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Response: activity- nephrotic syndrome
By: D2- Gil legarda and Joanalyn Balino
Title:Resistance Training To Counteract the Catabolism of a Low-Protein
Diet in Patients with Chronic Renal Insufficiency.ARandomized, Controlled Trial
Carmen Castaneda, MD, PhD; Patricia L. Gordon, RN, PhD; Katherine Leigh Uhlin, RD, MS; Andrew S. Levey, MD; Joseph J. Kehayias, PhD;
Johanna T. Dwyer, DSc, RD; Roger A. Fielding, PhD; Ronenn Roubenoff, MD, MHS; and Maria Fiatarone Singh, MD
Castaneda, C., Gordon, P. et al. made an experimental study (randomized, controlled trial) to analyze if resistance training would preserve lean body mass, nutritional status, and muscle function through alterations in protein synthesis and oxidation in patients with moderate chronic renal insufficiency who were consuming a low-protein diet to slow the progression of renal failure.A total of 26 patients participated in the study (17 men and 9 women). Inclusion criteria were: (1) Patients older than 50 yrs of age; (2) having physician approval to follow a low protein diet; (3) a nephrologist confirmed renal diagnosis (renal biochemistry results and clinical records);( 4) serum creatinine concentrations between 133 and 442 mmol/L. Exclusion criteria were: (1) having myocardial infarction within the past 6 months; (2) having any unstable chronic condition; (3) with dementia, alcoholism, dialysis or previous renal transplantation, current resistance training (4)recent involuntary weight change (62 kg); (5)albumin level less than 30 g/L; and proteinuria greater than 10 g/d, or abnormal stress test results at screening.These patients included in the study were randomly assigned to a low-protein diet plus resistance training or a low-protein diet plus sham exercises (referred to as low-protein dietalone). Procedures done to the patients were: sociodemographic and health history questionnaires; physical examination; electrocardiography; blood hematology, chemistry, and urine analyses; and a treadmill stress test.
Patients who performed resistance training had significantly larger increases in muscle strength 32% ± 14% than patients who followed the low-protein diet alone -13% ± 20% (P , 0.001). Resistance training significantly increased total body potassium 4% ± 8% and hypertrophied type I 24% ± 31% and type II 22% ± 29% muscle fiber areas compared with low-protein diet. There an increase in mid-thigh muscle area in those who performed resistance training compared with those who did not (P , 0.113). There is significant association between the change in total body potassium and change in muscle strength (r 0.36; P 0.05). From screening to the end of the run-in period (intervention), patients assigned to the resistance training group lost 2.1 ± 2.8 kg and those patients assigned to the lowprotein diet lost 1.1 ± 1.9 kg and P 0.02. Postintervention total body potassium was significantly correlated with post intervention serum albumin concentrations r 0.52; P ,0.01.Leucine oxidation increased with resistance training and decreased with those in low-protein diet group. Those who performed resistance training their urinary creatinine excretion decreased by 8% in and it did not change in those who were in low-protein diet. There is a small but significant improvement in glomerular filtration rate in those who performed resistance training compared with those who took a low-protein diet. Total body potassium was associated with both protein intake and energy intake as well as with body weight. The Mid-thigh muscle area was related with protein intake and body weight. There was a significant relationship between Total body potassium and concentrations of insulin-like growth factor I and with leucine oxidation.
This study provides evidences that Resistance training is a safe and effective countermeasure to the negative effects of protein restriction on muscle mass accretion, protein utilization, nutritional status, and muscle function in patients with moderate chronic renal insufficiency consuming a low-protein diet. Evidences were increased protein utilization and nitrogen retention indicated by higher rates of leucine oxidation) in patients with chronic renal insufficiency who performed 12 weeks of resistance training while consuming a low-protein diet. Also, the progression and intensity of the exercise regimen resulted to significant increased in upper and lower muscle strength with no exercise-related injuries or adverse effects. This study plays a key role in the therapeutic approach to chronic renal insufficiency. Resistance exercise s capable of offsetting the catabolic effects of low protein and energy intakes and the wasting syndrome of chronic uremia.
