eTheses
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Item Resistance (exercise) training in non-dialysis dependent chronic kidney disease (ckd stage 3) and validation of ultrasound in the measurement of muscle size and structure in haemodialysis patients (ckd stage 5)(Queen Margaret University, Edinburgh, 2014) Geneen, LouiseAIM: This thesis set out to make an original contribution to knowledge with regard to methods of assessing muscle size and architecture in the CKD and ESRD population, and to assess the ability to improve the muscle size and architecture, and symptoms of uraemia, by implementing an anabolic intervention (resistance exercise training) in the CKD population. OUTCOME MEASURES: Ultrasound was shown to have high validity (against gold standard MRI measures; ICCs: VLACSA 0.96, VL depth 0.99, fat depth 0.98) and intra-rater reliability (ICCs: VL depth 0.98, total muscle depth 0.97, fat depth 0.99; MDC: VL depth 0.14cm, total muscle depth 0.19cm, fat depth 0.22cm) in measuring regional body composition at the mid-VL site in the CKD population. There were significant (p<0.01) correlations between US-derived measures of (mid-VL) muscle size and architecture with strength and function (larger muscle mass and/or pennation angle positively correlated with higher strength and/or functional performance). Patient-reported uraemic symptoms were worse (p<0.01) in those with reduced strength and/or function. INTERVENTION RESULTS: An anabolic (resistance training) intervention (12-weeks, randomized to once [RT1 n=7] or three times [RT3 n=10] per week, 80%1RM) brought about significant improvements over time (p<0.01) in all measures of muscle size and architecture (VL depth, total muscle depth, VLACSA, pennation angle). Interaction effects (group*time) were only seen in pennation angle (p<0.05) and VLACSA (p<0.01) where RT3 gains were greater than RT1 from week 8 onwards. All measures of strength, function, and uraemic symptoms improved over time (p<0.01) with no interaction effects (no difference from greater training frequency/ volume). CLINICAL AND RESEARCH IMPLICATIONS: The intervention results suggest implementing a RT form of “prehabilitation” in early stage (CKD3) patients just once per week is sufficient to bring about statistically and clinically important changes in strength and function that benefit the patient through reduced frequency and/or intrusiveness of uraemic symptoms (improved health-related quality of life), with minimal time-commitment. Further research should examine if there is additional benefit to the significantly greater increases in VLACSA and pennation angle observed in RT3, with regards to long-term maintenance of functional improvements, and whether an RT1 or RT3 programme delays the progression of CKD, the need for RRT, and patient mortality.Item The effect of a 12 month intradialytic exercise intervention on function, quality of life, nutritional status and clinical status(Queen Margaret University, 2010) Smith, SaraHaemodialysis (HD) patients are reported to have low levels of physical function, poor quality of life, protein energy wasting and inflammation, which negatively impact on morbidity and mortality. Exercise has previously been used as an intervention in HD patients; however the majority of previous studies have been of short duration and utilised moderate or high intensities requiring individual supervision of each exercise session. These studies recruited young patients with low levels of comorbidity and primarily focused on changes in VO2max/peak. This limits the ability to generalise findings to the wider prevalent HD population. The aims of the present study were therefore to determine whether a low to moderate intensity intradialytic exercise intervention with broad applicability, could over a 12 month period improve functional status and in turn quality of life, nutritional status and clinical status in a prevalent HD population in Scotland. Patients were recruited from NHS Fife, to a non-randomised controlled study and followed a progressive intradialytic aerobic exercise programme. One exercise session was conducted with individual supervision and two sessions with general supervision from dialysis staff. Outcome measures included measures of function (sit to stand, timed up and go, and handgrip), quality of life (SF36v2), nutritional status (anthropometric measurements, dual frequency bioelectrical impedance analysis, dietary intake and appetite) and clinical status (dialysis adequacy, biochemistry, high sensitivity C-reactive protein, blood pressure, medications). Measurements were taken at 6 time points: -1, 0, 3, 6, 9 and 12 months. 25 patients (mean age 56 + 11.4 years) volunteered for the intervention and 13 patients (mean age 60.8 + 14.6 years) volunteered as controls. At baseline groups demonstrated functional impairment, poor quality of life, and low fat free mass and had evidence of low grade inflammation. 25 patients completed 3 months of the exercise intervention, 20 completed 6 months, 16 completed 9 months and 13 patients completed 12 months. Of the 13 control patients 6 remained at 3 months and 5 at 6 months. In the exercise group, significant improvements were observed in all measures of function and 6 out of 8 physical and psychosocial quality of life domains. Anthropometric measures of fat free mass increased. Clinical status improved significantly seen as reductions in systolic blood pressure and prescribed erythropoietin stimulating agent doses. These improvements were observed in the intervention group at 3 and 6 months. No improvements were observed in the control group. Improvements in the majority of outcome measures were also seen in the intervention group at 6 and 12 months. These results suggest that the introduction of a low to moderate intensity intradialytic exercise programme requiring minimal individual supervision is feasible and provides clinically significant improvements in function from 3 months onwards. Such improvements are accompanied by higher quality of life scores and improved aspects of nutritional and clinical status.