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      Effects of a six-month intradialytic physical ACTIvity program and adequate NUTritional support on protein-energy wasting, physical functioning and quality of life in chronic hemodialysis patients: ACTINUT study protocol for a randomised controlled trial

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          Abstract

          Background

          Protein-energy wasting (PEW) is common in hemodialysis patients and is a powerful predictor of morbidity and mortality. Although much progress has been made in recent years in identifying the causes and pathogenesis of PEW in hemodialysis patients, actual management by nutritional interventions is not always able to correct PEW . Some investigators suggest that physical exercise may increase the anabolic effects of nutritional interventions, and therefore may have a potential to reverse PEW. The aim of this study is to investigate the effect of intra-dialytic progressive exercise training and adequate nutritional supplementation on markers of PEW, functional capacities and quality of life of adult hemodialysis patients.

          Methods and design

          Fifty end-stage renal disease patients undergoing hemodialysis, who meet the diagnostic criteria for PEW, will be randomly allocated into an exercise or control group for 6 months. The exercise consists of a progressive submaximal individualized cycling exertion using an adapted cycle ergometer, during the three weekly dialysis sessions. Biological markers of nutrition (albumin, prealbumin) will be followed monthly and all patients will be assessed for body composition, walk function, muscle strength, postural stability and quality of life at baseline and during the eighth week (t +2), the sixteenth week (t +4) and the twenty-fourth week (t +6) of the 6-month adapted rehabilitation program.

          Discussion

          The successful completion of this current trial may give precious clues in understanding PEW and encourage nephrologists to extend prescription of exercise programs as well as therapeutic and as preventive interventions in this high-risk population.

          Trial registration

          The protocol for this study was registered with the France Clinical Trials Registry NCT01813851.

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          Most cited references37

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          Short form 36 (SF36) health survey questionnaire: normative data for adults of working age.

          C Jenkinson, A. Coulter, L. Wright (1993)
          To gain population norms for the short form 36 health survey questionnaire (SF36) in a large community sample and to explore the questionnaire's internal consistency and validity. Postal survey by using a booklet containing the SF36 and several other items concerned with lifestyles and illness. The sample was drawn from computerised registers of the family health services authorities for Berkshire, Buckinghamshire, Northamptonshire, and Oxfordshire. 13,042 randomly selected subjects aged 18-64 years. Scores for the eight health dimensions of the SF36. The survey achieved a response rate of 72% (n = 9332). Internal consistency of the different dimensions of the questionnaire was high. Normative data broken down by age, sex, and social class were consistent with those from previous studies. The SF36 is a potentially valuable tool in medical research. The normative data provided here may further facilitate its validation and use.
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            EBPG guideline on nutrition.

            Edi A. Malo, Ali Başçi, José L. Pedrini … (2007)
            Article 0 comments Cited 152 times – based on 0 reviews     Review now
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              Physical activity levels in patients on hemodialysis and healthy sedentary controls.

              Megan K. Mulligan, Krisztina K. Johansen, Carla A Ng … (2000)
              Patients on dialysis have reduced exercise tolerance compared with age-matched sedentary controls. The reasons for this debility have not been fully elucidated, but physical inactivity could be a contributing factor. The purpose of the current study was to determine whether patients on hemodialysis are less active than healthy sedentary controls and to explore clinical correlates of physical activity level in a group of hemodialysis patients. Thirty-four hemodialysis patients and 80 healthy sedentary individuals participated in the study. Physical activity was measured for seven days with a three-dimensional accelerometer and with an activity questionnaire. Vector magnitude values from the accelerometer for the dialysis and control subjects were 104,718 +/- 9631 and 161,255 +/- 6792 arbitrary units per day, respectively (P < 0.0001, mean +/- SEM). The estimated energy expenditure values derived from the questionnaire were 33.6 +/- 0.5 kcal/kg/day and 36.2 +/- 0.5 kcal/kg/day (P = 0.002). The difference between patients on dialysis and controls increased with advancing age. Among the dialysis subjects, some measures of nutritional status correlated with physical activity level, including serum albumin concentration (r = 0.58, P = 0.003), serum creatinine concentration (r = 0.37, P = 0. 03), and phase angle derived from bioelectrical impedance analysis (r = 0.40, P = 0.02). Patients on hemodialysis are less active than healthy sedentary controls, and this difference is more pronounced among older individuals. There is an association between the level of physical activity and nutritional status among patients on dialysis. These findings are of great concern, given the trend toward increasing age in incident dialysis patients and the well-known association between inactivity and increased mortality in the general population.
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                Author and article information

                Contributors
                Justine Magnard
                Thibault Deschamps
                Christophe Cornu
                Anne Paris
                Dan Hristea
                Journal
                Journal ID (nlm-ta): BMC Nephrol
                Journal ID (iso-abbrev): BMC Nephrol
                Title: BMC Nephrology
                Publisher: BioMed Central
                ISSN (Electronic): 1471-2369
                Publication date Collection: 2013
                Publication date (Electronic): 26 November 2013
                Volume: 14
                Page: 259
                Affiliations
                [1 ]University of Nantes, Laboratory “Motricité, Interactions, Performance” (UPRES EA 4334), F-44000 Nantes, France
                [2 ]ECHO Nantes, Centre de dialyse Laënnec, 23, rue des Piliers de la Chauvinière, 448000 Saint Herblain, France
                Article
                Publisher ID: 1471-2369-14-259
                DOI: 10.1186/1471-2369-14-259
                PMC ID: 4222262
                PubMed ID: 24279747
                SO-VID: 027c1f94-b340-41a6-a104-1937d4d5abe4
                Copyright © Copyright © 2013 Magnard et al.; licensee BioMed Central Ltd.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 31 May 2013
                Date accepted : 8 November 2013
                Categories
                Subject: Study Protocol

                ScienceOpen disciplines: Nephrology
                Keywords: hemodialysis,protein-energy wasting,nutritional supplementation,intradialytic physical activity,quality of life
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: hemodialysis, protein-energy wasting, nutritional supplementation, intradialytic physical activity, quality of life

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