Resistance Training To Counteract the Catabolism of a Low-Protein Diet in Patients with Chronic Renal Insufficiency

A Randomized, Controlled Trial

  1. Carmen Castaneda, MD, PhD;
  2. Patricia L. Gordon, RN, PhD;
  3. Katherine Leigh Uhlin, RD, MS;
  4. Andrew S. Levey, MD;
  5. Joseph J. Kehayias, PhD;
  6. Johanna T. Dwyer, DSc, RD;
  7. Roger A. Fielding, PhD;
  8. Ronenn Roubenoff, MD, MHS; and
  9. Maria Fiatarone Singh, MD
  1. From Tufts University, New England Medical Center, and Boston University Sargent College of Health and Rehabilitation Sciences, Boston, Massachusetts; and University of Sidney, Lidcome, Australia.

    Abstract

    Background: Chronic renal insufficiency leads to muscle wasting, which may be exacerbated by low-protein diets prescribed to delay disease progression. Resistance training increases protein utilization and muscle mass.

    Objective: To determine the efficacy of resistance training in improving protein utilization and muscle mass in patients with chronic renal insufficiency treated with a low-protein diet.

    Design: Randomized, controlled trial.

    Setting: Tufts University, Boston, Massachusetts.

    Patients: 26 older patients with moderate renal insufficiency (17 men, 9 women) who had achieved stabilization on a low-protein diet.

    Intervention: During a run-in period of 2 to 8 weeks, patients were instructed and their adherence to the low-protein diet (0.6 g/kg of body weight per day) was evaluated. They were randomly assigned to a low-protein diet plus resistance training (n = 14) or a low-protein diet alone (n = 12) for 12 weeks.

    Measurements: Total body potassium, mid-thigh muscle area, type I and II muscle-fiber cross-sectional area, and protein turnover.

    Results: Mean protein intake was 0.64 ± 0.07 g/kg per day after stabilization. Total body potassium and type I and II muscle-fiber cross-sectional areas increased in patients who performed resistance training by a mean (±SD) of 4% ± 8%, 24% ± 31%, and 22% ± 29%, respectively, compared with those who did not. Leucine oxidation and serum prealbumin levels also improved significantly. Patients assigned to resistance training maintained body weight compared with those who were not. Improvement in muscle strength was significantly greater with resistance training (32% ± 14%) than without (−13% ± 20%) (P < 0.001).

    Conclusion: By improving muscle mass, nutritional status, and function, resistance training seems to be effective against the catabolism of a low-protein diet and uremia in patients with renal failure.

    Article and Author Information

    • Disclaimer: Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the U.S. Department of Agriculture.

    • Acknowledgments: The authors thank the volunteers, who made this study possible, for their kind and valuable cooperation. They also thank the recruitment, nursing, and dietetic staff of the Metabolic Research Unit for their help in undertaking this study; the Nutrition Evaluation and Mass Spectrometry Laboratories at the HNRCA for their valuable assistance with biochemical and isotopic analyses; Keiser Sports Health Equipment, Inc., for the donation of the resistance training equipment; and Woodway USA for the donation of the treadmill. They especially thank the late Nancy Lundgren, MS, for her valuable help in the isotopic analyses. Finally, they thank Drs. James Strom and Geetha Narayan, Saint Elizabeth's Hospital; Dr. Henry Yager, Newton Wellesley Hospital; Drs. Elizabeth Bouthot, Chrisopher Ying, Mark Parker, and Samir Kassissieh, Lahey Hitchcock Clinic; and Drs. John T. Harrington, Nicolaos E. Madias, Klemens B. Meyer, Ronald D. Perrone, Andrew J. King, and Mark Sarnak, the attending physicians of the Nephrology Clinic at New England Medical Center.

    • Grant Support: In part by the National Institute on Aging (RO1 AG13457), the New England Medical Center Research Fund, and the U.S. Department of Agriculture, Agricultural Research Service (58-1950-9-001).

    • Requests for Single Reprints: Carmen Castaneda, MD, PhD, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111; e-mail, ccastaneda{at}hnrc.tufts.edu.

    • Current Author Addresses: Drs. Castaneda, Gordon, Kehayias, and Roubenoff: Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111.

    • Ms. Uhlin and Dr. Levey: Division of Nephrology, New England Medical Center, 35 Kneeland Street, Boston, MA 02111.

    • Dr. Dwyer: Frances Stern Nutrition Center, New England Medical Center, 750 Washington Street, Boston, MA 02111.

    • Dr. Fielding: Department of Health Sciences, Boston University Sargent College of Health and Rehabilitation Sciences, 635 Commonwealth Avenue, Boston, MA 02215.

    • Dr. Singh: School of Exercise and Sport Science, Faculty of Health Sciences, University of Sidney, East Street, Lidcombe 2141 NSW, Australia.

    • Author Contributions: Conception and design: C. Castaneda, A.S. Levey, J.T. Dwyer, R.A. Fielding, M.F. Singh.

    • Analysis and interpretation of the data: C. Castaneda, A.S. Levey, J.J. Kehayias, J.T. Dwyer, R. Roubenoff, M.F. Singh.

    • Drafting of the article: C. Castaneda, A.S. Levey, J.J. Kehayias, J.T. Dwyer, R. Roubenoff, M.F. Singh.

    • Critical revision of the article for important intellectual content: C. Castaneda, A.S. Levey, J.T. Dwyer, R. Roubenoff, M.F. Singh.

    • Final approval of the article: C. Castaneda, P.L. Gordon, K.L. Uhlin, A.S. Levey, J.J. Kehayias, J.T. Dwyer, R.A. Fielding, R. Roubenoff, M.F. Singh.

    • Provision of study materials or patients: C. Castaneda, A.S. Levey.

    • Statistical expertise: M.F. Singh.

    • Obtaining of funding: C. Castaneda, A.S. Levey, R.A. Fielding, M.F. Singh.

    • Administrative, technical, or logistic support: C. Castaneda, P.L. Gordon, K.L. Uhlin, J.T. Dwyer, R. Roubenoff, M.F. Singh.

    • Collection and assembly of data: C. Castaneda, P.L. Gordon, K.L. Uhlin, J.J. Kehayias.

    Summary for Patients

    • Summaries for Patients:Weight-Training Exercises To Counteract the Negative Effects of Low-Protein Diets in People with Kidney Disease Ann Intern Med December 4, 2001 135:S60
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    1. Ann Intern Med December 4, 2001 vol. 135 no. 11 965-976
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