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. 2014 Winter;66(1):44-53.
doi: 10.3138/ptc.2012-59.

Anabolic Effect of Exercise Training in People with End-Stage Renal Disease on Hemodialysis: A Systematic Review with Meta-analysis

Anuradha Sawant  1 , Andrew A House  2 , Tom J Overend  3
Affiliations

Anabolic Effect of Exercise Training in People with End-Stage Renal Disease on Hemodialysis: A Systematic Review with Meta-analysis

Anuradha Sawant et al. Physiother Can. 2014 Winter.

Abstract
in English, French

Purpose: 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.

Objectif : Cette critique systématique visait principalement à évaluer l'effet anabolique de l'exercice chez des adultes vivant avec une insuffisance rénale chronique au stade ultime et suivant des traitements d'hémodialyse (HD). Les objectifs secondaires consistaient à évaluer l'influence des caractéristiques des participants et des paramètres de l'exercice sur les changements de la taille des muscles. Méthodes : On a effectué des recherches dans des bases de données électroniques (Cochrane, CINAHL, EMBASE, PEDro, PubMed et SCOPUS) depuis leur création jusqu'en novembre 2012. On a inclus des essais cliniques randomisés publiés en anglais et portant sur des adultes en HD suivant un programme d'exercice au cours duquel on a mesuré la masse musculaire comme résultat. Deux examinateurs agissant indépendamment ont choisi les études, extrait des données et évalué le risque de biais dans les études incluses. Les résultats ont ensuite été combinés par méta-analyse. On a déterminé l'effet de l'exercice au moyen d'une différence moyenne normalisée (DMN) exprimée par la mesure g de Hedges, calculé au moyen d'un modèle à effet aléatoire. Résultats : Sept DMV extraites de cinq études ont été incluses pour analyse finale. On a utilisé la musculation dans toutes les études, dont une a utilisé l'entraînement aérobie et mixte (musculation et aérobie) avec deux sous-groupes de participants. L'effet global de l'exercice sur la masse musculaire a été statistiquement significatif (DMN: 0,272; IC à 95%, 0,020 à 0,525). Conclusion : Nos résultats confirment un effet modeste mais significatif de l'exercice de renforcement comme intervention anabolique visant à accroître la masse musculaire. Il faudrait inclure l'exercice dans la prise en charge de routine des personnes en HD d'entretien. Même si les résultats courants indiquent qu'une personne sur neuf en HD est susceptible de bénéficier de l'exercice, une recherche plus poussée s'impose au sujet des paramètres qui jouent sur ces résultats.

Keywords: bioelectrical impedance; computed tomography scan; dual energy x-ray absorptiometry; exercise; hemodialysis; magnetic resonance imaging; skeletal muscle.

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Figures

Figure 1
Figure 1
Flowchart of study selection.
Figure 2
Figure 2
Effect of exercises on muscle mass. Heterogeneity Q6=1.86; p=0.93; I2=0
Figure 3
Figure 3
Funnel plot for publication bias.
See this image and copyright information in PMC

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