Body composition and exercise intolerance in renal transplant patients: the response to exercise training. Eugénie van den Ham

Transcription

1 Body composition and exercise intolerance in renal transplant patients: the response to exercise training Eugénie van den Ham

2 Consequences of malnutrition in HD patients Involuntary weight loss Fat mass Fat-free mass (muscle mass) Muscle weakness and exercise intolerance Physical activity Quality of life Mortality risk

3 ? Effects of successful renal transplantation on nutritional state and physical performance? Factors influencing nutritional state and physical performance in renal transplant patients? Chapter 2 t/m 7

4 Changes in weight (kg) Changes in body weight after renal transplantation 8,0 7,0 # * p < (baseline) # p < (12 months) 6,0 5,0 4,0 * 3,0 2,0 1,0 0, ,0-2,0 Time after RTx (months) Chapter 2

5 ? Changes in body composition after successful renal transplantation? Techniques to assess body composition in renal transplant patients? Chapter 3, 4, 5, 6

6 Methods to assess body composition Isotope dilution techniques Anthropometry Dual energy x-ray absorptiometry (DEXA) Multi-frequency bio-electrical impedance spectroscopy (MF-BIA) Chapter 3

7 Validation MF-BIA in RTx patients MF-BIA Isotope dilution Water compartments (TBW and ECW) MF-BIA DEXA Fat and fat-free mass Anthropometry Chapter 3

8 MF-BIA in RTx patients Method agreement MF-BIA - isotope dilution TBW: ICC = 0.94 suitable ECW: ICC = 0.84 not satisfactory Method agreement MF-BIA - DEXA FM and FFM: ICC = 0.88 questionable Chapter 3

9 Changes in body composition in the first six months after transplantation t = 0 t = 3 m t = 6 m p Weight (kg) 77.4 ± ± ± Fat mass (kg) 21.4 ± ± ± Fat-free mass (kg) 52.8 ± ± ± Fat-free mass = indicator muscle mass Chapter 4

10 Body composition in renal transplant patients (longer-term) Percentage body fat males: 24 % (ideal %) females: 38 % (ideal %) Waist-hip circumference males: 12 % > 1.00 females: 66 % > 0.80!! Chapter 6

11 Nutritional state after renal transplantation Body weight Fat mass (truncal fat) Cardiovascular disease Graft survival Patient survival

12 ? Which factors are involved in changes in body weight and body composition after renal transplantation? Chapter 2, 5 en 6

13 Potential factors Prednisolone Dietary pattern Physical inactivity Chapter 2, 5 en 6

14 Physical inactivity Physical activity preventing weight gain Physical activity level muscle mass and fat mass accumulation adipose tissue in upper, central body regions Renal transplant patients? Chapter 6

15 Factors body composition Prednisolone Nutrient intake Physical activity physical activity fat mass and muscle mass Chapter 2, 5 en 6

16 ? Effects of succesful renal transplantation on physical performance? Determinants of physical functioning and performance in renal transplant patients? Chapter 7

17 Physical performance Skeletal muscle strength - quadriceps femoris (Cybex) - specific muscle groups (fitness equipment) Exercise capacity - Wpeak and VO 2 peak (symptom-limited graded cycle-ergometry) Renal transplant patients Hemodialysis patients Healthy, sedentary controls Chapter 7

18 Strength (nm) Wpeak (Watt) Muscle strength and exercise capacity Quadriceps strength (Cybex) p < Peak work load (Cycle-ergometry) p < RTx HD CON RTx HD CON 0 RTx = renal transplant HD = hemodialysis CON = controls Chapter 7

19 Determinants of exercise capacity in RTx patients Skeletal muscle strength + Physical activity level + Chapter 7

20 Physical activity level RTx patients Low physical activity levels Adverse effects body composition Strongly reduced exercise capacity

21 ? Effects of exercise training on - body composition? - skeletal muscle strength and exercise capacity? - quality of life? Comparison of the response to exercise training in - renal transplant patients - hemodialysis patients - healthy controls Chapter 8

22 Hypotheses Training improves - body composition - skeletal muscle strength - quality of life Response to training dialysis patients < renal transplant patients< controls Multiple catabolic factors uremia dialysis treatment itself chronic inflammation oxidative stress Subnormale renal function Mostly using corticosteroids Chapter 8

23 Design of the study medical examination baseline training program 12 weeks post-training t = 0 t = 1 t = 6 t = 13 t = 14 time (weeks) body composition exercise capacity muscle strength quality of life muscle biopsy Chapter 8

24 Training program I standardized, 12 weeks lasting training program 2 supervised sessions (2 hrs each) per week each session endurance training (30 min) - cycle-ergometry and treadmill walking dynamic strength training (30 min) - alternating resistance or strength-endurance training break (30 min) alternating swimming or gymnastics (30 min) mixed groups of renal patients and controls Chapter 8

25 Training program II intensity endurance training: 50 % Wmax 75 % Wmax strength training: - resistance 50 % Pmax 60 % Pmax, 1x 10 3x 10 - strength-endurance 25 % Pmax 35 % Pmax, 1x 30 3x 30 after 6 weeks of training: measurement of Wmax en Pmax training intensity adjusted constant relative training intensity

26 Training Endurance training Dynamic strength training Gymnastics Swimming Chapter 8

27 Effects of training in RTx and HD patients no changes in body composition exercise capacity and skeletal muscle strength (20-25%) quality of life proportion type I MyHC isoforms, proportion type IIa MyHC isoforms trend for an increase in HAD enzyme activity, suggesting an improvement in fatty acid oxidation Chapter 8

28 Quadriceps (Nm) Arm- and dorsal muscles (kg) Wpeak (Watt) VO2peak (ml/min/kg BW) Changes in exercise capacity and skeletal muscle strength after exercise training 250 P time < 0.001; P time * group = P time = 0.004; P time * group = baseline 12 w eeks 20 baseline 12 w eeks 140 P time = 0.001; P time * group = P time < 0.001; P time * group = baseline 12 w eeks baseline 12 w eeks RTx HD Control

29 MyHC type IIb/x (%) HAD (U / mg protein) MyHC type I (%) MyHC type IIa (%) Changes in skeletal muscle fiber type distribution and HAD activity after exercise training 40 P time < 0.001; P time * group = P time = 0.036; P time * group = baseline 12 w eeks 30 baseline 12 w eeks 40 P time = 0.173; P time * group = P time = 0.052; P time * group = RTx HD 0 baseline 12 w eeks 0 baseline 12 w eeks Control

30 Response to training - No significant differences in the functional response and the intrinsic changes in skeletal muscle between RTx patients, HD patients and controls - Disease-specific factors do not appear to affect the response to exercise training

31 Exercise training has to be considered as part of the routine treatment of renal transplant and hemodialysis patients!