic Renal Insufficiency , 2001, Annals of Internal Medicine.

[25]  Yi-Ping Li,et al.  Effect of tumor necrosis factor-α on skeletal muscle metabolism , 2001 .

[26]  Yi-Ping Li,et al.  Cytokines and oxidative signalling in skeletal muscle. , 2001, Acta physiologica Scandinavica.

[27]  O. Mehls,et al.  The interaction of glucocorticoids with the growth hormone-insulin-like growth factor axis and its effects on growth plate chondrocytes and bone cells. , 2001, Journal of pediatric endocrinology & metabolism : JPEM.

[28]  Y. Li,et al.  Effect of tumor necrosis factor-alpha on skeletal muscle metabolism. , 2001, Current opinion in rheumatology.

[29]  G. Dohm,et al.  Lipid oxidation is reduced in obese human skeletal muscle. , 2000, American journal of physiology. Endocrinology and metabolism.

[30]  K. Schulten,et al.  Insulin-like growth factor system components in hyperparathyroidism and renal osteodystrophy. , 2000, Kidney international.

[31]  P. Painter,et al.  Low-functioning hemodialysis patients improve with exercise training. , 2000, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[32]  M. Decramer,et al.  Skeletal muscle dysfunction in chronic obstructive pulmonary disease and chronic heart failure: underlying mechanisms and therapy perspectives. , 2000, The American journal of clinical nutrition.

[33]  P. Painter,et al.  Physical functioning and health-related quality-of-life changes with exercise training in hemodialysis patients. , 2000, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[34]  Rena R Wing,et al.  Skeletal muscle fatty acid metabolism in association with insulin resistance, obesity, and weight loss. , 1999, American journal of physiology. Endocrinology and metabolism.

[35]  R. Bailey,et al.  Insulin-like growth factor-I resistance. , 1998, Endocrine reviews.

[36]  E. Canalis.  Editorial: Inhibitory Actions of Glucocorticoids on Skeletal Growth. Is Local Insulin-Like Growth Factor I to Blame? , 1998, Endocrinology.

[37]  E. Kouidi,et al.  The effects of exercise training on muscle atrophy in haemodialysis patients. , 1998, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[38]  E. Canalis.  Inhibitory actions of glucocorticoids on skeletal growth. Is local insulin-like growth factor I to blame? , 1998, Endocrinology.

[39]  S. Mohan,et al.  Insulin-like growth factor-binding proteins in serum and other biological fluids: regulation and functions. , 1997, Endocrine reviews.

[40]  P. Deoreo,et al.  Hemodialysis patient-assessed functional health status predicts continued survival, hospitalization, and dialysis-attendance compliance. , 1997, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[41]  Michele Harms,et al.  Skeletal Muscle — Form and Function , 1997 .

[42]  T. K. Lapier.  Glucocorticoid-induced muscle atrophy. The role of exercise in treatment and prevention. , 1997, Journal of cardiopulmonary rehabilitation.

[43]  R. Edwards,et al.  Physiological abnormalities of skeletal muscle in dialysis patients. , 1997, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[44]  M. Buck,et al.  Muscle wasting and dedifferentiation induced by oxidative stress in a murine model of cachexia is prevented by inhibitors of nitric oxide synthesis and antioxidants. , 1996, The EMBO journal.

[45]  T. Noakes,et al.  Morphologic features of the myopathy associated with chronic renal failure. , 1993, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[46]  R R Roy,et al.  Electrophoretic separation of rat skeletal muscle myosin heavy-chain isoforms. , 1993, Journal of applied physiology.

[47]  P. Painter,et al.  31P-magnetic resonance spectroscopy assessment of subnormal oxidative metabolism in skeletal muscle of renal failure patients. , 1993, The Journal of clinical investigation.

[48]  T. Noakes,et al.  Isokinetic muscle strength predicts maximum exercise tolerance in renal patients on chronic hemodialysis. , 1990, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[49]  T. Noakes,et al.  Skeletal muscle limits the exercise tolerance of renal transplant recipients: effects of a graded exercise training program. , 1990, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[50]  W. E. Schreiber,et al.  An Automated Assay of Glycogen Phosphorylase in the Direction of Phosphorolysis , 1990, Annals of clinical biochemistry.

[51]  P. Painter,et al.  Exercise tolerance changes following renal transplantation. , 1987, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[52]  C. Gerber,et al.  Altered skeletal muscle ultrastructure in renal transplant patients on prednisone. , 1986, Kidney international.

[53]  P. Painter,et al.  Effects of exercise training during hemodialysis. , 1986, Nephron.

[54]  J. Fuscoe,et al.  Molecular characterization of the purity of seven human chromosome-specific DNA libraries. , 1986, Cytogenetics and cell genetics.

[55]  F. Horber,et al.  Thigh muscle mass and function in patients treated with glucocorticoids , 1985, European journal of clinical investigation.

[56]  F. Horber,et al.  Evidence that prednisone-induced myopathy is reversed by physical training. , 1985, The Journal of clinical endocrinology and metabolism.

[57]  P. Garland,et al.  [2] Citrate synthase from rat liver: [EC 4.1.3.7 Citrate oxaloacetage-lyase (CoA-acetylating)] , 1969 .

[58]  V. Paetkau,et al.  [77a] Phosphofructokinase: I. Skeletal Muscle , 1966 .