Lysleine Alves de Deus and Professor Thiago Rosa, Universidade Católica de Brasília, Brasil
Chronic kidney disease (CKD) is a progressive and irreversible disease. CKD patients are prone to cardiovascular diseases secondary to abnormalities, such as increased oxidative stress and autonomic cardiac dysfunction. Cardiovascular diseases are the most frequent cause of death among patients regardless of their stage of kidney disease.
Our research published in Experimental Physiology suggests resistance training as another viable training option for therapeutic purposes in CKD patients. In our study, it delayed the progression of the disease and protected them from secondary abnormalities. Resistance training, specifically with and without blood flow restriction could be safely used alongside the conventional treatments.
We demonstrated that resistance training with and without blood flow restriction can improve redox balance and positively impact autonomic cardiac modulation, delaying a decrease in renal function. (Redox balance refers to the dynamic relationship between biomarkers of antioxidant defence (e.g. vitamin A, C, E, nitric oxide, etc.) and pro-oxidant, free radicals (e.g. reactive nitrogen and oxygen species etc.).
These results have important clinical implications for the management of redox balance and autonomic cardiac function in CKD patients. Moreover, we highlighted that resistance training with and without blood flow restriction appear to be a significant treatment for improving the prognosis of CKD.
Finally, we cannot fail to mention that the costs of CKD treatments increase with its progression, especially whether the patients need haemodialysis.
During our research, we become experts in evaluating and prescribing physical exercises specifically for people with different health conditions (from hypertension to diabetes mellitus and obesity) to master athletes, with successful results.
This research started when some nephrologists challenged us to improve CKD patients’ lifestyle habits. So, we studied the patients and disease, and our new project was born.
We then invited people who were diagnosed with stage 2 CKD and had been receiving traditional treatments to participate in the study.
They were randomized into three groups: the control group who did not perform any physical training, a group who performed traditional resistance training, and finally a group who performed resistance training with blood flow restriction.
Both groups who did training, did so for six months, three times per week on non-consecutive days. The training load was adjusted every two months and the patients were accompanied by a strength and conditioning professional in all training sessions.
Before and after the intervention period, we assessed heart rate variability using a cardiac monitor and the redox balance from blood samples. Then, we compared the results.
Even though there are lots of positive patient testimonials related to their participation and feeling better with training, by the end of the research many patients refused to maintain the exercise routine if there were not accompanied by strength and conditioning professionals during the training sessions.
A limitation of the study is that we could not have strict control of the eating habits of the patients which impacts redox balance. However, even if we could do that, our experimental set up probably would not have reflected the patients’ food habits. We also could not assess some hypoxia markers which allow us to better understand the mechanisms of resistance training with blood flow restriction.
In our future studies, we will seek to understand the molecular mechanisms induced by physical exercises performed in different intensities that contribute to delaying the CKD. This will allow us to update the treatment guidelines of CKD in earlier stages of disease.
For instance, other studies have shown that oxidative stress and autonomic dysfunction are associated with insulin resistance in CKD patients. In addition, most CKD patients have type 2 diabetes, increasing the risk of major adverse cardiovascular events.
Thus, it seems sensible to investigate the response of molecules related to glycaemic homeostasis in the face of resistance training with and without blood flow restriction.