Effect of intradialytic progressive resistance exercise on hemoglobin and iron metabolism in maintenance hemodialysis patients_West China Medical Journal

Authors：

DAI Shanshan , YU Haiyan , LI Shuang , ZHENG Hanxu ,  MA Yingchun

Department of Nephrology, Beijing Bo’ai Hospital, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing 100068, P. R. China;

Corresponding author：

MA Yingchun, Email: mych323@163.com

Keywords：

Progressive resistance exercise; Maintenance hemodialysis; Iron metabolism; Hemoglobin

DOI：

10.7507/1002-0179.202006064

Video：

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Objective To investigate the effect of 24-week intradialytic progressive resistance exercise on hemoglobin and iron metabolism in maintenance hemodialysis (MHD) patients.Methods From April to May 2019, 62 MHD patients were enrolled and randomly assigned into exercise group (n=31) and control group (n=31). Both groups of patients received regular routine hemodialysis, on that basis, patients in the exercise group completed intradialytic resistance exercise three times per week for 24 weeks. Each exercise included 8-10 muscle groups (grasping the grip ring with both hands, flexion and extension of the elbows and shoulders on the non-vascular side and lower limbs with sandbag), 3 sets of 15 repetitions with a rest of 1-2 min between 2 sets. Exercise began with a low load, the sandbag weight was gradually increased, and the Borg score was aimed to be 11-13 points after exercise. Hemoglobin, serum ferritin, transferrin saturation, serum creatinine, high-sensitivity C-reactive protein, urea clearance index, recombinant human erythropoietin (rHuEPO) dosage at baseline and after 24 weeks, as well as the cumulative iron supplement dose and hemoglobin variation of the two groups during the study period were evaluated.Results There were 20 patients in the exercise group and 30 ones in the control group who completed the study. After 24 weeks of progressive resistance exercise, the medium (lower quartile, upper quartile) of the amount of rHuEPO in the exercise group decreased from 6 000 (6 000, 9 000) U/week to 6 000 (4 500, 7 125) U/week (Z=−2.599, P=0.009), while that in the control group had no statistically significant difference (Z=−1.340, P=0.180); there was no statistically difference in hemoglobin, hemoglobin coefficient of variation, serum ferritin, transferrin saturation, or 24-week cumulative iron supplementation between the two groups.Conclusion Intradialytic progressive resistance exercise can reduce the amount of rHuEPO in MHD patients, which is benefitial to optimizing the management of hemoglobin.

Citation： DAI Shanshan, YU Haiyan, LI Shuang, ZHENG Hanxu, MA Yingchun. Effect of intradialytic progressive resistance exercise on hemoglobin and iron metabolism in maintenance hemodialysis patients. West China Medical Journal, 2020, 35(7): 781-787. doi: 10.7507/1002-0179.202006064 Copy

