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PubMed1994

Effects of exercise training on alpha-adrenergic mediated pressor responses and baroreflex function in older subjects.

Endurance exercise training increases maximal O2 uptake (VO2max) in older subjects, and training also improves cardiac function in older men. Although the effects of training on beta-adrenergic responses have been investigated, little information is available regarding the effects of alpha-adrenergic responses and baroreflex function in older men and women. The purpose of the study was to determine whether endurance exercise training can affect alpha-adrenergic responses and baroreflex function in the elderly. We studied 13 men and women, 63 +/- 4 yrs old (mean +/- SE). VO2max was determined during treadmill exercise. Baroreflex function was determined from the change in heart rate (HR) relative to the change in systolic blood pressure (delta HR/delta SBP) during infusion of phenylephrine. VO2max was increased by 23% (1.9 +/- 0.16 vs 2.34 +/- 0.20 l/min; p < .01) in response to training. Maximal heart rate did not change, but HR during submaximal exercise at the same absolute exercise intensity was 17% lower after training. Resting heart rate was slower in the trained state. During alpha-adrenergic stimulation induced by graded doses of phenylephrine infusion, heart rate was lower after training because of training-induced bradycardia at rest. However, the elevation in systolic blood pressure (delta SBP) and mean blood pressure (delta MBP) from basal levels in response to a given dose of phenylephrine were significantly larger (delta SBP:18 +/- 3 vs 26 +/- 3 mmHg, p < .01; and delta MBP 10 +/- 2 vs 15 +/- 3 mmHg, p < .01) after than before training.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1993

Effects of exercise training on diet-induced lipogenic enzymes and body composition in rats.

It is well known that a carbohydrate-rich diet promotes lipogenesis via induction of hepatic lipogenic enzymes, whereas chronic physical exercise reduces body fat. The purpose of this study was to investigate whether exercise training can decrease diet-induced hepatic lipogenic enzymes and total body fat composition. Female Sprague-Dawley rats were randomly divided into exercise trained (T) and sedentary (S) groups. Training was performed on a treadmill for 8 weeks for up to 25 m/minute, 15% grade for 90 minutes/day, 5 days/week. The T and S groups were further divided into four dietary treatments. Fifty percent of the calories for each diet were from a basal ingredient and the other 50% were from either cornstarch (C), glucose (G), fructose (Fr), or fat (Fa). T significantly decreased body fat and increased body water content in all dietary groups (p < 0.01), but had no effect on body weight. Fr rats had significantly heavier liver weight than did the remaining groups. Activities of hepatic fatty acid synthase, ATP-citrate lyase (CL), malic enzyme (ME), pyruvate kinase, and glucose-6-phosphate dehydrogenase were significantly higher in Fr and lower in Fa compared with C and G. Training significantly increased activities of CL and ME in Fa, but had little effect on these enzymes in other groups. These data suggest that the fat-reducing effect of conventional exercise training is elicited by regulatory mechanisms other than by a reduction of hepatic lipogenic enzymes.

Acetyl-CoA Carboxylase↗

PubMed2000

The effect of repeated episodes of dietary restriction and refeeding on systolic blood pressure and food intake in exercise-trained normotensive rats.

OBJECTIVE: To explore the effects of weight cycling and exercise on blood pressure and macronutrient intake in Sprague-Dawley rats. RESEARCH METHODS AND PROCEDURES: Female Sprague-Dawley rats (n = 62; 5 months old) were assigned to an ad libitum (Con) or weight-cycled (Cyc) group. They were either sedentary (Con-Sed and Cyc-Sed) or exercise-trained (Con-Ex and Cyc-Ex) on a motorized treadmill (20 m/minute; 60 minutes/day; 6 days/week). The Cyc groups underwent 2 cycles of 3 weeks of 60% food restriction followed by 5 weeks of ad libitum refeeding using a macronutrient self-selection diet. Body mass and food intake were analyzed weekly. Systolic blood pressure (SBP) was measured at baseline and during the first and fifth weeks of each refeeding. RESULTS: For both cycling periods, SBP was elevated in Cyc vs. Con groups at Week 1 of refeeding, but was similar among groups by Week 5 of refeeding. Both Con groups had greater total energy intake than the Cyc groups for both cycling periods (Cycle 1: 2882.2 +/- 75.1, Con-Sed; 2916.1 +/- 67.1, Con-Ex; 2692.2 +/- 58.7, Cyc-Sed; and 2780.5 +/- 52.4 kcal, Cyc-Ex) (Cycle 2: 2815.8 +/- 75.1, Con-Sed; 2938.8 +/- 49.4, Con-Ex; 2577.1 +/- 60.5, Cyc-Sed; and 2643.5 +/- 65.9 kcal, Cyc-Ex). Relative fat intake (percentage of total kcal/week) was significantly less for Con-Ex and Cyc-Ex than Con-Sed and Cyc-Sed throughout both refeeding periods. DISCUSSION: Weight cycling failed to produce significant sustained effects on SBP, body mass, or food intake. Exercise training, irrespective of diet, lowered dietary fat intake.

