ABSTRACT
BACKGROUND: Physical and aerobic capacity are extremely limited in dialysis patients, but it is uncertain whether or not exercise training is safe or has beneficial effects. This study aimed to assess the effects of exercise training on functional capacity and quality of life of hemodialysis patients. METHODS: Ten hemodialysis patients (7 men, 3 women, aged 37 +/- 7 years) free from severe comorbidities were recruited. They underwent training sessions (up to 90 minutes of submaximal exercise) twice a week, on nondialysis days, for 12 months. At baseline and after the physical training program, all patients underwent biochemistry, cardiopulmonary exercise test, echocardiography and a self-rated health test (SF-36). RESULTS: At baseline, dialysis patients showed impaired VO2 uptake (20.6 +/- 5.0 ml/kg/min vs. 34.2 +/- 6.0 ml/kg/min, p<0.001) and peak working capacity (115 +/- 36 W vs. 192 +/- 46.7 W, p<0.001) compared with normal controls. Following the training program, both peak VO2 (20.4 +/- 4.9 ml/kg/min vs. 25.1 +/- 6.5 ml/kg/min, p<0.05), VO2 at anaerobic threshold (12.8 +/- 1.9 ml/kg/min vs. 15.1 +/- 3.8 ml/kg/min, p<0.05), peak working capacity (113 +/- 33 W vs. 134 +/- 37 W, p<0.01) and SF-36 scores improved. No side effects related to intervention occurred. CONCLUSIONS: Dialysis patients showed impaired muscular exercise capacity, but 12 months of moderate exercise training was able to improve their physical function, aerobic capacity and quality of life. Our study suggests that mild, regular physical activity should be recommended and encouraged as an important aspect of the care of selected dialysis patients.
Subject(s)
Anaerobic Threshold , Exercise Therapy , Quality of Life , Renal Dialysis , Adult , Exercise Test , Exercise Tolerance , Female , Heart Rate , Humans , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/therapy , Male , Oxygen ConsumptionABSTRACT
BACKGROUND: Physical training is believed the primary treatment of claudication symptoms. Although exercise therapy is self-effective, some drugs improving functional capacity have additive effects. TASC (Trans Atlantic Society Consensus) considers Propionil-L-Carnitine (PLC) and prostaglandin-E1 (PGE1) as poorly studied drugs with potential benefits in improving claudication. This retrospective, observational study was performed to compare the efficacy of PGE1 and PLC, and to evaluate both the immediate results of an intensive, short-course rehabilitation program and the outcome at one year follow-up. METHODS: Twenty-five patients with severe-moderate claudication were selected. All patients were subjected to an intensive, supervised exercise program for 4 weeks in combination with either PGE1 (10 patients) or PLC (15 patients). Drugs were infused i.v. before every exercise session: 60 microg PGE1 within 2 hours and 600 mg PLC within 10 minutes. Patients were trained with the same supervised tread-mill walking-exercise program. At the end of the rehabilitation period, patients were instructed to keep walking (advised home exercise). Initial claudication distance (ICD) and absolute claudication distance (ACD) were evaluated during a constant treadmill test (3 km/hour speed, 10% grade) at entry, after 4 weeks and at one year follow-up. A patient was considered as no-responder if his/her improvement in ACD was <33%. RESULTS: A significant increase of both ICD and ACD was detected after both 4 weeks (+269% and +135%, respectively, in PGE1 group; +245% and +125%, respectively, in PLC group) and one year (+364% and +202%, respectively, in PGE1 group; +279% and +176%, respectively, in PLC group). No-responder patients after the intensive training period (2 in PGE1 group and 4 in PLC group) remained no-responders also at one year follow-up. Both PGE1 and PLC treatments were well tolerated. No serious drug-related side effect requiring interruption of the treatment was observed. CONCLUSIONS: A short-course of intensive exercise treatment plus PLC or PGE1 may enhance walking ability. The result was confirmed at one year follow-up.
