Received December 7, 2006
Accepted on February 20, 2007

CLINICAL SCIENCE ARTICLES: Clinical Dialysis

Progressive Exercise for Anabolism in Kidney Disease (PEAK): A Randomized, Controlled Trial of Resistance Training during Hemodialysis

Bobby Cheema ^*1, Haifa Abas ^*, Benjamin Smith ^*, Anthony O’Sullivan , Maria Chan , Aditi Patwardhan ^||, John Kelly ^¶, Adrian Gillin ^**, Glen Pang , Brad Lloyd , and Maria Fiatarone Singh ^*

*School of Exercise and Sport Science and Faculty of Medicine, University of Sydney, Department of Medicine, University of New South Wales, Departments of Nutrition and Dietetics and ¶Renal Medicine, St. George Hospital, and Departments of ||Nutrition and Dietetics and **Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Food, Nutrition & Human Health, Massey University, Wellington, New Zealand; and Hebrew SeniorLife and Jean Mayer USDA Human Nutrition Center on Aging at Tufts University, Boston, Massachusetts

¹ To whom correspondence should be addressed. E-mail: b.cheema{at}massey.ac.nz.

	Abstract

Skeletal muscle wasting is common and insidious in patients who receive maintenance hemodialysis treatment for the management of ESRD. The objective of this study was to determine whether 12 wk of high-intensity, progressive resistance training (PRT) administered during routine hemodialysis treatment could improve skeletal muscle quantity and quality versus usual care. Forty-nine patients (62.6 ± 14.2 yr; 0.3 to 16.7 yr on dialysis) were recruited from the outpatient hemodialysis unit of the St. George Public Hospital (Sydney, Australia). Patients were randomized to PRT + usual care (n = 24) or usual care control only (n = 25). The PRT group performed two sets of 10 exercises at a high intensity (15 to 17/20 on the Borg Scale) using free weights, three times per week for 12 wk during routine hemodialysis treatment. Primary outcomes included thigh muscle quantity (cross-sectional area [CSA]) and quality (intramuscular lipid content via attenuation) evaluated by computed tomography scan. Secondary outcomes included muscle strength, exercise capacity, body circumference measures, proinflammatory cytokine C-reactive protein, and quality of life. There was no statistically significant difference in muscle CSA change between groups. However, there were statistically significant improvements in muscle attenuation, muscle strength, mid-thigh and mid-arm circumference, body weight, and C-reactive protein in the PRT group relative to the nonexercising control group. These findings suggest that patients with ESRD can improve skeletal muscle quality and derive other health-related adaptations solely by engaging in a 12-wk high-intensity PRT regimen during routine hemodialysis treatment sessions. Longer training durations or more sensitive analysis techniques may be required to document alterations in muscle CSA.