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Effects of Resistance Exercise Training and Nandrolone Decanoate on Body Composition and Muscle Function among Patients Who Receive Hemodialysis: A Randomized, Controlled Trial

Kirsten L. Johansen^*,, Patricia L. Painter, Giorgos K. Sakkas^,, Patricia Gordon, Julie Doyle^|| and Tiffany Shubert^||,¶

Nephrology Section, San Francisco VA Medical Center and Departments of; Medicine; Physiological Nursing, University of California, San Francisco, San Francisco, California; Department of Medicine, University of Thessaly, Thessaly, Greece; ^|| Northern California Institute for Research and Education, San Francisco, California; and ^¶ University of North Carolina School of Medicine, Chapel Hill, Chapel Hill, North Carolina

Address correspondence to: Dr. Kirsten L. Johansen, Nephrology Section, 111J, San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121. Phone: 415-221-4810, ext. 3598; Fax: 415-750-6949; kirsten.johansen{at}ucsf.edu

Received for publication January 13, 2006. Accepted for publication May 27, 2006.

Patients who are on hemodialysis commonly experience muscle wasting and weakness, which have a negative effect on physical functioning and quality of life. The objective of this study was to determine whether anabolic steroid administration and resistance exercise training induce anabolic effects among patients who receive maintenance hemodialysis. A randomized 2 x 2 factorial trial of anabolic steroid administration and resistance exercise training was conducted in 79 patients who were receiving maintenance hemodialysis at University of California, San Francisco–affiliated dialysis units. Interventions included double-blinded weekly nandrolone decanoate (100 mg for women; 200 mg for men) or placebo injections and lower extremity resistance exercise training for 12 wk during hemodialysis sessions three times per week using ankle weights. Primary outcomes included change in lean body mass (LBM) measured by dual-energy x-ray absorptiometry, quadriceps muscle cross-sectional area measured by magnetic resonance imaging, and knee extensor muscle strength. Secondary outcomes included changes in physical performance, self-reported physical functioning, and physical activity. Sixty-eight patients completed the study. Patients who received nandrolone decanoate increased their LBM by 3.1 ± 2.2 kg (P < 0.0001). Exercise did not result in a significant increase in LBM. Quadriceps muscle cross-sectional area increased in patients who were assigned to exercise (P = 0.01) and to nandrolone (P < 0.0001) in an additive manner. Patients who exercised increased their strength in a training-specific fashion, and exercise was associated with an improvement in self-reported physical functioning (P = 0.04 compared with nonexercising groups). Nandrolone decanoate and resistance exercise produced anabolic effects among patients who were on hemodialysis. Further studies are needed to determine whether these interventions improve survival.

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