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Effect of Progressive Resistance Training on Measures of Skeletal Muscle Hypertrophy, Muscular Strength and Health-Related Quality of Life in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis

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Abstract

Background and Objective

Skeletal muscle wasting resulting in reduced muscular strength and health-related quality of life (HR-QOL) is common in chronic kidney disease (CKD) and may be reversed with progressive resistance training (PRT). Therefore, we systematically assessed the effect of PRT on measures of skeletal muscle hypertrophy, muscular strength and HR-QOL in this cohort to inform clinical practice and guidelines.

Design

We performed a systematic review and meta-analysis.

Inclusion Criteria

We included randomised controlled trials (RCTs) that investigated the independent effect of PRT (>6 weeks) on measures of skeletal muscle hypertrophy [muscle mass or cross-sectional area (CSA)], muscular strength and/or HR-QOL in adults with CKD.

Data Extraction and Analysis

The standardised mean difference (SMD) from each study was pooled to produce an overall estimate of effect and associated 95 % confidence interval (95 % CI) between treatment and control groups on primary outcomes.

Results

Seven RCTs in 271 patients with Stage 3–5 CKD yielded seven studies on muscular strength (N = 249), six studies on total body muscle mass (N = 200) and six studies on HR-QOL (N = 223). PRT significantly improved standardised muscular strength [SMD 1.15 (95 % CI 0.80–1.49)] and HR-QOL [SMD 0.83 (95 % CI 0.51–1.16)], but not total body muscle mass [SMD 0.29 (95 % CI −0.27 to 0.86)] in our primary analysis. However, secondary analysis of six studies showed that PRT induced significant muscle hypertrophy of the lower extremities (leg mass, or mid-thigh or quadriceps CSA) [SMD 0.43 (95 % CI 0.11–0.76)], a pertinent analysis given that most studies implemented lower-body PRT only.

Conclusions

Robust evidence from RCTs indicates that PRT can induce skeletal muscle hypertrophy and increase muscular strength and HR-QOL outcomes in men and women with CKD. Therefore, clinical practice guidelines should be updated to inform clinicians on the benefits of PRT in this cohort.

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Acknowledgments

BSC is the guarantor of the paper, taking responsibility for the integrity of the work as a whole, from inception to published article. BSC, DC and EA conceived and designed the review, identified articles for inclusion and exclusion, extracted and interpreted the data and drafted the article. PF analysed and interpreted the data and revised the article. All authors have approved and read the final article. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The authors declare they have no competing interests. We sincerely thank Ms Katrina Chaudhary for her work in developing the database searches.

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Authors and Affiliations

  1. School of Science and Health, University of Western Sydney, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia

    Birinder S. Cheema, Danwin Chan & Paul Fahey

  2. The National Institute of Complementary Medicine (NICM), University of Western Sydney, Campbelltown, NSW, 2650, Australia

    Birinder S. Cheema

  3. School of Nursing and Midwifery, University of Western Sydney, Penrith, NSW, Australia

    Evan Atlantis

  4. School of Medicine, University of Adelaide, Adelaide, SA, Australia

    Evan Atlantis

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  1. Birinder S. Cheema
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Correspondence to Birinder S. Cheema.

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Cheema, B.S., Chan, D., Fahey, P. et al. Effect of Progressive Resistance Training on Measures of Skeletal Muscle Hypertrophy, Muscular Strength and Health-Related Quality of Life in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Sports Med 44, 1125–1138 (2014). https://doi.org/10.1007/s40279-014-0176-8

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