Exercício aeróbico baseado no primeiro limiar ventilatório em pacientes com excesso de peso e doença renal crônica: impacto sobre a capacidade cardiorrespiratória e funcional

INTRODUCTION: Chronic kidney disease (CKD) and obesity are both associated with reduced physical capacity. The potential benefit of aerobic training on physical capacity has been recognized. The exercise intensity can be established using different methods mostly subjective or indirect. Ventilatory threshold (VT) is a direct and objective method that allows prescribing exercise intensity according to individual capacity. OBJECTIVES: To evaluate the impact of aerobic training at VT intensity on cardiopulmonary and functional capacities in CKD patients with excess of body weight. METHODS: Ten CKD patients (eight men, 49.7 ± 10.1 years; BMI 30.4 ± 3.5 kg/m², creatinine clearance 39.4 ± 9.8 mL/min/1.73 m²) underwent training on a treadmill three times per week during 12 weeks. Cardiopulmonary capacity (ergoespirometry), functional capacity and clinical parameters were evaluated. RESULTS: At the end of 12 weeks, VO2PEAK increased by 20%, and the speed at VO2PEAK increased by 16%. The training resulted in improvement in functional capacity tests, such as six-minute walk test (9.2%), two-minute step test (20.3%), arm curl test (16.3%), sit and stand test (35.7%), and time up and go test (15.3%). In addition, a decrease in systolic and diastolic blood pressures was observed despite no change in body weight, sodium intake and antihypertensive medication. CONCLUSION: Aerobic exercise performed at VT intensity improved cardipulmonary and functional capacities of overweight CKD patients. Additional benefit on blood pressure was observed. These results suggest that VT can be effectively applied for prescribing exercise intensity in this particular group of patients.INTRODUÇÃO: O excesso de peso e a doença renal crônica (DRC) estão associados à baixa capacidade cardiorrespiratória (CR) e funcional (CF). Já foi observado que o treinamento aeróbico (TA) melhora a CR e CF. Métodos indiretos e subjetivos são comumente empregados para a prescrição da intensidade do TA. O limiar ventilatório (LV) é um método direto e objetivo que permite prescrever a intensidade do TA de acordo com a capacidade física do paciente. OBJETIVOS: Avaliar o impacto do TA com base na intensidade do LV sobre a CR e CF de pacientes com excesso de peso e portadores de DRC na fase não dialítica. MÉTODOS: Dez pacientes (oito homens; 49 ± 10,1 anos, IMC 30,4 ± 3,5 kg/m² , depuração de creatinina 39,4 ± 9,8 mL/min/1,73m²) foram submetidos à TA 3 vezes por semana durante 12 semanas. CR (ergoespirometria), CF e parâmetros clínicos foram avaliados. RESULTADOS: O TA promoveu aumento de 20% no consumo pico de O2 (VO2PICO), 16% na velocidade alcançada no VO2PICO e melhora em 9,2% na caminhada de seis minutos, 20,3% na marcha estacionária, 35,7% no sentar e levantar, 16,3% na resistência muscular de membro superior e 15,3% no tempo de ir e voltar. A pressão arterial diminuiu sem modificação nos anti-hipertensivos, no peso ou no consumo de sódio. CONCLUSÃO: Os resultados indicam que o TA baseado na intensidade do LV melhora a CR, CF e pressão arterial de pacientes portadores de DRC com excesso de peso. Isso sugere que o TA baseado na intensidade LV é eficaz e pode ser empregado com segurança nesses pacientes.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP)UNIFESP Fundação Oswaldo RamosUNIFESP, Fundação Oswaldo RamosSciEL

Physical activity and energy expenditure in haemodialysis patients: an international survey

