ORIGINAL PAPER
Metabolic bone changes after intradialytic resistive exercise in regular haemodialysis patients
 
More details
Hide details
1
Department of Physical Therapy, Kasr El-Aini, Cairo University Hospitals, Cairo, Egypt
 
2
Department of Physical Therapy for Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
 
3
Department of Internal Medicine and Nephrology, Faculty of Medicine, Cairo University, Giza, Egypt
 
4
Faculty of Applied Medical Science, King Khalid University, Abha, Saudi Arabia
 
 
Submission date: 2020-01-16
 
 
Acceptance date: 2020-03-26
 
 
Publication date: 2021-03-22
 
 
Physiother Quart. 2021;29(1):24-29
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Mineral bone disease is a crucial factor that contributes to mortality and morbidity in haemodialysis patients. Intradialytic resistance exercise training can be valuable in stimulating bone formation. The aim of this study was to evaluate the metabolic bone changes after intradialytic resistive exercise training in regular haemodialysis patients.

Methods:
The study involved 60 patients on regular haemodialysis, aged 20–60 years. The patients were divided into 2 groups: a high parathyroid hormone group (parathyroid hormone over 800 pg/ml) and a low parathyroid hormone group (parathyroid hormone below 200 pg/ml), both groups randomly assigned into study and control groups. They received intradialytic resistive exercise 3 times per week for 3 months. Calcium, phosphorus, and parathyroid hormone were evaluated before and after the exercise period.

Results:
The training protocol proved to be effective in improving bone metabolism parameters, as there were statistically significant differences in the high parathyroid hormone exercise group. Parathyroid hormone and phosphorus decreased and calcium increased (p = 0.001, p = 0.012, and p = 0.025, respectively). In the low parathyroid hormone exercise group, phosphorus decreased significantly (p = 0.030) and calcium increased, although not significantly (p = 0.111), while parathyroid hormone non-significantly increased in the exercise group (p = 0.770), with a significant increase in the control group (p = 0.007). These results supported the positive effects of intradialytic resistive exercise in improving bone metabolism.

Conclusions:
Intradialytic resistive exercise training improves bone metabolism in haemodialysis patients.

REFERENCES (32)
1.
Jian-Qing J, Lin S, Xu P-C, Zheng Z-F, Jia J-Y. Serum osteoprotegerin measurement for early diagnosis of chronic kidney disease-mineral and bone disorder. Nephrology. 2011;16(6):588–594; doi: 10.1111/j.1440-1797.2011.01481.x.
 
2.
Bouassida A, Latiri I, Bouassida S, Zalleg D, Zaouali M, Feki Y, et al. Parathyroid hormone and physical exercise: a brief review. J Sports Sci Med. 2006;5(3):367–374.
 
3.
Huang G-S, Chu T-S, Lou M-F, Hwang S-L, Yang RS. Factors associated with low bone mass in the hemodialysis patients – a cross-sectional correlation study. BMC Musculoskelet Disord. 2009;10:60; doi: 10.1186/1471-2474-10-60.
 
4.
Cheema BSB, Fiatarone Singh MA. Exercise training in patients receiving maintenance hemodialysis: a systematic review of clinical trials. Am J Nephrol. 2005;25(4):352–364; doi: 10.1159/000087184.
 
5.
Johansen KL. Exercise in the end-stage renal disease population. J Am Soc Nephrol. 2007;18(6):1845–1854; doi: 10.1681/ASN.2007010009.
 
6.
Jung T-D, Park S-H. Intradialytic exercise programs for hemodialysis patients. Chonnam Med J. 2011;47(2):61–65; doi: 10.4068/cmj.2011.47.2.61.
 
7.
Bessa B, de Oliveira Leal V, Moraes C, Barboza J, Fouque D, Mafra D. Resistance training in hemodialysis patients: a review. Rehabil Nurs. 2015;40(2):111–126; doi: 10.1002/rnj.146.
 
8.
Imai K, Watari S, Sakazume T, Mitsuyama S. Clinical chemistry and immunoassay testing supporting the individual healthy life. Hitachi Rev. 2008;57:1–7.
 
9.
Cobas® 6000 analyzer series. Available from: https://diagnostics.roche.com/....
 
10.
Brown LE, Weir JP. ASEP procedures recommendation I: accurate assessment of muscular strength and power. J Exerc Physiol. 2001;4(3):1–21.
 
11.
Materko W, Neves CEB, Santos EL. Prediction model of a maximal repetition (1RM) based on male and female anthropometrical characteristics [in Portuguese]. Rev Bras Med Esporte. 2007;13(1):27–32; doi: 10.1590/S1517-86922007000100007.
 
12.
Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15(8):2208–2218; doi: 10.1097/01.ASN.0000133041.27682.A2.
 
13.
Kestenbaum B, Sampson JN, Rudser KD, Patterson DJ, Seliger SL, Young B, et al. Serum phosphate levels and mortality risk among people with chronic kidney disease. J Am Soc Nephrol. 2005;16(2):520–528; doi: 10.1681/ASN.2004070602.
 
