title: The effectiveness of aerobic and muscle strength training in patients receiving hemodialysis and EPO: a randomized controlled trial.
abstract: BACKGROUND
  Individuals with end-stage renal disease on hemodialysis therapy have reduced aerobic exercise capacity and reduced muscle strength.
  
  
  METHODS
  This was a single-blind, randomized, placebo-controlled trial of an exercise intervention in hemodialysis patients administered erythropoietin. The intervention consisted of progressive resisted isotonic quadriceps and hamstrings exercise and training on a cycle ergometer three times weekly for 12 weeks. Individuals in the control group underwent a nonprogressive program of range-of-motion exercises. Both groups were observed for an additional 5 months without intervention. Outcomes were assessed without knowledge of treatment assignment at baseline, 12 weeks, and 5 months. A healthy age- and sex-matched sample provided comparative data.
  
  
  RESULTS
  Our sample was relatively high functioning, with a mean score on the Physical Function subscale of the Short Form 36 (SF-36) of 76 of 100. At 12 weeks, there were large and statistically significant differences in favor of the experimental group on the submaximal exercise test (14 W; 95% confidence interval, 2 to 26) and muscle strength (45 lb; 95% confidence interval, 9 to 81), but not in the 6-minute walk, symptoms questionnaire, or SF-36. Differences between the intervention and control groups at 12 weeks were not evident on retesting 5 months after the end of the intervention. Compared with the healthy sample, patients were significantly lower functioning on the submaximal exercise test, muscle strength, and 6-minute walk test at baseline.
  
  
  CONCLUSIONS
  In this high-functioning sample, the exercise program improved physical impairment measures, but had no effect on symptoms or health-related quality of life. The impact on patients with a greater degree of physical dysfunction needs to be rigorously studied.
authors.affiliation: Physiotherapy Department, St Joseph's Healthcare and McMaster University, Hamilton, Ontario, Canada. depaulv@mcmaster.ca
authors.forename: Vince
authors.initials: V
authors.lastname: DePaul
authors.forename: Julie
authors.initials: J
authors.lastname: Moreland
authors.forename: Tom
authors.initials: T
authors.lastname: Eager
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Clase
mesh_terms: D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D004334:Drug Administration Schedule; D004921:Erythropoietin / Q000008:administration & dosage / Q000627:therapeutic use*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods; D005081:Exercise Therapy / Q000379:methods*; D006306:Health Surveys; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014891:Weight Lifting / Q000502:physiology*
chemical_list: D004921:Erythropoietin