Endurance-oriented training program with children and adolescents on maintenance hemodialysis to enhance dialysis efficacy-DiaSport.

OBJECTIVE: Pediatric patients spend significant time on maintenance hemodialysis (HD) and traveling. They are often not capable of participating in sports activities. To assess the effects of exercise training during HD on dialysis efficacy in children and adolescents, we set up a multi-center randomized controlled trial (RCT). METHODS: Patients on HD, age 6 to 18 years, were randomized either to 3× weekly bicycle ergometer training or to no training during HD for 12 weeks. Change in single-pool Kt/V (spKt/V) was the primary outcome parameter. RESULTS: We randomized 54 patients of whom 45 qualified (23 in the intervention and 22 in the waiting control group, 14.5 ± 3.01 years, 32 male and 13 female) for the intention-to-treat (ITT) population. Only 26 patients finished study per-protocol (PP). Training was performed for an average of 11.96 weeks (0.14-13.14) at 2.08 ± 0.76 times per week and for a weekly mean of 55.52 ± 27.26 min. Single-pool Kt/V was similar in the intervention compared to the control group (1.70 [0.33] vs. 1.79 [0.55]) at V0 and (1.70 [0.36] vs. 1.71 [0.51]) at V1; secondary endpoints also showed no difference in both ITT and PP analysis. No significant adverse events were reported. No bleeding or needle dislocation occurred in 1670 training sessions. CONCLUSIONS: Intradialytic bicycle training is safe, but does not improve dialysis efficacy and physical fitness. However, the study can be considered underpowered, particularly because of high dropout rates. Future studies need better strategies to increase motivation and compliance and other more effective/intensive exercise measures should be evaluated. TRIAL REGISTRATION: The trial was registered in ClinicalTrials.Gov ( Clinicaltrials.gov identifier: NCT01561118) on March 22, 2012.

Endurance training during maintenance hemodialysis in pediatric and adolescent patients-theory and best practice suggestions.

Patients on maintenance hemodialysis (HD) spend significant sedentary time traveling to and receiving dialysis, which leaves little time for social or sport events. Also, chronic HD patients are not physically fit, too exhausted after HD, and are not necessarily motivated to perform sports. There is increasing evidence that endurance training during HD can both increase dialysis efficacy and improve the ability of patients to participate in social life. With limited spare time, how can we motivate patients to train? Would that training improve endurance and modify leisure activity choice? Since HD patients would be a captive audience, we would suggest that endurance training during HD would be a preferred solution, if pediatric and adolescent patients could be persuaded to participate. There are few data on how training should be organized, as well as which parameters are best markers of safety and efficacy. And, most importantly, motivational aspects for performing endurance training on a regular basis clearly have to be considered. It is therefore in any case important to assess whether training improves endurance and, thus, quality of life or also quality of care parameters.

Cardiorespiratory capacity in children and adolescents on maintenance haemodialysis.

BACKGROUND: Paediatric patients on maintenance haemodialysis (HD) often report their own physical fitness to be hampered. Their physical endurance capacity is known to be significantly lower than that of healthy controls. However, physical endurance was up to now only examined on non-HD days. We were interested in the effect of HD on the cardiorespiratory capacity of children and adolescents on maintenance HD. METHODS: We therefore examined the endurance capacity by cardiopulmonary exercise testing on a cycle ergospirometer, before and after HD in 14 patients (9 male, 5 female; mean age: 15.1 ± 3.0 years; mean period on HD: 16.3 ± 11.5 months). RESULTS: The feasible time spent on the cycle ergospirometer was significantly reduced after dialysis (8.6 ± 3.2 versus 6.4 ± 2.5 min, P < 0.001), also the maximal workload was decreased (95 ± 36 W to 74 ± 29 W, P < 0.003). The starting and recovery heart rates were higher after than before dialysis. The peak oxygen uptake (VO(2) peak, VO(2) peak/kg) was reduced from 1.644 ± 600 to 1.422 ± 450 mL/min (P < 0.02) and from 35 ± 7 to 31 ± 5 mL/min/kg (P < 0.03), respectively. The respiratory exchange ratio as well as the lactate values showed significant differences in varied workload levels (P < 0.05). CONCLUSIONS: Paediatric patients on maintenance HD in general have a significantly lower exercise capacity compared to a healthy age-matched population, which is expressed much more after dialysis.

How to carry out a health-orientated marathon training programme for running and inline skating.

BACKGROUND: More and more people want to do something for their health. Nevertheless, certain reluctance exists when it comes to committing oneself to higher sporting aims, as well as some uncertainty concerning proper training. DESIGN AND METHODS: Two model projects have been developed, aimed at motivating larger parts of the population towards a health-orientated training programme. Both projects serve as a basis for further, similarly designed large-scale projects. In the running project a health-focused run training programme was set up aimed at preparing people, previously inexperienced in running, for a marathon. In the inline project an inline training programme was developed which comprised both the training of essential techniques as well as individualized endurance training, the aim being the participation in an inline marathon. RESULTS: A total of more than 1000 people participated in both projects. The health check performed before the beginning of the project revealed some pathological findings, demonstrating the necessity of a medical examination before taking up regular training. Both projects led to an improvement in endurance performance. In addition, the blood-chemical metabolic parameters showed clear optimization, in particular the lipid profile. The inline technique training resulted in an improvement of the braking skills, which is accompanied by a reduction in the risk of injuries. CONCLUSIONS: Both model projects have shown that large-scale sports programmes that focus primarily on the prevention of injuries and disease (under sport-medical guidance) with a performance incentive are accepted by the population, provided they offer a high fun factor.