title: Combining intra-dialytic exercise and nutritional supplementation in malnourished older haemodialysis patients: Towards better quality of life and autonomy.
abstract: Protein-energy wasting (PEW), defined as a loss of body protein mass and fuel reserves, is a powerful predictor of adverse outcomes in haemodialysis (HD) patients. Robust arguments suggest that intra-dialytic exercise, combined with oral/parenteral nutrition, enhances the effect of nutritional interventions in HD patients. This pilot randomized controlled trial investigated the feasibility and the effects of a 6 month intra-dialytic cycling program combined to a nutritional support on PEW, physical functioning (gait, balance, muscle strength) and quality of life (QoL) in older HD patients (mean age 69.7 ± 14.2 years).Twenty-one patients fulfilling diagnostic criteria of PEW were randomly assigned to Nutrition-Exercise group (GN-Ex , n = 10) or Nutrition group (GN , n = 11). Both groups received nutritional supplements in order to reach recommended protein and energy intake goals. In addition GN-Ex completed a cycling program. No significant difference between groups was found in the number of patients having reached remission of PEW. Likewise, no change was observed in serum-albumin, -prealbumin, C-reactive protein, body mass index, lean- and fat-tissue index, or quadriceps force. Interestingly, we found positive effects of exercise on physical function and QoL for the GN-Ex , as evidenced by a significant improvement in the 6-min walk test (+22%), the absence of decline in balance (unlike the GN ), and a noteworthy increase in QoL (+53%). Combining intra-dialytic exercise and nutrition in HD patients is feasible, and well accepted, improves physical function and QoL but it appears not to have the potential to reverse PEW.
authors.affiliation: Dialysis Unit Laënnec, ECHO Association, Nantes, France.
authors.forename: Dan
authors.initials: D
authors.lastname: Hristea
authors.affiliation: Laboratory MIP (UPRES-EA4334), University of Nantes, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Deschamps
authors.affiliation: Dialysis Unit Laënnec, ECHO Association, Nantes, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Paris
authors.affiliation: Dialysis Unit Confluent, ECHO Association, Nantes, France.
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Lefrançois
authors.affiliation: Biometrics, CHU Nantes, Nantes, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Collet
authors.affiliation: Dialysis Unit Laënnec, ECHO Association, Nantes, France.
authors.forename: Corneliu
authors.initials: C
authors.lastname: Savoiu
authors.affiliation: Dialysis Unit Laënnec, ECHO Association, Nantes, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Ozenne
authors.affiliation: Dialysis Unit Confluent, ECHO Association, Nantes, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Coupel
authors.affiliation: Dialysis Unit Confluent, ECHO Association, Nantes, France.
authors.forename: Angelo
authors.initials: A
authors.lastname: Testa
authors.affiliation: Laboratory MIP (UPRES-EA4334), University of Nantes, France.
authors.forename: Justine
authors.initials: J
authors.lastname: Magnard
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001642:Bicycling; D001823:Body Composition; D004750:Enteral Nutrition; D005081:Exercise Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005602:France; D005684:Gait; D015577:Geriatric Assessment; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods*; D010288:Parenteral Nutrition; D026684:Personal Autonomy; D010865:Pilot Projects; D004856:Postural Balance; D011502:Protein-Energy Malnutrition / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D020127:Recovery of Function; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: aging; intra-dialytic exercise; nutrition; protein energy wasting; quality of life