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Effects of exercise training on noninvasive cardiac measures in patients undergoing long-term hemodialysis: a
Evangelia J Kouidi1, Dimitrios M Grekas, Asterios P Deligiannis
1Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Insights
Supervised exercise training significantly reduced sudden cardiac death risk markers in hemodialysis patients. This intervention improved aerobic capacity and cardiac function indicators over 10 months.
Area of Science:
- Cardiology
- Nephrology
- Exercise Physiology
Background:
- Hemodialysis (HD) patients face increased risk of sudden cardiac death.
- Noninvasive screening identifies at-risk individuals.
- Interventions targeting screening findings may reduce mortality.
Purpose of the Study:
- To evaluate the impact of supervised exercise training on sudden cardiac death risk markers in HD patients.
- To assess changes in aerobic capacity and cardiac function.
Main Methods:
- Randomized controlled trial with 59 HD patients.
- Intervention group (30 patients) underwent 10-month supervised exercise training during HD sessions.
- Control group (29 patients) received standard care.
- Assessed peak oxygen consumption (Vo(2)peak), left ventricular ejection fraction, heart rate variability (SDNN, LF/HF ratio), T-wave alternans, and late potentials.
Main Results:
- Exercise training group showed a significant reduction in the number of risk markers compared to the control group.
- Improvements observed in Vo(2)peak, left ventricular ejection fraction, and SDNN in the exercise group.
- Significant differences in changes of Vo(2)peak, ejection fraction, SDNN, and LF/HF ratio between groups.
Conclusions:
- Supervised exercise training is effective in improving aerobic capacity in HD patients.
- Exercise training ameliorates several indicators associated with sudden cardiac death risk.
- Further studies are needed to assess clinical outcomes like survival.
Background:
Noninvasive screening studies may identify hemodialysis (HD) patients at increased risk of sudden cardiac death. Interventions that improve the findings of such screening studies may reduce sudden cardiac death.
Study Design:
Randomized and controlled clinical trial.
Setting & Participants:
59 HD patients were randomly assigned to an exercise training group (group A; 30 patients) or control group (group B; 29 patients).
Intervention:
Group A participated in a 10-month supervised exercise training program during the HD sessions (3 times weekly).
Outcomes:
Each risk factor separately and the composite risk score. Patients were considered high risk according to the criteria (aerobic capacity: peak oxygen consumption [Vo(2)peak] < or = 14 mL/kg/min, left ventricular ejection fraction < or = 30%, SD of normal RR intervals [SDNN] < or = 70 milliseconds, positive T-wave alternans, or positive late potentials). Statistical analysis included a 2-group comparison of change scores and analysis of covariance adjusting for baseline.
Measurements:
At entry and end of the study, Vo(2)peak and left ventricular ejection fraction were estimated, heart rate variability was calculated (measurement of SDNN, mean RR intervals), and the ratio between low- (LF) to high-frequency (HF) components (LF/HF) and late potentials and T-wave alternans were detected.
Results:
Baseline measurements were similar between the 2 groups. At follow-up, 9 patients from group A and 20 from group B (P = 0.003) were considered high risk. The change in number of risk markers over time was significantly different between groups (-0.5 +/- 0.7 in group A versus 0.07 +/- 0.3 in group B; P < 0.001). Additionally, the change in Vo(2)peak over time was 3.5 +/- 3.2 in group A and -0.2 +/- 3.5 mL/kg/min in group B (P < 0.001), left ventricular ejection fractions were 3.4% +/- 3.9% and 0.2% +/- 7.7% (P < 0.05), SDNNs were 12.6 +/- 16.3 and -1.1 +/- 10.2 milliseconds (P < 0.001), and LF/HF ratios were 0.3 +/- 0.4 and -0.1 +/- 0.3 (P < 0.001), respectively. Change in numerical score of the signal-averaged electrocardiogram also was found to be statistically different (P < 0.05) between groups.
Limitations:
Clinical outcomes, including survival, were not assessed.
Conclusions:
Exercise training improves aerobic capacity and ameliorates some indicators of risk of sudden cardiac death in HD patients.
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