Charles Milch

Exercise training improves HR responses and V˙O2peak in predialysis kidney patients.

PURPOSE The current pilot and feasibility study was designed to examine the effect of 48 wk of moderate-intensity exercise training and dietary modification on kidney function and vascular parameters in chronic kidney disease (CKD) patients. METHODS Twenty-one stage 2-4 CKD patients (age, 18-70 yr) were randomly assigned to either the training group (TG, n = 10) or the usual care group (n = 11) for 48 wk. The TG received 48 wk of personal training (3 d·wk for up to 55 min per session at 50%-60% V˙O2peak) and dietary counseling, whereas individuals in the usual care group received standard of care and were instructed not to start a structured exercise program while in the study. V˙O2peak, estimated glomerular filtration rate (eGFR), resting and ambulatory HR, plasma lipids (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides), and inflammatory markers (high-sensitivity C-reactive protein and interleukin 6) were assessed at baseline and weeks 24 and 48. An independent groups t-test was used to compare glomerular filtration rate slopes between groups, whereas all other data were analyzed with ANCOVA using the baseline value as the covariate. RESULTS There were no statistically significant differences in any of the parameters at baseline. The 48-wk intervention led to a significant increase in V˙O2peak, reductions in both resting and ambulatory HR, and increases in LDL cholesterol and in TG, but it had no effect on the rate of change of eGFR over time. CONCLUSIONS A 48-wk exercise training program, primarily focused on aerobic exercise, increases V˙O2peak and favorably alters autonomic function as evidenced by reductions in HR in stages 2-4 CKD patients. The exercise intervention had no effect on kidney function as assessed by eGFR.

Lack of circulating bioactive and immunoreactive IGF-I changes despite improved fitness in chronic kidney disease patients following 48 weeks of physical training

OBJECTIVE As known abnormalities exist in the insulin-like growth factor (IGF) system in chronic kidney disease (CKD) patients, the measurement of bioactive IGF-I may provide further insight into the therapeutic potential of long-term exercise training. DESIGN Patients (N=21) with stages 3 and 4 CKD were recruited from a local nephrology practice in Springfield, MA and randomized into matched treatment and control groups. The treatment group participated in 48 weeks of supervised, progressive exercise training and dietary counseling, while the control group received only usual care. Treadmill testing, anthropometric measurements, and blood samples for analysis of immunoreactive IGF-I, IGF-II, IGFBP-1 and -2, and bioactive IGF-I were taken at baseline, 24 weeks, and 48 weeks. RESULTS There were no significant differences in any of the components of the IGF system (all p-values>0.05). Immunoreactive IGF-I levels correlated significantly with bioactive IGF-I at baseline (r=0.50, p=0.02) and at 48 weeks (r=0.64, p=0.01). There was a significant interaction between group and time for both VO(2peak) (p=0.03) and total treadmill time (TT) (p<0.01). CONCLUSIONS Despite improvements in physical performance, a 48-week training program did not affect any of the circulating IGF system measurements. Disparities between these findings and those of other researchers reporting a biphasic response to long-term training may be explained by differences in study groups and exercise programs.

Immediate blood pressure-lowering effects of aerobic exercise among patients with chronic kidney disease

Aim:  The current study was designed to determine the effect of moderate‐intensity aerobic exercise on blood pressure responses within the laboratory for 60 min post exercise and in the subsequent 24 h period in patients with chronic kidney disease.

Preservation of Fat-Free Mass After Two Distinct Weight Loss Diets with and without Progressive Resistance Exercise