Background. The assessment of physical activity and energy expenditure is relevant to the care of maintenance haemodialysis (MHD) patients. In the current study, we aimed to evaluate measurements of physical activity and energy expenditure in MHD patients from different centres and countries and explored the predictors of physical activity in these patients. Methods. In this cross-sectional multicentre study, 134 MHD patients from four countries (France, Switzerland, Sweden and Brazil) were included. The physical activity was evaluated for 5.0 ± 1.4 days (mean ± SD) by a multisensory device (SenseWear Armband) and comprised the assessment of number of steps per day, activity-related energy expenditure (activity-related EE) and physical activity level (PAL). Results. The number of steps per day, activity-related EE and PAL from the MHD patients were compatible with a sedentary lifestyle. In addition, all parameters were significantly lower in dialysis days when compared to non-dialysis days (P < 0.001). The multivariate regression analysis revealed that diabetes and higher body mass index (BMI) predicted a lower PAL and older age and diabetes predicted a reduced number of steps. Conclusions. The physical activity parameters of MHD patients were compatible with a sedentary lifestyle. This inactivity was worsened by aging, diabetes and higher BMI. Our results indicate that MHD patients should be encouraged by the health care team to increase their physical activit

Effect of aerobic exercise on body composition in overweight or obese patients suffering from chronic kidney disease

Introdução: Assim como observado na populacao geral, a prevalencia de obesidade aumentou acentuadamente na populacao de pacientes portadores de doenca renal cronica (DRC). A obesidade e um fator de risco bem estabelecido para diabetes e hipertensao, as duas principais causas de DRC. Alem disso, a obesidade pode ser um fator de risco independente para o desenvolvimento e progressao da doenca. Independente do indice de massa corporal (IMC), o excesso de gordura abdominal, especialmente gordura visceral, esta associado a uma serie de complicacoes metabolicas nesta populacao. Assim, intervencoes que promovam reducao da gordura abdominal, especialmente de gordura visceral, poderiam ser de grande valia para os pacientes portadores de DRC. Objetivos: O presente estudo teve como objetivo investigar o efeito do exercicio fisico aerobico sobre os parametros de composicao corporal, com enfase na gordura visceral, de pacientes com sobrepeso ou obesidade portadores de DRC na fase nao dialitica. Alem disso, tambem foi testada a hipotese de que o exercicio aerobico realizado a distancia teria efeito similar ao presencial. Metodos: Foram incluidos 27 homens sedentarios (52,1±9,5 anos, IMC 30,4±3,8 kg/m² e taxa de filtracao glomerular estimada de 27,5±11,6 mL/min) aleatoriamente designados ao grupo exercicio (n=19) e grupo controle (n=10). Os pacientes do grupo exercicio foram divididos em grupo presencial (n=10) e grupo distancia (n=9). O treinamento aerobico (caminhada) foi prescrito na intensidade do 1º limiar ventilatorio e realizado tres vezes por semana durante 12 semanas. O grupo presencial realizou as sessoes de treinamento em um centro de treinamento sob supervisao continua de um educador fisico. O grupo distancia foi orientado a realizar as sessoes em parques, pracas, ou vias publicas sem supervisao direta. O grupo controle permaneceu sem praticar qualquer tipo de exercicio durante o periodo de estudo. A composicao corporal foi avaliada por meio da absortometria de raio-X de dupla energia e a gordura abdominal pela tomografia computadorizada. Resultados: No grupo presencial, a gordura visceral (GV) e circunferencia da cintura (CC) diminuiram 6,4±6,4 mm (P<0,01) e 2,0±2,3 cm (P=0,03), respectivamente, enquanto a massa magra perna (MMP) aumentou 0,5±0,4 kg (P<0,01). Nao foram observadas alteracoes significantes nestes parametros no grupo que realizou exercicio a distancia (GV-7,8±11,1 mm, P=0,09; CC -1,4±2,0 cm, P=0,09; MMP -0,08±0,8 kg, P=0,81 respectivamente). No grupo controle, a gordura visceral aumentou 5,0±4,4 mm (P=0,01) e a circunferencia da cintura nao mudou de forma significante (1,5±3,2 cm, P=0,16). Houve uma interacao tempo e grupo significante, em relacao ao grupo controle, para a gordura visceral e circunferencia da cintura em ambos os grupos de exercicio e para massa magra perna apenas no grupo presencial. Apesar do grupo distancia nao apresentar alteracoes significantes nos parametros de composicao corporal, o exercicio foi capaz de prevenir o aumento espontaneo da gordura visceral. Houve diminuicao da pressao arterial em ambos os grupos de exercicio (presencial 13%, P<0,01 e distancia 10%, P=0,03). A taxa de filtracao glomerular estimada aumentou em 3,6±4,6 mL/min (P=0,03) apenas no grupo presencial. Estes parametros permaneceram inalterados no grupo de controle. Conclusao: O exercicio fisico aerobico supervisionado foi seguro e efetivo para reduzir gordura visceral alem de promover beneficios clinicos em pacientes do sexo masculino com excesso de peso na fase nao dialitica da DRCBV UNIFESP: Teses e dissertaçõe

