The functional, metabolic, and anabolic responses to exercise training in renal transplant and hemodialysis patients.
BACKGROUND
Exercise intolerance is common in hemodialysis (HD) and renal transplant (RTx) patients and is related to muscle weakness. Its pathogenesis may vary between these groups leading to a different response to exercise. The aim of the study was to compare intrinsic muscular parameters between HD and RTx patients and controls, and to assess the response to exercise training on exercise capacity and muscular structure and function in these groups.


METHODS
Quadriceps function (isokinetic dynamometry), body composition (dual-energy x-ray absorptiometry), and vastus lateralis muscle biopsies were analyzed before and after a 12-week lasting training-program in 35 RTx patients, 16 HD patients, and 21 healthy controls.


RESULTS
At baseline, myosin heavy chain (MyHC) isoform composition and enzyme activities were not different between the groups. VO2peak and muscle strength improved significantly and comparably over the training-period in RTx, HD patients and controls (p(time)<0.05). The proportion of MyHC type I isoforms decreased (p(time)<0.001) and type IIa MyHC isoforms increased (p(time)<0.05). The 3-hydroxyacyl-CoA-dehydrogenase activity increased (p(time)=0.052). Intrinsic muscular changes were not significantly different between groups. In the HD group, changes in lean body mass were significantly related to changes in muscle insulin-like growth factor (IGF)-II and IGF binding protein-3.


CONCLUSIONS
Abnormalities in metabolic enzyme activities or muscle fiber redistribution do not appear to be involved in muscle dysfunction in RTx and HD patients. Exercise training has comparable beneficial effects on functional and intrinsic muscular parameters in RTx patients, HD patients, and controls. In HD patients, the anabolic response to exercise training is related to changes in the muscle IGF system.
van den Ham
Eugénie C H
EC
Department of Internal Medicine, University Hospital Maastricht, Maastricht, the Netherlands. evha@groupwise.azm.nl
Kooman
Jeroen P
JP
Schols
Annemie M W J
AM
Nieman
Fred H M
FH
Does
Joan D
JD
Akkermans
Marco A
MA
Janssen
Paul P
PP
Gosker
Harry R
HR
Ward
Kimberly A
KA
MacDonald
Jamie H
JH
Christiaans
Maarten H L
MH
Leunissen
Karel M L
KM
van Hooff
Johannes P
JP
D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D007668:Kidney / Q000378:metabolism*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000378:metabolism; D006435:Renal Dialysis