Animals↗

PubMed1995

A controlled trial of exercise training in older coronary patients.

BACKGROUND: This study compared the effects of a formal exercise conditioning program of 3 and 12 months duration to spontaneous recovery in a population of older, post-coronary event patients. METHODS: Indices of peak exercise and submaximal exercise performance such as oxygen consumption, treadmill work capacity, minute ventilation, heart rate, and systolic blood pressure were assessed before and after conditioning in 60 post-myocardial infarction and post-coronary bypass surgery patients (mean age 68 +/- 5 years) and compared to measures of fitness in a usual care control group (n = 23, mean age 68 +/- 5 years). RESULTS: Maximal treadmill work capacity increased by 47% in the intervention group at 3 months compared to no improvement in the usual care control group. However, both groups increased peak oxygen consumption similarly at 3 and 12 months, increasing by 16% and 20% in the intervention group at 3 and 12 months and by 7% and 14% in the control group (p = n.s.). Only the exercise training group manifested submaximal indices of conditioning such as a lower heart rate and minute ventilation at a standard workload. CONCLUSION: While spontaneous improvements in peak oxygen consumption are seen in older coronary patients in the months following a coronary event, a formal exercise training program results in significantly greater increases in peak exercise capacity and in peak and submaximal exercise efficiency.

Aged↗

PubMed2000

Effects of a residential exercise training on baroreflex sensitivity and heart rate variability in patients with coronary artery disease: A randomized, controlled study.

BACKGROUND: Myocardial ischemia and infarction impair baroreflex sensitivity (BRS), which when depressed is predictive of future cardiac events after myocardial infarction (MI). The main objective of this study was to determine whether exercise training improves BRS in patients with coronary artery disease. METHODS AND RESULTS: Ninety-seven male patients with and without a previous MI were recruited after myocardial revascularization surgery and randomized into trained (TR) or untrained (UTR) groups. TR patients underwent a residential exercise program at 85% of maximum heart rate (HRmax) consisting of 2 daily sessions 6 times a week for 2 weeks. Eighty-six patients (45 TR and 41 UTR) completed the study. BRS was assessed at baseline and at the end of the protocol by the spontaneous baroreflex method. The standard deviation of mean R-R interval (RRSD) was also assessed as a measure of heart rate variability. At baseline, there were no significant differences between TR and UTR patients in any variable. In TR patients, BRS increased from 3.0+/-0.3 to 5.3+/-0.7 ms/mm Hg (P:<0.001), RRSD from 18.7+/-1.4 to 23.6+/-1.6 ms (P:<0.01), and R-R interval from 792. 0+/-15.5 to 851.3+/-20.5 ms (P:<0.001). No significant changes occurred in UTR patients. Increases in BRS and RRSD were significant in patients either with or without a previous MI. CONCLUSIONS: Exercise training increases BRS and heart rate variability in patients with coronary artery disease. Improved cardiac autonomic function might add to the other benefits of exercise training in secondary prevention of ischemic heart disease.

Baroreflex↗

PubMed1993

Differences in cardiovascular adaptations to endurance exercise training between older men and women.