14.
Cunningham J, Locatelli F, Rodriguez M. Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options. Clin J Am Soc Nephrol. 2011;6(4):913–921; doi: 10.2215/CJN.06040710.
 
15.
Marinho SMS, Mafra D, Pelletier S, Hage V, Teuma C, Laville M, et al. In hemodialysis patients, intradialytic resistance exercise improves osteoblast function: a pilot study. J Renal Nutr. 2016;26(5):341–345; doi: 10.1053/j.jrn.2016.03.002.
 
16.
Ryan ZC, Ketha H, McNulty MS, McGee-Lawrence M, Craig TA, Grande JP, et al. Sclerostin alters serum vitamin D metabolite and fibroblast growth factor 23 concentrations and the urinary excretion of calcium. Proc Natl Acad Sci U S A. 2013;110(15):6199–6204; doi: 10.1073/pnas.1221255110.
 
17.
Alghadir AH, Gabr SA, Al-Eisa ES, Alghadir MH. Correlation between bone mineral density and serum trace elements in response to supervised aerobic training in older adults. Clin Interv Aging. 2016;11:265–273; doi: 10.2147/CIA.S100566.
 
18.
Goodman WG. Recent development in the management of secondary hyperparathyroidism. Kidney Int. 2001;59(3):1187–1201; doi: 10.1046/j.1523-1755.2001.0590031187.x.
 
19.
National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42(4 Suppl. 3):S1–S201; doi: 10.1053/S0272-6386(03)00905-3.
 
20.
Eknoyan G, Levin NW. Impact of the new K/DOQI guidelines. Blood Purif. 2002;20(1):103–108; doi: 10.1159/000046992.
 
21.
Marinho SM, Moraes C, Barbosa JESM, Carraro Eduardo JC, Fouque D, Pelletier S, et al. Exercise training alters the bone mineral density of hemodialysis patients. J Strength Cond Res. 2016;30(10):2918–2923; doi: 10.1519/JSC.0000000000001374.
 
22.
Alghadir AH, Aly FA, Gabr SA. Effect of moderate aerobic training on bone metabolism indices among adult humans. Pak J Med Sci. 2014;30(4):840–844. doi: 10.12669/pjms.304.4624.
 
23.
Liao M-T, Liu W-C, Lin F-H, Huang C-F, Chen S-Y, Liu C-C, et al. Intradialytic aerobic cycling exercise alleviates inflammation and improves endothelial progenitor cell count and bone density in hemodialysis patients. Medicine. 2016;95(27):e4134; doi: 10.1097/MD.0000000000004134.
 
24.
Marenzana M, Shipley AM, Squitiero P, Kunkel JG, Rubinacci A. Bone as an ion exchange organ: evidence for instantaneous cell-dependent calcium efflux from bone not due to resorption. Bone. 2005;37(4):545–554; doi: 10.1016/j.bone.2005.04.036.
 
25.
Jüppner H, Brown E, Kroneberg H. Parathyroid hormone. In: Favus M (ed.), Primer on the metabolic bone diseases and disorders of mineral metabolism, 4th ed. Philadelphia: Lippincott Williams & Wilkins; 1999; 80–87.
 
26.
Koch Nogueira PC, David L, Cochat P. Evolution of secondary hyperparathyroidism after renal transplantation. Pediatr Nephrol. 2000;14(4):342–346; doi: 10.1007/s004670050772.
 
27.
Evans RK, Antczak AJ, Lester M, Yanovich R, Israeli E, Moran DS. Effects of a 4-month recruit training program on markers of bone metabolism. Med Sci Sports Exerc. 2008;40(11 Suppl.):S660–S670; doi: 10.1249/MSS.0b013e318189422b.
 
28.
Pourvaghar M. The effect of 2 month-regular aerobic training on students’ rest time serum calcium, phosphorus and magnesium variations. Gazzeta Medica Italiana. 2008;167(3):105–108.
 
29.
Owda A, Elhwairis H, Narra S, Towery H, Osama S. Secondary hyperparathyroidism in chronic hemodialysis patients: prevalence and race. Ren Fail. 2003;25(4):595–602; doi: 10.1081/jdi-120022551.
 
30.
Lombardi G, Sanchis-Gomar F, Perego S, Sansoni V, Banfi G. Implications of exercise-induced adipo-myokines in bone metabolism. Endocrine. 2016; 54(2):284–305; doi: 10.1007/s12020-015-0834-0.
 
31.
Klein-Nulend J, Bakker AD, Bacabac RG, Vatsa A, Weinbaum S. Mechanosensation and transduction in osteocytes. Bone. 2013;54(2):182–190; doi: 10.1016/j.bone.2012.10.013.
 
32.
Li L, Chen X, Lv S, Dong M, Zhang L, Tu J, et al. Influence of exercise on bone remodeling-related hormones and cytokines inovariectomized rats: a model of postmenopausal osteoporosis. PLoS One. 2014;9(11):e112845; doi: 10.1371/journal.pone.0112845.
 
eISSN:2544-4395
Journals System - logo
Scroll to top