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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #165466
Title: RESISTANCE TRAINING TO COUNTERACT THE CATABOLISM OF A LOW-PROTEIN DIET IN PATIENTS WITH CHRONIC RENAL INSUFFICIENCY

Author
item CASTANEDA, CARMEN - TUFTS-HNRCA
item GORDON, PATRICIA - TUFTS-HNRCA
item UHLIN, KATHERIN - TUFTS-NEMC
item LEVEY, ANDREW - TUFTS-NEMC
item KEHAYIAS, JOSEPH - TUFTS-HNRCA
item DWYER, JOHANNA - TUFTS-NEMC
item ROUBENOFF, RONNEN - TUFTS-HNRCA
item FIELDING, ROGER - BOSTON UNIVERSITY
item FIATARONE, MARIA - UNIVERSITY OF SYDNEY

Submitted to: Annals of Internal Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/1/2001
Publication Date: 12/4/2001
Citation: Castaneda, C., Gordon, P.L., Uhlin, K.L., Levey, A.S., Kehayias, J.J., Dwyer, J.T., Roubenoff, R., Fielding, R.A., Fiatarone, M.A. 2001. Resistance training to counteract the catabolism of a low-protein diet in patients with chronic renal insufficiency. Annals Of Internal Medicine. 135:965-976.

Interpretive Summary: This study suggests that resistance training is a safe and effective countermeasure to the negative effects of protein restriction on muscle mass accretion, protein utilization, nutritional status, and muscle function in patients with moderate chronic renal insufficiency consuming a low-protein diet. After 12 weeks of resistance training, patients successfully adapted to the low-protein diet. This was evidenced by improved nitrogen retention, as shown by gains in total body potassium level; hypertrophy of type I and type II muscle-fiber area; increased prealbumin levels; maintenance of body weight; and increased protein utilization, as measured by leucine oxidation rates. The anabolic effects of resistance training were observed despite patient age, uremia, self-reported low energy intakes, anemia, low aerobic capacity, and comorbid diseases. We found that measurements of total body potassium were a precise indicator of small but significant changes in body cell mass resulting from successful adaptation and nitrogen retention. The significant association between levels of total body potassium and serum albumin concentrations, as well as the association between the changes in total body potassium level and muscle strength we observed, suggest that these measures may be useful as surrogates for protein homeostasis and adaptation in this patient population. If nutritional status cannot be improved by simply increasing protein or energy intake, resistance training may be a central component in the multifactorial therapeutic approach to chronic renal insufficiency and may result in successful adaptation to low-protein diets secondary to prescription or anorexia. Future studies with longer intervention periods, patients with more advanced stages of renal failure, and larger patient samples may confirm and extend our findings.

Technical Abstract: 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. 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. 26 older patients with moderate renal insufficiency (17 men, 9 women) who had achieved stabilization on a low-protein diet. 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. Total body potassium, mid-thigh muscle area, type I and II muscle-fiber cross-sectional area, and protein turnover. Mean protein intake was 0.64 +/- 0.07g/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 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 (32% +/- 14%) than without resistance training. 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.