Objective and subjective measures of fatigability in Veterans with chronic kidney disease before and after flywheel resistance plus aerobic exercise

慢性肾脏病（CKD）是一种复杂的医学疾病，影响多达36%的退伍军人。 人口经验和轶事证据都将疲劳性的升高确定为主要的健康问题 在患有CKD的退伍军人透析前。CKD导致的神经肌肉恶化可能导致 过度疲劳，影响个体的功能状态。飞轮阻力练习（FRE）使用惯性 阻力，以允许通过整个同心肌肉动作的最佳肌肉负荷，并促进更大的 与传统的阻力练习相比，偏心力的产生。FRE已被证明优于上级 传统的阻力练习，以提高肌肉力量，力量和身体功能，在健康 这表明它可能是一种有效的治疗方法，用于解决神经肌肉损伤和功能障碍。 下降然而，目前还不清楚，如果有氧运动，以FRE将提供额外的改善 CKD患者的抗疲劳性，而不影响神经肌肉和功能益处。的 本研究的目的是（1）增进我们对工作疲劳和知觉疲劳的理解， 以及与慢性肾病3期和4期退伍军人透析前神经肌肉能力的相关性，以及（2）确定 FRE加有氧运动训练对改善疲劳状态的程度， 神经肌肉能力和身体功能在患有CKD 3期和4期的退伍军人透析前。中央 假设神经肌肉能力的降低与疲劳严重程度的增加有关， FRE加有氧运动训练将降低疲劳的严重程度，同时增强神经肌肉和 CKD 3期和4期退伍军人透析前的功能能力。为了解决这个问题，我们将 表征表现疲劳性和感知疲劳性，并评估疲劳性之间的关联 慢性肾脏病3期和4期退伍军人透析前的结果和神经肌肉能力，并检查 12-FRE加有氧运动训练周对性能和感知疲劳的变化， 神经肌肉能力和身体功能在患有CKD 3期和4期的退伍军人透析前。时发现的问题 该项目将提供有价值的信息，促进对性能疲劳性的理解， 慢性肾脏病3期和4期退伍军人的感知疲劳及其相互关系。此外，小说 关于表现和感知疲劳、神经肌肉能力和质量反应的证据 FRE加有氧运动训练将获得生命的最大价值。

Chronic kidney disease (CKD) is a complex medical condition affecting as much as 36% of the Veteran population. Both empirical and anecdotal evidence identify elevations in fatigability as a major health concern in Veterans with CKD predialysis. Neuromuscular deteriorations resulting from CKD are likely to contribute to excessive fatigability, impacting an individual’s functional status. Flywheel resistance exercise (FRE) uses inertial resistance to allow for optimal muscle loading through the entire concentric muscle action and promotes greater eccentric force generation compared to traditional resistance exercise. FRE has been shown to be superior to traditional resistance exercise for improving muscle strength, power, and physical function in healthy populations suggesting it may be a useful treatment for addressing neuromuscular impairments and functional decline. However, it is unclear if the addition of aerobic exercise to FRE would provide additive improvements in fatigue resistance in patients with CKD, without compromising neuromuscular and functional benefits. The purpose of this project is to (1) advance our understanding of performance fatigability and perceived fatigability, and the association with neuromuscular capacity in Veterans with CKD stage 3 & 4 predialysis and (2) determine the extent to which combination FRE plus aerobic exercise training can improve fatigability status, neuromuscular capacity, and physical function in Veterans with CKD stage 3 & 4 predialysis. The central hypothesis is that reductions in neuromuscular capacity are associated with increases in fatigability severity, and that FRE plus aerobic exercise training will reduce fatigability severity while enhancing neuromuscular and functional capabilities in Veterans with CKD stage 3 & 4 predialysis. To address this hypothesis, we will characterize performance fatigability and perceived fatigability, and assess the associations between fatigability outcomes and neuromuscular capacity in Veterans with CKD stage 3 & 4 predialysis and examine the effects of 12-weeks of FRE plus aerobic exercise training on changes in performance and perceived fatigability, neuromuscular capacity, and physical function in Veterans with CKD stage 3 & 4 predialysis. Findings from this project will provide valuable information for advancing the understanding of performance fatigability and perceived fatigability, and their inter-relationship, in Veterans with CKD stages 3 and 4. Additionally, novel evidence on the responsiveness of performance and perceived fatigability, neuromuscular capacity, and quality of life to FRE plus aerobic exercise training will be gained.