BACKGROUND Preserving fat-free mass (FFM) during weight loss is important in older adults. The purpose was to examine a low-fat diet (LFD) versus a carbohydrate-restricted diet (CRD) with and without progressive resistance exercise (PRE) on preservation of FFM in older men with metabolic syndrome. METHODS A total of 42 men (59±7 years) were matched [body mass index (BMI)] and randomized to LFD, LFD&PRE, CRD, and CRD&PRE. PRE groups performed supervised strength training three times per week. Body weight, composition, metabolic syndrome criteria, and strength were measured at baseline and week 12. A 3-day diet record was kept at baseline and at weeks 1, 6, and 12. RESULTS Attrition (24%) was similar between groups. Depicted as % carbohydrate:fat:protein, the intervention diet was: LFD=55:24:18, LFD&PRE=57:20:20, CRD=16:54:28, and CRD&PRE=12:56:31. Weight (lb) decreased similarly in all groups (LFD, -18.0±7.4; LFD&PRE, -19.8±12.8; CRD, -20.2±8.0; CRD&PRE, -22.7±6.0; P<0.001), and number of participants with metabolic syndrome decreased in all groups (-3, -6, -3, -4, respectively). Percent of weight loss from appendicular FFM was 27.5%, 15.9%, 15.7%, and 17.3% respectively. A trend was found when comparing LFD and LFD&PRE (P=0.068), and when comparing LFD&CRD (P=0.072). Triglycerides improved more for the LFD&PRE, CRD, and CRD&PRE groups compared to the LFD group (P<0.05). Improvements in high-density lipoprotein-cholesterol were better in the CRD&PRE group (4.1±5.1 mg/dL) versus the LFD group (-5.0±5.9 mg/dL; P<0.01). CONCLUSIONS LFD&PRE, CRD, and CRD&PRE preserve FFM similarly. PRE is an important component of a LFD during weight loss in this population.

Blood pressure response to acute and chronic exercise in chronic kidney disease

The current study was designed to determine if a relationship exists between acute and chronic blood pressure responses to aerobic exercise in pre‐dialysis patients.

Metabolic Effects of Diet and Exercise in Patients with Moderate to Severe CKD: A Randomized Clinical Trial

CKD is steadily increasing along with obesity worldwide. Furthermore, obesity is a proinflammatory risk factor for progression of CKD and cardiovascular disease. We tested the hypothesis that implementation of caloric restriction and aerobic exercise is feasible and can improve the proinflammatory metabolic milieu in patients with moderate to severe CKD through a pilot, randomized, 2×2 factorial design trial. Of 122 participants consented, 111 were randomized to receive caloric restriction and aerobic exercise, caloric restriction alone, aerobic exercise alone, or usual care. Of those randomized, 42% were women, 25% were diabetic, and 91% were hypertensive; 104 started intervention, and 92 completed the 4-month study. Primary outcomes were a change from baseline in absolute fat mass, body weight, plasma F2-isoprostane concentrations, and peak oxygen uptake (VO2 peak). Compared with usual care, the combined intervention led to statistically significant decreases in body weight and body fat percentage. Caloric restriction alone also led to significant decreases in these measures, but aerobic exercise alone did not. The combined intervention and each independent intervention also led to significant decreases in F2-isoprostane and IL-6 concentrations. No intervention produced significant changes in VO2 peak, kidney function, or urine albumin-to-creatinine ratio. In conclusion, 4-month dietary calorie restriction and aerobic exercise had significant, albeit clinically modest, benefits on body weight, fat mass, and markers of oxidative stress and inflammatory response in patients with moderate to severe CKD. These results suggest healthy lifestyle interventions as a nonpharmacologic strategy to improve markers of metabolic health in these patients.

High-density lipoprotein particle pattern and overall lipid responses to a short-term moderate-intensity aerobic exercise training intervention in patients with chronic kidney disease

Abstract Background Chronic kidney disease (CKD) is associated with abnormal lipid profiles and altered high-density lipoprotein (HDL) particle size patterns. Lower levels of the larger, cardioprotective HDL particles found in CKD may play a role in the increased risk for cardiovascular disease in these patients. The current study was designed to assess the effects of short-term moderate-intensity aerobic exercise training on the HDL particle pattern and overall lipid profiles in stage 3 CKD patients. Methods Forty-six men and women with stage 3 CKD were randomized to either exercise (EX, n = 25) or control (CON, n = 21). Those in the EX group completed 16 weeks of supervised moderate-intensity aerobic exercise three times per week. Serum total cholesterol, HDL cholesterol (HDL-C), triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C), HDL particle size, estimated glomerular filtration rate (eGFR), body composition and peak oxygen uptake (VO2peak) were assessed at baseline and week 16. Results The rate of compliance in the EX group was 97 ± 7.2%. No change was observed in eGFR over time in either group. There was an 8.2% improvement in VO2peak in the EX group (P = 0.05), while VO2peak decreased in the CON group. HDL-C, TGs, HDL particle size and body composition remained unchanged in both groups. A trend was found for lower total cholesterol (TC) (P = 0.051) and LDL-C (P = 0.07) in the CON group. Conclusion Our findings indicate that a short-term aerobic exercise training intervention in stage 3 CKD patients does not induce changes in HDL particle size or favorable lipid profile modifications.