37 research outputs found
Exercise in haemodialysis patients: impact on markers of inflammation
End-stage renal disease patients have a greatly increased risk of cardiovascular disease
partly attributed to the elevated levels of systemic inflammation observed in uraemia.
One of the key mechanisms underlying inflammation appears to be the immune
dysfunction that afflicts almost every aspect of the uraemic immune system. As a
consequence patients experience immunosuppression and reduced responsiveness to
antigen as well as a simultaneous over-activation leading to a pro-inflammatory
environment. In addition, the haemodialysis (HD) treatment itself induces a proinflammatory
response but may provide an otherwise opportune time to complete
supervised exercise. [Continues.
The impact of exercising during haemodialysis on blood pressure, markers of cardiac injury and systemic inflammation - preliminary results of a pilot study
Background/Aims: Patients requiring haemodialysis have cardiovascular and immune
dysfunction. Little is known about the acute effects of exercise during haemodialysis. Exercise
has numerous health benefits but in other populations has a profound impact upon blood
pressure, inflammation and immune function; therefore having the potential to exacerbate
cardiovascular and immune dysfunction in this vulnerable population. Methods: Fifteen
patients took part in a randomised-crossover study investigating the effect of a 30-min
bout of exercise during haemodialysis compared to resting haemodialysis. We assessed
blood pressure, plasma markers of cardiac injury and systemic inflammation and neutrophil
degranulation. Results: Exercise increased blood pressure immediately post-exercise; however,
1 hour after exercise blood pressure was lower than resting levels (106±22 vs. 117±25 mm
Hg). No differences in h-FABP, cTnI, myoglobin or CKMB were observed between trial arms.
Exercise did not alter circulating concentrations of IL-6, TNF-α or IL-1ra nor clearly suppress
neutrophil function. Conclusions: This study demonstrates fluctuations in blood pressure
during haemodialysis in response to exercise. However, since the fall in blood pressure
occurred without evidence of cardiac injury, we regard it as a normal response to exercise
superimposed onto the haemodynamic response to haemodialysis. Importantly, exercise did
not exacerbate systemic inflammation or immune dysfunction; intradialytic exercise was well
tolerated
An increase in circulating monocyte and platelet derived microparticles during haemodialysis
An increase in circulating monocyte and platelet derived microparticles during haemodialysi
Regular exercise during haemodialysis promotes an anti-inflammatory leucocyte profile
Background
Cardiovascular disease (CVD) is the most common cause of mortality in haemodialysis (HD) patients and is highly predicted by markers of chronic inflammation. Regular exercise may have beneficial anti-inflammatory effects, but this is unclear in HD patients. This study assessed the effect of regular intradialytic exercise on soluble inflammatory factors and inflammatory leukocyte phenotypes.
Methods
Twenty-two HD patients from a centre where intradialytic cycling was offered thrice-weekly and 16 HD patients receiving usual care volunteered. Exercising patients aimed to cycle for 30 min at RPE of “somewhat hard”. Baseline characteristic were compared with 16 healthy age-matched individuals. Physical function, soluble inflammatory markers and leukocyte phenotypes were assessed again after 6 months of regular exercise.
Results
Patients were less active than their healthy counterparts and had significant elevations in
measures of inflammation (IL-6, CRP, TNF-α, intermediate and non-classical monocytes; all
P<0.001). Six months of regular intradialytic exercise improved physical function (sit-to-stand 60). After 6 months the proportion of intermediate monocytes in the exercising patients reduced compared to non-exercisers (7.58±1.68 to 6.38±1.81% vs. 6.86±1.45 to 7.88±1.66%; P<0.01). Numbers (but not proportion) of regulatory T cells decreased in the non-exercising patients only (P<0.05). Training had no significant effect on circulating IL-6, CRP or TNF-α concentrations.
Conclusions
These findings suggest regular intradialytic exercise is associated with an anti-inflammatory effect at a circulating cellular level but not in circulating cytokines. This may be protective against the increased risk of CVD and mortality that is associated with chronic inflammation and elevated numbers of intermediate monocytes
Implementing a theory-based intradialytic exercise programme in practice: a quality improvement project
Background Research evidence outlines the benefits of intradialytic exercise (IDE), yet implementation into practice has been slow, ostensibly due to lack of patient and staff engagement. The aim of this quality improvement project was to improve patient outcomes via the introduction of an IDE programme; evaluate patient uptake, sustainability and enhance the engagement of routine haemodialysis (HD) staff with the delivery of the IDE programme. Methods We developed and refined an IDE programme, including interventions designed to increase
patient and staff engagement that were based upon the Theoretical Domains Framework, using a series of ‘Plan, Do, Study, Act’ cycles. The programme was introduced at two UK NHS HD units. Process measures included patient uptake, withdrawals, adherence and HD staff involvement. Outcomes measures were patient-reported functional capacity, anxiety, depression and symptomology. All measures were collected over 12 months. Results 95 patients enrolled in the IDE programme. 64 (75%) were still participating at three months, dropping to 41 (48%) at 12 months. Adherence was high (78%) at three months, dropping to 63% by 12 months. Provision of IDE by HD staff accounted for a mean of 2 (5%) sessions per three-month time point. Patients displayed significant improvements in functional ability (p=0.01), and reduction in depression (p=0.02) over 12 months, but effects seen were limited to those who completed the programme. Conclusions A theory-based IDE programme is feasible and leads to improvement in functional capacity and depression. Sustaining IDE over time is marred by high levels of patient withdrawal from the programme. Significant change at an organisational level is required to enhance
sustainability by increasing HD staff engagement or access to exercise professional support
Inflammatory factors and exercise in chronic kidney disease.
Patients with chronic kidney disease frequently present with chronic elevations in markers of inflammation, a condition that appears to be exacerbated by disease progression and onset of haemodialysis. Systemic inflammation is interlinked with malnutrition and muscle protein wasting and is implicated in a number of morbidities including cardiovascular disease: the most common cause of mortality in this population. Research in the general population and other chronic disease cohorts suggests that an increase in habitual activity levels over a prolonged period may help redress basal increases in systemic inflammation. Furthermore, those populations with the highest baseline levels of systemic inflammation appear to have the greatest improvements from training. On the whole, the activity levels of the chronic kidney disease population reflect a sedentary lifestyle, indicating the potential for increasing physical activity and observing health benefits. This review explores the current literature investigating exercise and inflammatory factors in the chronic kidney disease population and then attempts to explain the contradictory findings and suggests where future research is required