One-year intradialytic leg exercises with resistance bands and fat mass increase in elderly hemodialysis patients: a retrospective study

Abstract

Background: Intradialytic exercises are recommended to be available as a treatment for enhancing physical functioning. However, there have been few reports which evaluated the results of long-term mild intradialytic exercises in elderly patients. The purpose of this study is to investigate the changes in body weight, body composition, and laboratory data in elderly hemodialysis patients after 1-year intradialytic leg exercises with resistance bands.

Methods: A retrospective study. Twenty-one outpatients, aged 65 or older (mean ± SD, 75.2 ± 5.1 years), received intradialytic leg exercises with resistance bands for a year were analyzed. The values of dry weight, body composition, and laboratory data were collected from the year-ago period, at baseline and 1 year after baseline. Fat and muscle mass were evaluated by using a multi-frequency bioimpedance device.

Results: Physical performance changed and body weight increased after 1-year resistance band exercises. However, the participants gained fat mass, not muscle mass. Although the changes in biochemical data related to protein intake were equivocal, triglyceride levels increased significantly after 1-year exercises. An elevation in serum creatinine levels was observed, even if solute clearance increased significantly.

Conclusions: One-year intradialytic leg exercises with resistance bands may have a potential clinical benefit for body mass index even in elderly hemodialysis patients. However, optimal dietary modification is needed to achieve a balanced increase of muscle and fat mass. An increase of serum creatinine levels does not always mean muscle mass hypertrophy.

Supplementary information: The online version contains supplementary material available at 10.1186/s41100-021-00341-z.

Keywords: Body composition; Dialysis; Multi-frequency bioimpedance; Nutrition; Resistance exercise.

Fig. 1

A flow diagram of the patient selection and exclusion process

Fig. 2

Prescriptions for intradialytic leg exercises with resistance bands

Fig. 3

Physical performance in participants undergoing resistance exercises. a 10-m walk test (10MWT) results. b Timed up and go test (TUG) results. N = 21 at base and 1y. N = 20 at 3 and 6 M, because we forgot to perform the tests for one participant. c Weight-bearing index (WBI). N = 21 at base, 3M, and 1y. N = 20 at 6M because we failed to remember to measure the value for one participant. base, at the time of the exercise initiation. 3M, 6M, and 1y, 3, 6 months, and 1 year after the exercise initiation. *P<0.01. **P<0.05

Fig. 4

The changes in dry weight and body composition by intradialytic leg exercises with resistance bands (N=21). a Dry weight. b Extracellular water/total body water (ECW/TBW) ratio. c Fat tissue index (FTI). d Skeletal muscle mass index (SMI). Mean ± SD are shown. base, at the time of the exercise initiation. 1y, 1 year after the exercise initiation. *P<0.01. **P<0.05

Fig. 5

The changes in biochemical data related to dietary intake (N=21). a Albumin. b Normalized protein catabolic ratio (nPCR). c Phosphate. d Triglyceride. Mean ± SD are shown. base, at the time of the exercise initiation. 1 y, 1 year after the exercise initiation. *P<0.01

Fig. 6

The changes in biochemical data related to serum creatinine levels (N=21). a Creatinine. b Creatinine generation ratio (CGR). c Urea nitrogen (UN). d Kt/V. Mean ± SD are shown. base, at the time of the exercise initiation. 1y, 1 year after the exercise initiation. *P<0.01. **P<0.05

Fig. 7

The changes in dry weight and body composition before and after intradialytic leg exercises with resistance bands (N=15). a Dry weight. b Extracellular water/total body water (ECW/TBW) ratio. c Fat tissue index (FTI). d Skeletal muscle mass index (SMI). Mean ± SD are shown. −1y, 1 year before the exercise initiation. base, at the time of the exercise initiation. 1y, 1 year after the exercise initiation. *P<0.01. **P<0.05

Fig. 8

The changes in biochemical data related to dietary intake (N=15). a Albumin. b Normalized protein catabolic ratio (nPCR). c Phosphate. d Triglyceride. Mean ± SD are shown. −1y, 1 year before the exercise initiation. base, at the time of the exercise initiation. 1y, 1 year after the exercise initiation. *P<0.01. **P<0.05

Fig. 9

The changes in biochemical data related to serum creatinine levels (N=15). a Creatinine. b Creatinine generation ratio (CGR). c Urea nitrogen (UN). d Kt/V. Mean ± SD are shown. −1y, 1 year before the exercise initiation. base, at the time of the exercise initiation. 1y, 1 year after the exercise initiation. *P<0.01. **P<0.05 Fig. 9