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

慢性肾脏疾病(CKD)是一种复杂的医学状况，影响多达36%的退伍军人 人口。经验证据和坊间证据都表明，疲劳性的升高是一个主要的健康问题 患有慢性肾脏病透析前的退伍军人。慢性肾脏病引起的神经肌肉退化可能会导致 过度疲劳感，影响个人的机能状态。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 与传统的抗力练习相比，偏心力量的产生。FRE已被证明优于 改善健康人肌肉力量、力量和身体功能的传统阻力练习 人群认为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性 拒绝。然而，目前还不清楚在FRE中加入有氧运动是否会带来额外的改善 在不影响神经肌肉和功能益处的情况下，在CKD患者的疲劳抵抗方面。这个 本项目的目的是(1)增进我们对性能疲劳性和感知疲劳性的理解， 以及与CKD阶段3和4级的退伍军人透析前和(2)确定的神经肌肉能力的关系 FRE结合有氧运动训练改善疲劳状态的程度， 慢性肾脏病3期和4期透析前退伍军人的神经肌肉能力和身体功能中环 假设是神经肌肉能力的减少与疲劳性严重程度的增加有关，并且 FRE加有氧运动训练将降低疲劳严重程度，同时增强神经肌肉和 慢性肾脏病3期和4期透析前退伍军人的功能能力为了解决这一假设，我们将 表征性能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级和4级退伍军人透析前的预后和神经肌肉能力 12周的FRE加有氧运动训练对表现和感觉疲劳感的变化， 慢性肾脏病3期和4期透析前退伍军人的神经肌肉能力和身体功能由此得出的结论 项目将提供有价值的信息，促进对性能疲劳性和 CKD 3期和4期退伍军人的疲劳感知及其相互关系。 关于表现的反应性和感知疲劳性、神经肌肉能力和质量的证据 FRE加上有氧运动训练的寿命将会增加。

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.