Recent studies have shown that people in their seventh decade are able to adapt to exercise training with an increase in maximal O2 uptake (VO2max) similar in relative magnitude to that observed in young people. The purpose of this study was to determine the relative contributions of increases in stroke volume and O2 extraction to the training-induced increase in VO2max in older men and women. Fifteen men [63 +/- 3 (SE) yr] and 16 women (64 +/- 3 yr), in good health, participated in 9-12 mo of endurance exercise training at 70 to 85% of maximal heart rate for 45 min/day, 4 days/wk. VO2max increased 19% (2.35 +/- 0.1 to 2.8 +/- 0.1 l/min; P < 0.01) in the men and 22% (1.36 +/- 0.1 to 1.66 +/- 0.1 l/min; P < 0.01) in the women in response to training. In the men, stroke volume during maximal exercise was 15% higher after training, and this increase accounted for 66% of the increase in VO2max. The remainder of the increase in VO2max was accounted for by a 7% greater arteriovenous O2 content difference during maximal exercise. In contrast, training resulted in no change in stroke volume in women, in whom the entire increase in VO2max was accounted for by a greater arteriovenous O2 content difference (12.2 +/- 0.4 before vs. 14.4 +/- 0.4 ml O2/100 ml blood after; P < 0.01) during maximal exercise. There were no changes in these variables in the control subjects. The mechanisms responsible for the training-induced increase in VO2max in the older men were similar to those found in young people.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗

PubMed2002

Individual assessment of intensity-level for exercise training in patients with coronary artery disease is necessary.

BACKGROUND: Target intensity-level of exercise training in patients with coronary artery disease is adjusted usually by a target heart rate (THR). This THR is aimed to be at or nearby the anaerobic threshold (AT) and is calculated commonly from parameters of regular exercise training, instead of an actual measurement of AT and its related heart rate. Therefore, this study evaluated whether a calculation is reliable. METHODS: In 91 male patients (age 52+/-9 years) exercise capacity was measured after a recent (>4 weeks) coronary event. AT was compared with peak exercise capacity and heart rate at AT was compared with THR, using the Karvonen method. RESULTS: Mean AT (18.2 ml/min/kg, range 9.2-32.2) and mean peak V(O2) (24.5, range 10.9-43.9) were slightly decreased (respectively 0.83 and 0.79 of predicted). When related to peak exercise capacity, AT showed a large inter-individual variation. For example, heart rate at AT ranged from 0.55 to 0.96 of peak heart rate. As a result heart rate at AT varied considerably with THR. The mean THR, although significantly higher, correlated well with mean heart rate at AT (respectively, 109 and 105/min, P<0.01; r=0.86, P<0.001). However, in an important number of patients heart rate at AT was more than 10% below or above THR (respectively, 30 and 7%). CONCLUSION: In individual exercise prescription for cardiac rehabilitation the training level should be determined directly, and not indirectly by calculation from heart rate parameters of exercise testing.

Anaerobic Threshold↗

PubMed2001

Exercise training increases creatine kinase capacity in canine myocardium.

INTRODUCTION: The creatine kinase (CK) energy shuttle of cardiomyocytes channels metabolic energy from the mitochondria to sites of energy utilization at contracting myofibrils and sarcolemmal and sarcoplasmic reticular ion pumps. Although plasticity of the myocardial CK system in response to hemodynamic overload has been repeatedly demonstrated, the effects of aerobic exercise training on myocardial CK are less well understood. This investigation tested the hypothesis that aerobic exercise training increases the capacity of the CK system in canine myocardium. METHODS: Mongrel dogs were conditioned by a 9-wk treadmill running program or cage-rested for 4 wk. Total CK activity was measured colorimetrically; CK(MB) was separated from other CK isoforms and measured by electrophoresis. RESULTS: Relative to sedentary controls, training increased left ventricular total CK activity 46% (P < 0.05) but did not alter total CK activity in right ventricular myocardium. Also in left ventricular myocardium, training increased CK(MB) isoenzyme activity 4.5-fold and the CK(MB) fraction of total CK threefold from 1.1+/-0.4 to 3.4+/-0.8% (P < 0.05). In contrast to left ventricle, CK(MB) activity and its fraction of total CK activity were not altered by training in right ventricular myocardium. CONCLUSIONS: Aerobic exercise training increases total myocardial CK activity and CK(MB) content in canine left ventricular myocardium, although CK(MB) remains a minor component of the myocardial CK system. The right ventricular CK system was not affected by training.

Animals↗

PubMedDate not supplied

Response of cardiac antioxidant system to alcohol and exercise training in the rat.

