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Combining intra‐dialytic exercise and nutritional supplementation in malnourished older haemodialysis patients: Towards better quality of life and autonomy
Author(s) -
Hristea Dan,
Deschamps Thibault,
Paris Anne,
Lefrançois Gaëlle,
Collet Valérie,
Savoiu Corneliu,
Ozenne Sophie,
Coupel Stéphanie,
Testa Angelo,
Magnard Justine
Publication year - 2016
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12752
Subject(s) - medicine , wasting , quality of life (healthcare) , nutritional supplementation , physical therapy , randomized controlled trial , adverse effect , lean body mass , body mass index , sarcopenia , balance (ability) , body weight , nursing
Protein‐energy wasting (PEW), defined as a loss of body protein mass and fuel reserves, is a powerful predictor of adverse outcomes in haemodialysis (HD) patients. Robust arguments suggest that intra‐dialytic exercise, combined with oral/parenteral nutrition, enhances the effect of nutritional interventions in HD patients. This pilot randomized controlled trial investigated the feasibility and the effects of a 6 month intra‐dialytic cycling program combined to a nutritional support on PEW, physical functioning (gait, balance, muscle strength) and quality of life (QoL) in older HD patients (mean age 69.7 ± 14.2 years).Twenty‐one patients fulfilling diagnostic criteria of PEW were randomly assigned to Nutrition‐Exercise group (G N‐Ex , n = 10) or Nutrition group (G N , n = 11). Both groups received nutritional supplements in order to reach recommended protein and energy intake goals. In addition G N‐Ex completed a cycling program. No significant difference between groups was found in the number of patients having reached remission of PEW. Likewise, no change was observed in serum‐albumin, ‐prealbumin, C‐reactive protein, body mass index, lean‐ and fat‐tissue index, or quadriceps force. Interestingly, we found positive effects of exercise on physical function and QoL for the G N‐Ex , as evidenced by a significant improvement in the 6‐min walk test (+22%), the absence of decline in balance (unlike the G N ), and a noteworthy increase in QoL (+53%). Combining intra‐dialytic exercise and nutrition in HD patients is feasible, and well accepted, improves physical function and QoL but it appears not to have the potential to reverse PEW.