Respiratory muscle impairment in dialysis patients: can minimal dose of exercise limit the damage? A Preliminary study in a sample of patients enrolled in the EXCITE trial.
OBJECTIVE
Skeletal muscle atrophy and dysfunction with associated weakness may involve the respiratory muscles of dialysis patients. We evaluated the effect of moderate-intensity exercise on lung function and respiratory muscle strength.


METHODS
Fifty-nine patients (25 F, aged 65 ± 13 years) from two centers participating in the multicenter randomized clinical trial EXerCise Introduction To Enhance Performance in Dialysis (EXCITE) were studied. Subjects were randomized into a prescribed exercise group (E), wherein subjects performed two 10-min walking sessions every second day at an intensity below the self-selected speed, or a control group (C) with usual care. Physical performance was assessed by the 6-min walk test (6MWT). Patient lung function and respiratory muscle strength were evaluated by spirometry and maximal inspiratory pressure (MIP), respectively.


RESULTS
Forty-two patients (14 F) completed the study. At baseline, the groups did not differ in any parameters. In total, 7 patients (4 in E; 3 in C) showed an obstructive pattern. The pulmonary function parameters were significantly correlated with 6MWT but not with any biochemical measurements. Group E safely performed the exercise program. At follow-up, the spirometry parameters did not change in either group. A deterioration of MIP (-7 %; p = 0.008) was observed in group C, but not in group E (+3.3 %, p = ns). In E, an increase of 6MWT was also found (+12 vs. 0 % in C; p = 0.038).


CONCLUSIONS
In dialysis patients, a minimal dose of structured exercise improved physical capacity and maintained a stable respiratory muscle function, in contrast to the control group where it worsened.
Biomedical Sport Studies Centre, University of Ferrara, Ferrara, Italy. pmdlcu@unife.it.|Esercizio Vita ONLUS, Via Don Giovanni Calabria 13, 44124, Ferrara, Italy. pmdlcu@unife.it.
Luca
http://orcid.org/0000-0001-9587-3143
L
Pomidori
Department of Biomedical and Surgical Specialties Sciences, Section of Sport Sciences, University of Ferrara, Ferrara, Italy.
Nicola
N
Lamberti
Biomedical Sport Studies Centre, University of Ferrara, Ferrara, Italy.|Unit of Translational Surgery, Hospital University of Ferrara, Ferrara, Italy.
Anna Maria
AM
Malagoni
Department of Biomedical and Surgical Specialties Sciences, Section of Sport Sciences, University of Ferrara, Ferrara, Italy.
Fabio
F
Manfredini
Biomedical Sport Studies Centre, University of Ferrara, Ferrara, Italy.|Esercizio Vita ONLUS, Via Don Giovanni Calabria 13, 44124, Ferrara, Italy.
Enrico
E
Pozzato
Biomedical Sport Studies Centre, University of Ferrara, Ferrara, Italy.|Esercizio Vita ONLUS, Via Don Giovanni Calabria 13, 44124, Ferrara, Italy.
Michele
M
Felisatti
Nephrology Dialysis Unit, Hospital University of Ferrara, Ferrara, Italy.
Luigi
L
Catizone
Nephrology Dialysis Unit, Hospital University of Ferrara, Ferrara, Italy.
Antonio
A
Barillà
Nephrology Dialysis Unit, Civil Hospital of Imola, Imola, Italy.
Alessandro
A
Zuccalà
CNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, Reggio Calabria, Italy.
Giovanni
G
Tripepi
CNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, Reggio Calabria, Italy.|Nephrology and Renal Transplantation Division, Ospedali Riuniti, Reggio Calabria, Italy.
Francesca
F
Mallamaci
Nephrology and Renal Transplantation Division, Ospedali Riuniti, Reggio Calabria, Italy.
Carmine
C
Zoccali
Biomedical Sport Studies Centre, University of Ferrara, Ferrara, Italy.|Department of Biomedical and Surgical Specialties Sciences, Section of Sport Sciences, University of Ferrara, Ferrara, Italy.
Annalisa
A
Cogo
D000368:Aged; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D005684:Gait; D006304:Health Status; D006801:Humans; D007558:Italy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008168:Lung / Q000503:physiopathology*; D008297:Male; D000072277:Maximal Respiratory Pressures; D008875:Middle Aged; D053580:Muscle Strength; D020127:Recovery of Function; D006435:Renal Dialysis / Q000009:adverse effects; D012132:Respiratory Muscles / Q000503:physiopathology*; D013147:Spirometry; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity; D000070857:Walk Test; D016138:Walking
Chronic kidney disease; Dialysis; Exercise; Muscle weakness; Respiratory function tests