title: Aerobic or Resistance Training and Pulse Wave Velocity in Kidney Transplant Recipients: A 12-Week Pilot Randomized Controlled Trial (the Exercise in Renal Transplant [ExeRT] Trial).
abstract: BACKGROUND
  Cardiovascular disease remains the leading cause of death in kidney transplant recipients. This pilot study examined the potential effect of aerobic training or resistance training on vascular health and indexes of cardiovascular risk in kidney transplant recipients.
  
  
  METHODS
  Single-blind, randomized, controlled, parallel trial.
  
  
  METHODS
  60 participants (mean age, 54 years; 34 men) were randomly assigned to aerobic training (n=20), resistance training (n=20), or usual care (n=20). Participants were included if they had a kidney transplant within 12 months prior to baseline assessment. Patients were excluded if they had unstable medical conditions or had recently started regular exercise.
  
  
  METHODS
  Aerobic training and resistance training were delivered 3 days per week for a 12-week period. The usual-care group received standard care.
  
  
  METHODS
  Pulse wave velocity, peak oxygen uptake (Vo2peak), sit-to-stand 60, isometric quadriceps force, and inflammatory biomarkers were assessed at 0 and 12 weeks.
  
  
  RESULTS
  The anticipated 60 participants were recruited within 12 months. 46 participants completed the study (aerobic training, n=13; resistance training, n=13; and usual care, n=20), resulting in a 23% attrition rate. Analyses of covariance, adjusted for baseline values, age, and dialysis vintage pretransplantation, revealed significant mean differences between aerobic training and usual care in pulse wave velocity of -2.2±0.4 (95% CI, -3.1 to -1.3) m/s (P<0.001) and between resistance training and usual care of -2.6±0.4 (95% CI, -3.4 to -1.7) m/s (P<0.001) at 12 weeks. Secondary analyses indicated significant improvements in Vo2peak in the aerobic training group and in Vo2peak, sit-to-stand 60, and isometric muscle force in the resistance training group compared with usual care at 12 weeks. There were no reported adverse events, cardiovascular events, or hospitalizations as a result of the intervention.
  
  
  CONCLUSIONS
  Pilot study, small sample size, no measure of endothelial function.
  
  
  CONCLUSIONS
  Both aerobic training and resistance training interventions appear to be feasible and clinically beneficial in this patient population.
authors.affiliation: Department of Renal Medicine, London, United Kingdom; Department of Physiotherapy, King's College Hospital, London, United Kingdom. Electronic address: sharlene.greenwood@nhs.net.
authors.forename: Sharlene A
authors.initials: SA
authors.lastname: Greenwood
authors.affiliation: School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom.
authors.forename: Pelagia
authors.initials: P
authors.lastname: Koufaki
authors.affiliation: School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mercer
authors.affiliation: School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Rush
authors.affiliation: Department of Renal Medicine, London, United Kingdom; Department of Physiotherapy, King's College Hospital, London, United Kingdom.
authors.forename: Ellen
authors.initials: E
authors.lastname: O'Connor
authors.affiliation: Department of Renal Medicine, London, United Kingdom; Department of Physiotherapy, King's College Hospital, London, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Tuffnell
authors.affiliation: Department of Physiotherapy, King's College Hospital, London, United Kingdom.
authors.forename: Herolin
authors.initials: H
authors.lastname: Lindup
authors.affiliation: Department of Physiotherapy, King's College Hospital, London, United Kingdom.
authors.forename: Lynda
authors.initials: L
authors.lastname: Haggis
authors.affiliation: Department of Clinical Biochemistry, King's College Hospital, London, United Kingdom.
authors.forename: Tracy
authors.initials: T
authors.lastname: Dew
authors.affiliation: Department of Renal Medicine, Guy's and St Thomas' Hospital, London, United Kingdom.
authors.forename: Lyndsey
authors.initials: L
authors.lastname: Abdulnassir
authors.affiliation: Department of Renal Medicine, Guy's and St Thomas' Hospital, London, United Kingdom.
authors.forename: Eilish
authors.initials: E
authors.lastname: Nugent
authors.affiliation: Department of Renal Medicine, Guy's and St Thomas' Hospital, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Goldsmith
authors.affiliation: Department of Renal Medicine, London, United Kingdom.
authors.forename: Iain C
authors.initials: IC
authors.lastname: Macdougall
mesh_terms: D000328:Adult; D015444:Exercise / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D053580:Muscle Strength / Q000502:physiology; D010809:Physical Fitness / Q000502:physiology; D010865:Pilot Projects; D011182:Postoperative Care / Q000379:methods; D063177:Pulse Wave Analysis; D055070:Resistance Training / Q000379:methods*; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome
keywords: Exercise therapy; aerobic training; arterial stiffness; cardiovascular risk; chronic kidney disease (CKD); kidney transplantation; pulse-wave velocity (PWV); randomized controlled trial (RCT); rehabilitation; renal transplant recipient; resistance training; vascular health