1.	Johansen KL, Chertow GM, Alexander VN, et al. Physical activity levels in patients on hemodialysis and healthy sedentary controls. Kidney Int, 2000, 57(6): 2564-2570.
2.	Fleishman TT, Dreiher J, Shvartzman P. Patient-reported outcomes in maintenance hemodialysis: a cross-sectional, multicenter study. Qual Life Res, 2020.
3.	Tamura MK, Covinsky KE, Chertow GM, et al. Functional status of elderly adults before and after initiation of dialysis. N Engl J Med, 2009, 361(16): 1539-1547.
4.	Painter P. Physical functioning in end-stage renal disease patients: update 2005. Hemodial Int, 2005, 9(3): 218-235.
5.	O’Hare AM, Tawney K, Bacchetti P, et al. Decreased survival among sedentary patients undergoing dialysis: results from the dialysis morbidity and mortality study wave 2. Am J Kidney Dis, 2003, 41(2): 447-454.
6.	王欣欣, 孙超, 崔家祯, 等. 透析中递增式抗阻运动改善维持性血液透析(MHD)患者的心肺耐力、心理状态和健康相关生活质量. 中国血液净化, 2014, 13(5): 390-393.
7.	程艳娇, 韩玮, 宋桂芸, 等. 透析中的卧位体操对维持性血液透析患者的影响. 中华肾脏病杂志, 2015, 31(8): 583-588.
8.	Clarkson MJ, Bennett PN, Fraser SF, et al. Exercise interventions for improving objective physical function in patients with end-stage kidney disease on dialysis: a systematic review and meta-analysis. Am J Physiol Renal Physiol, 2019, 316(5): F856-F872.
9.	Smith MP. Independent cardioprotective effects of resistance and aerobic exercise training in adults. Eur J Prev Cardiol, 2019.
10.	Lopes AA, Lantz B, Morgenstern H, et al. Associations of self-reported physical activity types and levels with quality of life, depression symptoms, and mortality in hemodialysis patients: the DOPPS. Clin J Am Soc Nephrol, 2014, 9(10): 1702-1712.
11.	美国运动医学会. ACSM运动测试与运动处方指南. 10 版. 王正珍, 译. 北京: 北京体育大学出版社, 2019: 314-318.
12.	中国医师协会康复医师分会肾康复专业委员会, 马迎春. 我国成人慢性肾脏病患者运动康复的专家共识. 中华肾脏病杂志, 2019, 35(7): 537-543.
13.	Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc, 1982, 14(5): 377-381.
14.	中华医学会肾脏病学分会肾性贫血诊断和治疗共识专家组. 肾性贫血诊断与治疗中国专家共识(2018修订版). 中华肾脏病杂志, 2018, 34(11): 860-866.
15.	Torres E, Aragoncillo I, Moreno J, et al. Exercise training during hemodialysis sessions: physical and biochemical benefits. Ther Apher Dial, 2019.
16.	DePaul V, Moreland J, Eager T, et al. The effectiveness of aerobic and muscle strength training in patients receiving hemodialysis and EPO: a randomized controlled trial. Am J Kidney Dis, 2002, 40(6): 1219-1229.
17.	Frih B, Jaafar H, Mkacher W, et al. The effect of interdialytic combined resistance and aerobic exercise training on health related outcomes in chronic hemodialysis patients: the tunisian randomized controlled study. Front Physiol, 2017, 8: 288.
