Anabolic Effect of Exercise Training in People with End-Stage Renal Disease on Hemodialysis: A Systematic Review with Meta-analysis.
OBJECTIVE
The primary purpose of this systematic review was to evaluate the anabolic effect of exercise intervention in adults with end-stage renal disease on hemodialysis (HD). The secondary objectives were to evaluate the influences of participant characteristics and exercise parameters on changes in muscle size.


METHODS
Electronic databases (Cochrane, CINAHL, EMBASE, PEDro, PubMed and SCOPUS) were searched from inception to November 2012. Randomized clinical trials published in English that included adults on HD undergoing an exercise intervention where muscle mass was measured as an outcome were included in this review. Two reviewers independently selected the studies, extracted data, and assessed risk of bias within the included studies. RESULTS were then combined by meta-analysis. The effect of exercises was determined using a standardized mean difference (SMD), expressed as Hedges' g, computed using a random effects model.


RESULTS
Seven SMDs extracted from five studies were included for final analysis. Strength training was used in all studies; one study used aerobic and mixed strength and aerobic training with two subgroups of participants. The overall effect of exercise on muscle mass was statistically significant (SMD: 0.272; 95% CI, 0.020-0.525).


CONCLUSIONS
Our results confirm a small but significant effect of strengthening exercise as an anabolic intervention to increase muscle mass. Exercise training should be included in routine management of people on maintenance HD. Although current results indicate that one in nine people on HD is likely to benefit from exercise intervention, parameters influencing these results require further research.
Graduate Program in Health and Rehabilitation Sciences, Physical Therapy Field, Western University ; University Hospital Campus.
Anuradha
A
Sawant
Western University Division of Nephrology, London Health Sciences Centre.
Andrew A
AA
House
School of Physical Therapy, Western University, London, Ont.
Tom J
TJ
Overend
bioelectrical impedance; computed tomography scan; dual energy x-ray absorptiometry; exercise; hemodialysis; magnetic resonance imaging; skeletal muscle