title: The effect of resistance exercise to augment long-term benefits of intradialytic oral nutritional supplementation in chronic hemodialysis patients.
abstract: BACKGROUND
  Resistance exercise combined with intradialytic oral nutrition (IDON) supplementation improves net protein balance in the acute setting in chronic hemodialysis patients. We hypothesized that combination of long-term resistance exercise and IDON would improve markers of muscle mass and strength further compared with IDON alone.
  
  
  METHODS
  Thirty-two participants (21 male; mean age, 43 ± 13 years) on chronic hemodialysis were randomly assigned to IDON plus resistance exercise (NS + EX), or IDON (NS) alone for 6 months. IDON consisted of a lactose-free formula consisting of protein, carbohydrate, and fat. Three sets of 12 repetitions of leg-press were completed before each dialysis session in the NS + EX arm. Primary outcome measurement was lean body mass. Muscle strength and other nutritional parameters were measured as secondary outcomes.
  
  
  RESULTS
  Of 32 participants, 22 completed the 6-month intervention. There were no statistically significant differences between the study interventions with respect to changes in lean body mass and body weight, when comparing NS + EX to NS. There were also no statistically significant differences in any of the secondary outcomes measured in the study. Body weight (80.3 ± 16.6 kg, 81.1 ± 17.5 kg, and 80.9 ± 18.2 kg at baseline, month 3, and month 6, respectively; P = .02) and 1-repetition maximum (468 ± 148 lb, 535 ± 144 lb, and 552 ± 142 lb, respectively; P = .001) increased statistically significantly during the study for all patients combined.
  
  
  CONCLUSIONS
  This study did not show further benefits of additional resistance exercise on long-term somatic protein accretion above and beyond nutritional supplementation alone. When both treatments groups were combined, body weight and muscle strength improved during the study.
authors.affiliation: Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2372, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Dong
authors.forename: Mary B
authors.initials: MB
authors.lastname: Sundell
authors.forename: Lara B
authors.initials: LB
authors.lastname: Pupim
authors.forename: Pingsheng
authors.initials: P
authors.lastname: Wu
authors.forename: Ayumi
authors.initials: A
authors.lastname: Shintani
authors.forename: T Alp
authors.initials: TA
authors.lastname: Ikizler
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001823:Body Composition; D019587:Dietary Supplements; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D011446:Prospective Studies; D011506:Proteins / Q000378:metabolism; D006435:Renal Dialysis / Q000379:methods; D055070:Resistance Training
chemical_list: D011506:Proteins