title: Progressive Resistance Exercise Training in CKD: A Feasibility Study.
abstract: BACKGROUND
  Skeletal muscle wasting in chronic kidney disease (CKD) is associated with morbidity and mortality. Resistance exercise results in muscle hypertrophy in the healthy population, but is underinvestigated in CKD. We aimed to determine the feasibility of delivering a supervised progressive resistance exercise program in CKD, with secondary aims to investigate effects on muscle size, strength, and physical functioning.
  
  
  METHODS
  Parallel randomized controlled feasibility study.
  
  
  METHODS
  Patients with CKD stages 3b to 4 were randomly assigned to the exercise (n=20; 11 men; median age, 63 [IQR, 57-65] years; median estimated glomerular filtration rate, 28.5 [IQR, 19.0-32.0] mL/min/1.73 m(2)) or nonexercise control (n=18; 14 men; median age, 66 [IQR, 45-79] years; estimated glomerular filtration rate, 20.5 [IQR, 16.0-26.0] mL/min/1.73 m(2)) group.
  
  
  METHODS
  Patients in the exercise group undertook an 8-week progressive resistance exercise program consisting of 3 sets of 10 to 12 leg extensions at 70% of estimated 1-repetition maximum thrice weekly. Patients in the control group continued with usual physical activity.
  
  
  RESULTS
  Primary outcomes were related to study feasibility: eligibility, recruitment, retention, and adherence rates. Secondary outcomes were muscle anatomical cross-sectional area, muscle volume, pennation angle, knee extensor strength, and exercise capacity.
  
  
  METHODS
  Two- and 3-dimensional ultrasonography of skeletal muscle, dynamometry, and shuttle walk tests at baseline and 8 weeks.
  
  
  RESULTS
  Of 2,349 patients screened, 403 were identified as eligible and 38 enrolled in the study. 33 (87%) completed the study, and those in the exercise group attended 92% of training sessions. No changes were seen in controls for any parameter. Progressive resistance exercise increased muscle anatomical cross-sectional area, muscle volume, knee extensor strength, and exercise capacity.
  
  
  CONCLUSIONS
  No blinded assessors, magnetic resonance imaging not used to assess muscle mass, lack of a healthy control group.
  
  
  CONCLUSIONS
  This type of exercise is well tolerated by patients with CKD and confers important clinical benefits; however, low recruitment rates suggest that a supervised outpatient-based program is not the most practical implementation strategy.
authors.affiliation: Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom. Electronic address: ec174@le.ac.uk.
authors.forename: Emma L
authors.initials: EL
authors.lastname: Watson
authors.affiliation: Department of Respiratory Medicine, Institute for Lung Health, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Greening
authors.affiliation: School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.
authors.forename: João L
authors.initials: JL
authors.lastname: Viana
authors.affiliation: Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom.
authors.forename: Jaspreet
authors.initials: J
authors.lastname: Aulakh
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester, United Kingdom.
authors.forename: Danielle H
authors.initials: DH
authors.lastname: Bodicoat
authors.affiliation: Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Barratt
authors.affiliation: John Walls Renal Unit, University Hospitals of Leicester Trust, Leicester, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Feehally
authors.affiliation: Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom; John Walls Renal Unit, University Hospitals of Leicester Trust, Leicester, United Kingdom.
authors.forename: Alice C
authors.initials: AC
authors.lastname: Smith
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D053581:Muscle Strength Dynamometer; D009133:Muscular Atrophy / Q000209:etiology / Q000517:prevention & control*; D009929:Organ Size; D052097:Quadriceps Muscle / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000502:physiology*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy*; D055070:Resistance Training / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Chronic kidney disease (CKD); exercise training; feasibility; functional capacity; muscle mass; physical functioning; resistance exercise; skeletal muscle wasting; strength