Recent evidence has shown that alcohol as well as exercise induces oxidative stress. However, the combination of both on the cardiac antioxidant system is not known. This study investigates the interactive effects of exercise training and chronic ethanol consumption on the antioxidant system of the rat heart. Male Fisher-344 rats were treated as follows: 1) sedentary control (SC); 2) exercise training (ET) for 6.5 weeks; 3) ethanol (2 g/kg, PO) for 6.5 weeks, and 4) ET plus ethanol for 6.5 weeks. Rats were sacrificed and hearts were isolated. Glutathione (GSH), oxidized glutathione (GSSG), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), glutathione reductase (GR), and lipid peroxidation (MDA) were determined in heart tissues. SOD and GSH-Px activities were significantly increased 118% and 148% of SC, respectively, due to ET. GSH level increased 118% of SC in ET rats. GSH-Px activity increased 118% of SC whereas SOD activity and CuZn-SOD protein level and GR activity decreased 87%, 71%, and 90% of SC due to chronic ethanol administration. GSH level decreased 87% of SC and lipid peroxidation increased 149% of SC due to ethanol consumption. GSH-Px activity and GSH levels increased 143% and 130% of SC due to combination of ET and ethanol. This study suggests that ET and chronic ethanol ingestion augments the antioxidant enzyme activity and GSH levels in the heart. This combination reduced the extent of ethanol-induced lipid peroxidation. The data suggest that ET may reduce the extent of the damage caused by ethanol consumption on the myocardium.

Animals↗

PubMed2003

Antiremodeling effect of long-term exercise training in patients with stable chronic heart failure: results of the Exercise in Left Ventricular Dysfunction and Chronic Heart Failure (ELVD-CHF) Trial.

BACKGROUND: The effects of exercise training (ET) on left ventricular (LV) remodeling in chronic heart failure are not definitively established, and the safety of ET in these patients is still debated. METHODS AND RESULTS: This multicenter study investigated the long-term effect of moderate ET on LV remodeling, work capacity, and quality of life (QoL) in 90 patients with stable chronic heart failure caused by LV systolic dysfunction, randomized to a 6-month ET program (T, n=45) or a control group (C, n=45). All patients underwent resting echocardiography, a cardiopulmonary exercise test, 6-minute walking test, and QoL assessment at entry and after 6 months. At entry, end-diastolic (EDV) and end-systolic (ESV) volume, ejection fraction, work capacity, peak o2, and walking distance were similar in the 2 groups. After 6 months, LV volumes diminished in T (EDV, from 142+/-26 to 135+/-26 mL/m2, P<0.006; ESV, from 107+/-24 to 97+/-24 mL/m2, P<0.05) but increased in C (EDV, from 147+/-41 to 156+/-42 mL/m2, P<0.01; ESV, from 110+/-34 to 118+/-34 mL/m2, P<0.01). Ejection fraction improved in T (P<0.001) but was unchanged in C (P=NS). Significant improvement in work capacity (P<0.001), peak VO2 (P<0.006), walking distance (P<0.001), and QoL (P<0.01) was observed in T but not in C (P=NS). T showed a trend toward fewer (P=0.05) hospital readmissions for worsening dyspnea in the absence of other adverse cardiac events. CONCLUSIONS: In stable chronic heart failure, long-term moderate ET has no detrimental effect on LV volumes and function; rather, it attenuates abnormal remodeling. Furthermore, ET is safe and effective in improving exercise tolerance and QoL.

Cardiac Volume↗

PubMed2003

Effects of exercise training on conduit and resistance vessel function in treated and untreated hypercholesterolaemic subjects.

AIMS: Despite the importance of both lipid metabolism and physical activity to cardiovascular health, few studies have examined the effect of exercise training on vascular function in hypercholesterolaemic humans. METHODS AND RESULTS: A randomized, cross-over design investigated the effect of 8 weeks of combined aerobic and resistance exercise training on conduit and resistance vessel function in 11 untreated subjects with hypercholesterolaemia and 11 subjects taking lipid-lowering medication. High-resolution vascular ultrasonography following forearm ischaemia and glyceryl trinitrate administration determined conduit vessel endothelium-dependent and independent function. Strain-gauge plethysmography, with intra-aerial infusions of acetylcholine, sodium nitroprusside and N(G)-monomethyl-L-arginine, determined resistance vessel function. Flow-mediated dilation and the forearm blood flow response to acetylcholine improved significantly following training in the treated subgroup (both P<0.05) but not the untreated, although the blood flow response to N(G)-monomethyl-L-arginine was augmented following training in the untreated subjects (P<0.05), indicating greater basal nitric oxide bioactivity. Training did not alter responsiveness to glyceryl trinitrate or sodium nitroprusside. CONCLUSIONS: Combined aerobic and resistance training improves endothelium-dependent conduit and resistance vessel function in hypercholesterolaemic subjects taking lipid-lowering medications and basal nitric oxide bioactivity in untreated hypercholesterolaemic subjects. Exercise training may provide additional cardiovascular benefits for hypercholesterolaemic patients including those taking lipid-lowering medication.