Castaneda, C., Gordon, P. et al.(2001). Resistance Training To Counteract the Catabolism of a Low-Protein
Diet in Patients with Chronic Renal Insufficiency
A Randomized, Controlled Trial. Ann Internal Medicine 135:965-976.Retrived July 3, 2009 from
http://www.annals.org/cgi/reprint/135/11/965
By: D2- Gil legarda and Joanalyn Balino
Title:Resistance Training To Counteract the Catabolism of a Low-Protein
Diet in Patients with Chronic Renal Insufficiency.ARandomized, Controlled Trial
Carmen Castaneda, MD, PhD; Patricia L. Gordon, RN, PhD; Katherine Leigh Uhlin, RD, MS; Andrew S. Levey, MD; Joseph J. Kehayias, PhD;
Johanna T. Dwyer, DSc, RD; Roger A. Fielding, PhD; Ronenn Roubenoff, MD, MHS; and Maria Fiatarone Singh, MD
Castaneda, C., Gordon, P. et al. made an experimental study (randomized, controlled trial) to analyze if resistance training would preserve lean body mass, nutritional status, and muscle function through alterations in protein synthesis and oxidation in patients with moderate chronic renal insufficiency who were consuming a low-protein diet to slow the progression of renal failure.A total of 26 patients participated in the study (17 men and 9 women). Inclusion criteria were: (1) Patients older than 50 yrs of age; (2) having physician approval to follow a low protein diet; (3) a nephrologist confirmed renal diagnosis (renal biochemistry results and clinical records);( 4) serum creatinine concentrations between 133 and 442 mmol/L. Exclusion criteria were: (1) having myocardial infarction within the past 6 months; (2) having any unstable chronic condition; (3) with dementia, alcoholism, dialysis or previous renal transplantation, current resistance training (4)recent involuntary weight change (62 kg); (5)albumin level less than 30 g/L; and proteinuria greater than 10 g/d, or abnormal stress test results at screening.These patients included in the study were randomly assigned to a low-protein diet plus resistance training or a low-protein diet plus sham exercises (referred to as low-protein dietalone). Procedures done to the patients were: sociodemographic and health history questionnaires; physical examination; electrocardiography; blood hematology, chemistry, and urine analyses; and a treadmill stress test.
Patients who performed resistance training had significantly larger increases in muscle strength 32% ± 14% than patients who followed the low-protein diet alone -13% ± 20% (P , 0.001). Resistance training significantly increased total body potassium 4% ± 8% and hypertrophied type I 24% ± 31% and type II 22% ± 29% muscle fiber areas compared with low-protein diet. There an increase in mid-thigh muscle area in those who performed resistance training compared with those who did not (P , 0.113). There is significant association between the change in total body potassium and change in muscle strength (r 0.36; P 0.05). From screening to the end of the run-in period (intervention), patients assigned to the resistance training group lost 2.1 ± 2.8 kg and those patients assigned to the lowprotein diet lost 1.1 ± 1.9 kg and P 0.02. Postintervention total body potassium was significantly correlated with post intervention serum albumin concentrations r 0.52; P ,0.01.Leucine oxidation increased with resistance training and decreased with those in low-protein diet group. Those who performed resistance training their urinary creatinine excretion decreased by 8% in and it did not change in those who were in low-protein diet. There is a small but significant improvement in glomerular filtration rate in those who performed resistance training compared with those who took a low-protein diet. Total body potassium was associated with both protein intake and energy intake as well as with body weight. The Mid-thigh muscle area was related with protein intake and body weight. There was a significant relationship between Total body potassium and concentrations of insulin-like growth factor I and with leucine oxidation.
This study provides evidences that Resistance training is a safe and effective countermeasure to the negative effects of protein restriction on muscle mass accretion, protein utilization, nutritional status, and muscle function in patients with moderate chronic renal insufficiency consuming a low-protein diet. Evidences were increased protein utilization and nitrogen retention indicated by higher rates of leucine oxidation) in patients with chronic renal insufficiency who performed 12 weeks of resistance training while consuming a low-protein diet. Also, the progression and intensity of the exercise regimen resulted to significant increased in upper and lower muscle strength with no exercise-related injuries or adverse effects. This study plays a key role in the therapeutic approach to chronic renal insufficiency. Resistance exercise s capable of offsetting the catabolic effects of low protein and energy intakes and the wasting syndrome of chronic uremia.
Castaneda, C., Gordon, P. et al.(2001). Resistance Training To Counteract the Catabolism of a Low-Protein
Diet in Patients with Chronic Renal Insufficiency
A Randomized, Controlled Trial. Ann Internal Medicine 135:965-976.Retrived July 3, 2009 from
http://www.annals.org/cgi/reprint/135/11/965