HOME-BASED VS IN CENTER AEROBIC EXERCISE: IMPACT ON CARDIORESPIRATORY (CR) AND FUNCTIONAL CAPACITIES (FC) OF NONDIALYSIS DEPENDENT OVERWEIGHT CKD PATIENTS

We tested the hypothesis that home-based exercise (HE) was similarly effective to the in center exercise (CE) on CR and FC. This is a randomized controlled study that included 35 sedentary patients (23 men; 53±8.1 years, BMI 30.7±4.2 kg/m2, creatinine clearance 30.9±4.2 mL/min; DM 23%). Patients were randomly assigned to HE (n=11), CE (n=12) or control (CO, n=12) groups. CE and HE underwent to an identical exercise program, three times per week during 12 weeks. The CO group remained without practicing exercise during follow up. The CE patients trained on a treadmill while the HE patients were instructed how to perform the training at home and were monitored by phone once a week. The training resulted in increase 20% and 19% in maximal ventilation (p<0.05), 14.5% and 11% in speed of VO2peak (p<0.01), 25.7% and 17.5% in speed of ventilatory threshold (p<0.01) and 20% and 17.2% in speed of respiratory compensation point (p<0.001) only in CE and HE groups respectively. In the exercise groups, improvement in functional capacity tests such as 2-min step (p<0.01), sit-stand (p<0.001) and arm curl (p<0.001) was observed. Blood pressure decreassed only in the exercise groups (p<0.01), in conclusion HE promoted similarly effective that CE and can be effectively applied for this particular group of patients

IMPACT OF AEROBIC EXERCISE ON VISCERAL FAT OF NONDIALYSIS DEPENDENT OVERWEIGHT CKD PATIENTS: A PILOT STUDY

This is a randomized controlled study that aimed to assess the impact of aerobic exercise on visceral fat of overweight CKD patients. Twenty-six sedentary patients in stages 3–4 of CKD (73% men; 52.3±8.6 years, BMI 30.6±4.3 kg/m2) were included. Patients were assigned to aerobic exercise group (EG; n=13) or control group (CG; n=13). The aerobic training was conducted on a treadmill at the ventilatory threshold three times per week during 12 weeks. The CG patients remained without practicing exercise during follow up. Visceral and subcutaneous fat were assessed by computed tomography, and lean body mass (LBM) by DEXA. At the end of 12 weeks, visceral fat decreased 5% in EG and increased 3% in CG (p=0.02). Waist circumference decreased 1.5% in EG and increased 0.8% in CG (p=0.02). No changes were observed in body weight and subcutaneous fat. LBM tended to increase in EG and decrease in CG (p=0.09). In addition, blood pressure decreased (p<0.01) despite no change in body weight, 24 h urinary sodium and antihypertensive medication. Our results suggest aerobic exercise as an effective approach to reduce visceral fat while maintaining lean body mass in CKD patients

Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease

Home-based exercise has been shown to provide benefits in terms of physical capacity in the general population, but has been scarcely investigated in patients with chronic kidney disease (CKD).To evaluate the impact of a home-based aerobic training on the cardiopulmonary and functional capacities of overweight non-dialysis-dependent patients with CKD (NDD-CKD).Twenty-nine sedentary patients (55.1 +/- A 11.6 years, BMI = 31.2 +/- A 6.1 kg/m(2), eGFR = 26.9 +/- A 17.4 mL/min/1.73 m(2)) were randomly assigned to a home-based exercise group (n = 14) or to a control group (n = 15) that remained without performing exercise. Aerobic training was performed three times per week for 12 weeks. A cardiopulmonary exercise test, functional capacity and clinical parameters were evaluated.A significant increase, ranging from 8.3 to 17 %, was observed in the cardiopulmonary capacity parameters, such as maximal ventilation (p = 0.005), VO2peak (p = 0.049), ventilatory threshold (p = 0.040) and respiratory compensation point (p < 0.001), of the exercise group. A simultaneous improvement in the functional capacity tests [6-min walk test (p < 0.001), time up and go test (p < 0.001), arm curl test (p < 0.001), sit and stand test (p < 0.001), 2-min step test (p < 0.001) and back scratch test (p = 0.042)] was also found in patients who were submitted to the exercise. Exercised patients experienced a decrease in systolic and diastolic blood pressure, average 10.6 % (p < 0.001) and 9.2 % (p = 0.007), respectively, and a trend toward improved renal function (p = 0.1). No change in any parameter was found in the control group during the follow-up.The home-based aerobic exercise program was feasible, safe and effective for the improvement in the cardiopulmonary and functional capacities of overweight NDD-CKD patients.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Oswaldo Ramos FoundationCentro de Estudos em Psicobiologia e Exercicio/Associacao de Fundo e Incentivo a PesquisaUniversidade Federal de São Paulo, Div Nephrol, BR-04039000 São Paulo, BrazilUniversidade Federal de São Paulo, Nutr Program, BR-04039000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, BR-04039000 São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, BR-04039000 São Paulo, BrazilUniversidade Federal de São Paulo, Nutr Program, BR-04039000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, BR-04039000 São Paulo, BrazilFAPESP: 2009/147860Web of Scienc

Effect of Aerobic Exercise on Markers of Bone Metabolism of Overweight and Obese Patients With Chronic Kidney Disease

Objective: The aim of the study was to investigate the effect of aerobic exercise on markers of bone metabolism in overweight and obese nondialysis-dependent patients with chronic kidney disease. Methods: This is a post-hoc study with 39 sedentary patients (55.5 +/- 68.3 years, body mass index 31.2 +/- 64.4 kg/m(2), estimated glomerular filtration rate 26.9 +/- 6 11.7 mL/minute) who were randomly assigned to the aerobic exercise group (n = 24) or the control group (n = 15). The aerobic training (walking) was prescribed according to ventilatory threshold and was performed 3 times per week during 24 weeks. Carboxylated and undercarboxylated osteocalcin (GLA and GLU), sclerostin and tartrate-resistant acid phosphatase isoform 5b (TRAP-5b), parathyroid hormone, total alkaline phosphatase (AP), body composition, cardiorespiratory, and functional capacity tests were measured at baseline and after the follow-up. Results: At baseline, carboxylated osteocalcin (GLA) and undercarboxylated osteocalcin (GLU) were inversely correlated with estimated glomerular filtration rate (r = -0.64r = -0.38, respectively). Both osteocalcin fragments were positively correlated with total AP (GLA: r = 0.36GLU: r = 0.53). An inverse correlation was found between GLA and sclerostin with body fat (r = -0.36r = -0.46, respectively). GLU was negatively correlated with markers of muscle mass (r = -0.34). TRAP-5b and sclerostin were inversely correlated with 6-minute walk test and time up and go test, respectively (r = -0.34r = -0.35, respectively). After 24 weeks, all physical capacity parameters increased in the exercise group (P < .001). Except for total AP that increased after 24 weeks in the exercise group (P < 05), no other changes were observed in both groups in relation to the bone metabolism biomarkers investigated. Conclusion(s): In this post-hoc study, the aerobic training used did not promote relevant changes in the bone metabolism markers investigated. (C) 2017 by the National Kidney Foundation, Inc. All rights reserved.Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Oswaldo Ramos FoundationUniv Fed São Paulo, Nutr Program, São Paulo, BrazilUniv Fed São Paulo, Div Nephrol, Dept Med, São Paulo, BrazilUniv São Paulo, Div Nephrol, Dept Med, São Paulo, BrazilNove de Julho Univ UNINOVE, São Paulo, BrazilUniv Fed São Paulo, Nutr Program, São Paulo, BrazilUniv Fed São Paulo, Div Nephrol, Dept Med, São Paulo, BrazilFAPESP: 2009/14786-0Web of Scienc