Cholesterol↗

PubMed1976

Effects of exercise training and exhaustion on 45Ca uptake by rat skeletal muscle mitochondria and sarcoplasmic reticulum.

Mitochondrial and sarcoplasmic reticular 45Ca2+ uptake and Ca2+-ATPase activity were determined in skeletal muscle from exercise trained and non-trained rats at rest or following short-term exhaustive exercise. In trained rats exercised to exhaustion, mitochondrial 45Ca2+ uptake was significantly depressed when compared to non-trained rats at rest. Ca2+-ATPase activity of sarcoplasmic reticulum from trained rats exercised to exhaustion was significantly increased as compared to trained rats at rest. These data suggest that the disruptive influence of Ca2+ accumulation in mitochondria isolated following exhaustive exercise may be diminished as a result of training.

Adenosine Triphosphatases↗

PubMed1997

Exercise training and the progression of chronic renal failure.

The possible beneficial effect of regular exercise training on the progression of chronic renal failure was studied in a prospective randomized controlled study. Thirty patients with a median glomerular filtration rate (GFR) of 25 ml/(min.1.73 m2) (range 10-43) were randomized to physical training (30 min of bicycling daily or an equal amount of other physical activities) or to maintenance of the usual lifestyle. The median maximal work capacity increased significantly in the exercise group and remained unchanged in the control group during a median observation time of 20 months whereas the rate of progression judged by the slope of GFR versus time plot was equal in the two groups. Hence, the beneficial effect of exercise training, earlier observed in rat studies, could not be reproduced in our patients. Physical exercise had no untoward effect on progression of renal disease.

Adult↗

PubMed2006

Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis: A randomized, controlled trial.

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.

Absorptiometry, Photon↗

PubMed1986

Rate-related left bundle branch block with chest pain and normal coronary arteriograms treated by exercise training.

A clinical observation of chest pain associated with the onset of rate-related left bundle branch block has been described in patients with normal coronary arteriograms. The authors used standard cardiac rehabilitation techniques for exercise training in a 47-year-old woman with these manifestations. Serial treadmill tests revealed that during the course of 3 months of exercise training, the heart rate at onset of LBBB gradually rose from 133 to 175 beats per minute, and she no longer developed symptoms during her routine daily activities or exercises. Exercise training was a successful nonpharmacologic strategy that delayed the onset of rate-related LBBB and chest pain in this patient and avoided the need for beta blocker therapy.

Bundle-Branch Block↗

PubMed2005

Predictors of a sustained response to exercise training in patients with chronic heart failure: a telemonitoring study.

BACKGROUND: Exercise training (ExT) improves exercise capacity in chronic heart failure, but the results of home-based training have been variable. We sought the predictors of favorable outcome using a telemonitoring approach. METHODS: Exercise capacity and quality of life (QOL) were assessed in 30 patients (28 men, age 64 +/- 8 years) with symptomatic chronic heart failure and left ventricular ejection fraction < or = 35% (28% +/- 9%) undergoing 8 months of home ExT. Patients were provided with heart rate monitors and exercise diaries after undergoing 4 months of hospital-based ExT. Weekly telephone contact was established and heart rate data were downloaded bimonthly. Changes in peak oxygen consumption per unit time (V*O2) and QOL were compared between the 15 most and 15 least adherent patients defined by the number of hours per week at > 60% maximum heart rate, observed during heart-rate monitoring. RESULTS: Peak V*O2 increased by 26% (P < .001) after 4 months of hospital ExT, but this increase had fallen to 8% (P = .07) at 12 months; only adherent patients (n = 15) showed persistent improvement of peak V*O2 at 12 months (P = .02). Improvement in peak V*O2 at 12 months was associated with baseline peak V*O2 (r = -0.61, P < .001) and hours logged on the heart rate monitor (r = 0.47, P = .01). Quality of life improvements were sustained at 12 months for the Minnesota Living with Heart Failure Questionnaire and Hare-Davis Depression Questionnaire. Nevertheless, QOL improvements achieved during the outpatient program were lost or attenuated at 12 months in nonadherent patients but were maintained in adherent patients. CONCLUSIONS: Telemonitoring is feasible for following adherence to home ExT. Ongoing adherence is critical in obtaining sustained benefit from ExT in heart failure.