18.	Afshar R, Shegarfy L, Shavandi N, et al. Effects of aerobic exercise and resistance training on lipid profiles and inflammation status in patients on maintenance hemodialysis. Indian J Nephrol, 2010, 20(4): 185-189.
19.	Cho JH, Lee JY, Lee S, et al. Effect of intradialytic exercise on daily physical activity and sleep quality in maintenance hemodialysis patients. Int Urol Nephrol, 2018, 50(4): 745-754.
20.	Pu J, Jiang Z, Wu W, et al. Efficacy and safety of intradialytic exercise in haemodialysis patients: a systematic review and meta-analysis. BMJ Open, 2019, 9(1): e020633.
21.	Kouidi EJ, Grekas DM, Deligiannis AP. Effects of exercise training on noninvasive cardiac measures in patients undergoing long-term hemodialysis: a randomized controlled trial. Am J Kidney Dis, 2009, 54(3): 511-521.
22.	Sheng K, Zhang P, Chen L, et al. Intradialytic exercise in hemodialysis patients: a systematic review and meta-analysis. AmJ Nephrol, 2014, 40(5): 478-490.
23.	Bogataj Š, Pajek M, Pajek J, et al. Exercise-based interventions in hemodialysis patients: a systematic review with a meta-analysis of randomized controlled trials. J Clin Med, 2019, 9(1): 43.
24.	Donges CE, Duffield R, Drinkwater EJ. Effects of resistance or aerobic exercise training on interleukin-6, C-reactive protein, and body composition. Med Sci Sports Exerc, 2010, 42(2): 304-313.
25.	Moraes C, Marinho S, Lobo JC, et al. Effects of resistance exercise training on acyl-ghrelin and obestatin levels in hemodialysis patients. Ren Fail, 2015, 37(5): 851-857.
26.	Sawant A, Andrew AH, Overend TJ. Anabolic effect of exercise training in people with end-stage renal disease on hemodialysis: a systematic review with meta-analysis. Physiother Can, 2014, 66(1): 44-53.
27.	滕菲, 李雪梅. 低氧诱导因子与肾性贫血. 中华肾脏病杂志, 2017, 33(1): 63-68.
28.	赵杰修, 田野, 曹建民, 等. 不同运动方式对大鼠血红蛋白浓度的影响—大鼠运动性贫血模型建立方法探讨. 中国运动医学杂志, 2004, 23(4): 436-440.
29.	林宇峰, 韦军, 何建伟. 运动性贫血发生中红细胞变形能力与一氧化氮的关系. 中国运动医学杂志, 2014, 33(7): 682-686.
30.	Shaskey DJ, Green GA. Sports haematology. Sports Med, 2000, 29(1): 27-38.
31.	Sim M, Garvican-Lewis LA, Cox GR, et al. Iron considerations for the athlete: a narrative review. Eur J Appl Physiol, 2019, 119(7): 1463-1478.
32.	Wouthuyzen-Bakker M, van Assen S. Exercise-induced anaemia: a forgotten cause of iron deficiency anaemia in young adults. Br J Gen Pract, 2015, 65(634): 268-269.

