Randomized controlled trial of intradialytic resistance training to target muscle wasting in ESRD: The progressive exercise for anabolism in kidney disease (PEAK) study
Randomized controlled trial of intradialytic resistance training to target muscle wasting in ESRD: The progressive exercise for anabolism in kidney disease (PEAK) study
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DOI：
10.1053/j.ajkd.2007.07.005
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发表时间：
2007-10-01
影响因子：
13.2
通讯作者：
Singh, Maria Fiatarone
中科院分区：
文献类型：
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作者：
Cheema, Bobby;Abas, Haifa;Singh, Maria Fiatarone
背景：为了确定对于终末期肾病患者，长期（24 周）透析中渐进阻力训练 (PRT) 是否比短期训练（12 周）更有效地抵消肌肉萎缩。研究设计：随机对照试验。背景和参与者：49 名患者（年龄，62.6 +/- 14.2 岁；接受血液透析治疗 0.3 至 16.7 年）被随机分配至 PRT 加常规护理，为期 24 次周（24 周组）或交叉对照组，前 12 周接受常规护理，然后在后 12 周接受 PRT 加常规护理（1 2 周组）。干预：在每周三次的常规血液透析治疗期间，在直接监督下进行两组 10 次高强度自由重量 PRT 锻炼。结果和测量：主要结果包括通过计算机断层扫描测量的大腿肌肉横截面积和通过衰减。次要结局包括肌肉力量、运动能力和 C 反应蛋白水平。 结果：24WK 组肌肉横截面积增加 (+1.82 +/- 3.25 cm(2))，而 12WK 组肌肉横截面积减少 (- 1.37 +/- 6.87 cm(2))；相对效应大小，0.59；95% 置信区间 [Cl]，-0.27 至 6.65；P = 0.04）。然而，在对多项主要结果进行 Bonferroni 校正后，该结果并未达到所需的统计显着性水平 (P < 0.025)。组间肌内脂质含量没有显着变化（24WK 和 12WK 组分别为 +0.19 +/- 1.32 与 +0.16 +/- 1.69 Hounsfield 单位；P = 0.31）。与 12WK 组相比，24WK 组的 Log C 反应蛋白水平呈下降趋势（相对效应大小，-0.63；95% Cl，-0.27 [-0.54 至 0.00]；P= 0.05）。 24WK 组在整个试验过程中改善了肌肉力量测量和运动能力。 局限性：使用单一地理位置；没有没有运动暴露的对照组；对一些次要结果指标的公正评估。结论：与较短持续时间的运动相比，延长透析内 PRT 并未显着改善肌肉横截面积或肌内脂质含量。未来的试验需要更彻底地研究该队列中肌源性适应 PRT 的临床重要性和程度。
Background: To determine whether prolonged (24 weeks) intradialytic progressive resistance training (PRT) could counteract muscle wasting more effectively than short-duration training (12 weeks) in patients with end-stage renal disease.Study Design: Randomized controlled trial.Setting & Participants: 49 patients (age, 62.6 +/- 14.2 years; 0.3 to 16.7 years on hemodialysis therapy) were randomly assigned to PRT plus usual care for 24 weeks (24WK group) or a crossover control group that received usual care for the first 12 weeks, then PRT plus usual care for the latter 12 weeks (1 2WK group).Intervention: Two sets of 10 free-weight PRT exercises were performed at a high intensity during routine thrice-weekly hemodialysis treatment under direct supervision.Outcomes & Measurements: Primary outcomes include thigh muscle cross-sectional area by means of computed tomography and intramuscular lipid content estimated through attenuation. Secondary outcomes include muscular strength, exercise capacity, and C-reactive protein level.Results: The 24WK group increased muscle cross-sectional area (+1.82 +/- 3.25 cm(2)) compared with losses in the 12WK group (- 1.37 +/- 6.87 cm(2); relative effect size, 0.59; 95% confidence interval [Cl], -0.27 to 6.65; P = 0.04). However, this outcome did not achieve the level of statistical significance required (P 0.025) after Bonferroni correction for multiple primary outcomes. There was no significant change in intramuscular lipid content between groups (+0.19 +/- 1.32 versus +0.16 +/- 1.69 Hounsfield units in the 24WK and 12WK groups, respectively; P = 0.31). Log C-reactive protein level tended to decrease in the 24WK group compared with the 12WK group (relative effect size, -0.63; 95% Cl, -0.27 [-0.54 to 0.00]; P= 0.05). The 24WK group improved muscular strength measures and exercise capacity throughout the trial.Limitations: Single geographic site used; no control group without exercise exposure; unblincled assessment of some secondary outcome measures.Conclusions: Prolonged intradialytic PRT did not significantly improve muscle cross-sectional area or intramuscular lipid content compared with a shorter duration of exercise. Future trials are required to more thoroughly investigate the clinical importance and magnitude of myogenic adaptations to PRT in this cohort.