Aged↗

PubMed1991

Biochemical characterization of exercise-trained porcine myocardium.

The purpose of this study was to determine whether cardiac biochemical adaptations are induced by chronic exercise training (ET) of miniature swine. Female Yucatan miniature swine were trained on a treadmill or were cage confined (C) for 16-22 wk. After training, the ET pigs had increased exercise tolerance, lower heart rates during exercise at submaximal intensities, moderate cardiac hypertrophy, increased coronary blood flow capacity, and increased oxidative capacity of skeletal muscle. Myosin from both the C and ET hearts was 100% of the V3 isozyme, and there were no differences between the myosin adenosine triphosphatase (ATPase) or myofibrillar ATPase activities of C and ET hearts. Also, the sarcoplasmic reticulum Ca(2+)-ATPase activity and Na(+)-Ca2+ exchange activity of sarcolemmal vesicles were the same in cardiac muscle of C and ET hearts. Finally, the glycolytic and oxidative capacity of ET cardiac muscle was not different from control, since phosphofructokinase, citrate synthase, and 3-hydroxyacyl-CoA dehydrogenase activities were the same in cardiac tissue from ET and C pigs. We conclude that endurance exercise training does not provide sufficient stress on the heart of a large mammal to induce changes in any of the three major cardiac biochemical systems of the porcine myocardium: the contractile system, the Ca2+ regulatory systems, or the metabolic system.

Aging↗

PubMed2002

Exercise training in patients with end-stage renal disease on hemodialysis: comparison of three rehabilitation programs.

Functional capacity of end-stage renal disease patients is dramatically impaired. Although exercise training programs appear to have beneficial morphological, functional and psychosocial effects in end-stage renal disease patients on hemodialysis (HD), the adherence rate is high. The purpose of this study was to compare the effects of three modes of exercise training on aerobic capacity and to identify the most favourable, efficient and preferable to patients on HD with regard to functional improvements and participation rate in the programs. Fifty-eight volunteer patients were screened for low-risk status and selected from the dialysis population. The 48 patients who completed the study protocol were randomly assigned either to one of the three training groups or to a control group. Sixteen of them (Group A - mean age 46.4+/-13.9 years) completed a 6-month supervised outpatient exercise renal rehabilitation program consisting of three weekly sessions of aerobic and strengthening training on the non-dialysis days; 10 (Group B - mean age 48.3+/-12.1 years) completed a 6-month exercise program during HD; 10 (Group C - mean age 51.4+/-12.5 years) followed an unsupervised moderate exercise program at home, and 12 patients (Group D-mean age 50.2+/-7.9 years) were used as patient controls. The level of anemia, the medications and the HD prescription remained stable during the study. Fifteen sex- and age-matched sedentary individuals (Group E - mean age 46.9+/-6.4 years) comprised a healthy control group for baseline data. All subjects at the beginning and end of the study underwent clinical examination, laboratory tests and a treadmill exercise test to fatigue endpoints with direct measurement of aerobic capacity. Group A had a higher dropout rate (24%) compared to groups B (17%) and C (17%). Peak oxygen consumption (VO2 peak) increased by 43% (p < 0.05), anaerobic threshold (VO2AT) by 37% (p < 0.05) and exercise time by 33% (p < 0.05) after training in Group A; by 24% (p < 0.05), 18% (p < 0.05) and 22% (p < 0.05), respectively, in B; and by 17% (p < 0.05), 8% (p < 0.05) and 14% (p < 0.05), respectively, in C; while both remained almost unchanged in Group D. These results demonstrate that intense exercise training on non-dialysis days is the most effective way of training, whereas exercise during HD is also effective and preferable.

Adult↗