1. Johansen KL, Chertow GM, Alexander VN, et al. Physical activity levels in patients on hemodialysis and healthy sedentary controls. Kidney Int, 2000, 57(6): 2564-2570.
2. Fleishman TT, Dreiher J, Shvartzman P. Patient-reported outcomes in maintenance hemodialysis: a cross-sectional, multicenter study. Qual Life Res, 2020.
3. Tamura MK, Covinsky KE, Chertow GM, et al. Functional status of elderly adults before and after initiation of dialysis. N Engl J Med, 2009, 361(16): 1539-1547.
4. Painter P. Physical functioning in end-stage renal disease patients: update 2005. Hemodial Int, 2005, 9(3): 218-235.
5. O’Hare AM, Tawney K, Bacchetti P, et al. Decreased survival among sedentary patients undergoing dialysis: results from the dialysis morbidity and mortality study wave 2. Am J Kidney Dis, 2003, 41(2): 447-454.
6. 王欣欣, 孙超, 崔家祯, 等. 透析中递增式抗阻运动改善维持性血液透析(MHD)患者的心肺耐力、心理状态和健康相关生活质量. 中国血液净化, 2014, 13(5): 390-393.
7. 程艳娇, 韩玮, 宋桂芸, 等. 透析中的卧位体操对维持性血液透析患者的影响. 中华肾脏病杂志, 2015, 31(8): 583-588.
8. Clarkson MJ, Bennett PN, Fraser SF, et al. Exercise interventions for improving objective physical function in patients with end-stage kidney disease on dialysis: a systematic review and meta-analysis. Am J Physiol Renal Physiol, 2019, 316(5): F856-F872.
9. Smith MP. Independent cardioprotective effects of resistance and aerobic exercise training in adults. Eur J Prev Cardiol, 2019.
10. Lopes AA, Lantz B, Morgenstern H, et al. Associations of self-reported physical activity types and levels with quality of life, depression symptoms, and mortality in hemodialysis patients: the DOPPS. Clin J Am Soc Nephrol, 2014, 9(10): 1702-1712.
11. 美国运动医学会. ACSM运动测试与运动处方指南. 10 版. 王正珍, 译. 北京: 北京体育大学出版社, 2019: 314-318.
12. 中国医师协会康复医师分会肾康复专业委员会, 马迎春. 我国成人慢性肾脏病患者运动康复的专家共识. 中华肾脏病杂志, 2019, 35(7): 537-543.
13. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc, 1982, 14(5): 377-381.
14. 中华医学会肾脏病学分会肾性贫血诊断和治疗共识专家组. 肾性贫血诊断与治疗中国专家共识(2018修订版). 中华肾脏病杂志, 2018, 34(11): 860-866.
15. Torres E, Aragoncillo I, Moreno J, et al. Exercise training during hemodialysis sessions: physical and biochemical benefits. Ther Apher Dial, 2019.
16. DePaul V, Moreland J, Eager T, et al. The effectiveness of aerobic and muscle strength training in patients receiving hemodialysis and EPO: a randomized controlled trial. Am J Kidney Dis, 2002, 40(6): 1219-1229.
17. Frih B, Jaafar H, Mkacher W, et al. The effect of interdialytic combined resistance and aerobic exercise training on health related outcomes in chronic hemodialysis patients: the tunisian randomized controlled study. Front Physiol, 2017, 8: 288.
18. Afshar R, Shegarfy L, Shavandi N, et al. Effects of aerobic exercise and resistance training on lipid profiles and inflammation status in patients on maintenance hemodialysis. Indian J Nephrol, 2010, 20(4): 185-189.
19. Cho JH, Lee JY, Lee S, et al. Effect of intradialytic exercise on daily physical activity and sleep quality in maintenance hemodialysis patients. Int Urol Nephrol, 2018, 50(4): 745-754.
20. Pu J, Jiang Z, Wu W, et al. Efficacy and safety of intradialytic exercise in haemodialysis patients: a systematic review and meta-analysis. BMJ Open, 2019, 9(1): e020633.
21. Kouidi EJ, Grekas DM, Deligiannis AP. Effects of exercise training on noninvasive cardiac measures in patients undergoing long-term hemodialysis: a randomized controlled trial. Am J Kidney Dis, 2009, 54(3): 511-521.
22. Sheng K, Zhang P, Chen L, et al. Intradialytic exercise in hemodialysis patients: a systematic review and meta-analysis. AmJ Nephrol, 2014, 40(5): 478-490.
23. Bogataj Š, Pajek M, Pajek J, et al. Exercise-based interventions in hemodialysis patients: a systematic review with a meta-analysis of randomized controlled trials. J Clin Med, 2019, 9(1): 43.
24. Donges CE, Duffield R, Drinkwater EJ. Effects of resistance or aerobic exercise training on interleukin-6, C-reactive protein, and body composition. Med Sci Sports Exerc, 2010, 42(2): 304-313.
25. Moraes C, Marinho S, Lobo JC, et al. Effects of resistance exercise training on acyl-ghrelin and obestatin levels in hemodialysis patients. Ren Fail, 2015, 37(5): 851-857.
26. Sawant A, Andrew AH, Overend TJ. Anabolic effect of exercise training in people with end-stage renal disease on hemodialysis: a systematic review with meta-analysis. Physiother Can, 2014, 66(1): 44-53.
27. 滕菲, 李雪梅. 低氧诱导因子与肾性贫血. 中华肾脏病杂志, 2017, 33(1): 63-68.
28. 赵杰修, 田野, 曹建民, 等. 不同运动方式对大鼠血红蛋白浓度的影响—大鼠运动性贫血模型建立方法探讨. 中国运动医学杂志, 2004, 23(4): 436-440.
29. 林宇峰, 韦军, 何建伟. 运动性贫血发生中红细胞变形能力与一氧化氮的关系. 中国运动医学杂志, 2014, 33(7): 682-686.
30. Shaskey DJ, Green GA. Sports haematology. Sports Med, 2000, 29(1): 27-38.
31. Sim M, Garvican-Lewis LA, Cox GR, et al. Iron considerations for the athlete: a narrative review. Eur J Appl Physiol, 2019, 119(7): 1463-1478.
32. Wouthuyzen-Bakker M, van Assen S. Exercise-induced anaemia: a forgotten cause of iron deficiency anaemia in young adults. Br J Gen Pract, 2015, 65(634): 268-269.

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