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Response of the oxygen uptake efficiency slope to exercise training in patients with chronic kidney disease.

ABSTRACT: Background:Chronic kidney disease (CKD) patients have poor cardiorespiratory fitness. Although cardiopulmonary exercise testing (CPET) is a universal assessment of cardiorespiratory fitness, values taken at 'peak' effort are strongly influenced by motivation and the choice of test endpoint. The oxygen uptake efficiency slope (OUES) integrates cardiovascular, musculoskeletal, and respiratory function into a single index to provide a more pragmatic and safer alternative to maximal testing. No research has explored whether exercise can improve the OUES in CKD patients. Methods:Thirty-two patients with non-dialysis CKD were recruited into a 12-week exercise program consisting of mixed aerobic and resistance training three times a week. CPET was conducted at baseline, and then, following a 6-week control period, at pre- and post-exercise intervention. Direct measurements of oxygen consumption (V?O2) and ventilatory parameters were collected. The OUES was calculated as the relationship between V?O2 and the log10 of minute ventilation (V?E). Results:No changes were observed in any variable during the control period, although modest increases in V?O2peak were observed. No meaningful changes were observed as a result of exercise in any cardiorespiratory value obtained. The OUES calculated at 100%, 90%, 75%, and 50% of exercise duration did not change significantly after 12 weeks of exercise training. Conclusion:Our results show that 12 weeks of exercise training had no beneficial effects on the OUES, which supports the modest change observed in V?O2peak. The lack of change in the OUES and other parameters could indicate a dysfunctional cardiorespiratory response to exercise in patients with CKD, likely mediated by dysfunctional peripheral metabolic mechanisms.

SUBMITTER: Wilkinson TJ

PROVIDER: S-EPMC7530363 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Response of the oxygen uptake efficiency slope to exercise training in patients with chronic kidney disease.

Wilkinson Thomas J TJ Watson Emma L EL Vadaszy Noemi N Baker Luke A LA Viana João L JL Smith Alice C AC

Kidney research and clinical practice 20200901 3

<h4>Background</h4>Chronic kidney disease (CKD) patients have poor cardiorespiratory fitness. Although cardiopulmonary exercise testing (CPET) is a universal assessment of cardiorespiratory fitness, values taken at 'peak' effort are strongly influenced by motivation and the choice of test endpoint. The oxygen uptake efficiency slope (OUES) integrates cardiovascular, musculoskeletal, and respiratory function into a single index to provide a more pragmatic and safer alternative to maximal testing. ...[more]

PMID: 32550710

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Project description:BackgroundThe potential effects of aerobic and resistance training in patients with severe chronic kidney disease (CKD) are not fully elucidated. This study investigated the effects of a home-based exercise programme on physical functioning and health-related quality of life (HRQOL) in patients with Stage 4 CKD, equivalent to estimated glomerular filtration rate of 15-30 mL/min/1.73 m2 .MethodsForty-six patients with Stage 4 CKD (median age, 73 years; 33 men) were randomly assigned to exercise (n = 23) and control (n = 23) groups. Exercise group patients performed aerobic exercise at 40-60% peak heart rate thrice weekly and resistance training at 70% of one-repetition maximum twice weekly at home for 6 months. Control patients received no specific intervention. Primary outcomes were distance in incremental shuttle walking test and HRQOL assessed using the Kidney Disease Quality of Life-Short Form questionnaire. Secondary outcomes included kidney function assessed with combined urea and creatinine clearance, urinary biomarkers, and anthropometric and biochemical parameters associated with CKD.ResultsImprovement in incremental shuttle walking test was significantly greater in the exercise group compared with controls (39.4 ± 54.6 vs. -21.3 ± 46.1; P < 0.001). Among Kidney Disease Quality of Life domains, significant mean differences were observed between the exercise group and the control group in work status, quality of social interaction, and kidney disease component summary outcomes (12.76 ± 5.76, P = 0.03; 5.97 ± 2.59, P = 0.03; and 4.81 ± 1.71, P = 0.007, respectively). There were greater reductions in natural log (ln)-transformed urinary excretion of liver-type fatty acid-binding protein, ln serum C-reactive protein, and acylcarnitine to free carnitine ratio in the exercise group compared with controls, with significant between-group differences of -0.579 ± 0.217 (P = 0.008), -1.13 ± 0.35 (P = 0.003), and -0. 058 ± 0.024 (P = 0.01), respectively.ConclusionsOur 6 month home-based exercise programme improved aerobic capacity and HRQOL in patients with Stage 4 CKD, with possible beneficial effects on kidney function and CKD-related parameters.

Project description:Low cardiorespiratory fitness is a powerful predictor of morbidity and cardiovascular mortality. In 473 sedentary adults, all whites, from 99 families of the Health, Risk Factors, Exercise Training, and Genetics (HERITAGE) Family Study, the heritability of gains in maximal O(2) uptake (VO(2max)) after exposure to a standardized 20-wk exercise program was estimated at 47%. A genome-wide association study based on 324,611 single-nucleotide polymorphisms (SNPs) was undertaken to identify SNPs associated with improvements in VO(2max) Based on single-SNP analysis, 39 SNPs were associated with the gains with P < 1.5 × 10(-4). Stepwise multiple regression analysis of the 39 SNPs identified a panel of 21 SNPs that accounted for 49% of the variance in VO(2max) trainability. Subjects who carried ≤9 favorable alleles at these 21 SNPs improved their VO(2max) by 221 ml/min, whereas those who carried ≥19 of these alleles gained, on average, 604 ml/min. The strongest association was with rs6552828, located in the acyl-CoA synthase long-chain member 1 (ACSL1) gene, which accounted by itself for ~6% of the training response of VO(2max). The genes nearest to the SNPs that were the strongest predictors were PR domain-containing 1 with ZNF domain (PRDM1); glutamate receptor, ionotropic, N-methyl-D-aspartate 3A (GRIN3A); K(+) channel, voltage gated, subfamily H, member 8 (KCNH8); and zinc finger protein of the cerebellum 4 (ZIC4). The association with the SNP nearest to ZIC4 was replicated in 40- to 65-yr-old, sedentary, overweight, and dyslipidemic subjects trained in Studies of a Targeted Risk Reduction Intervention Through Defined Exercise (STRRIDE; n = 183). Two SNPs were replicated in sedentary obese white women exercise trained in the Dose Response to Exercise (DREW) study (n = 112): rs1956197 near dishevelled associated activator of morphogenesis 1 (DAAM1) and rs17117533 in the vicinity of necdin (NDN). The association of SNPs rs884736 in the calmodulin-binding transcription activator 1 (CAMTA1) locus and rs17581162 ~68 kb upstream from regulator of G protein signaling 18 (RGS18) with the gains in VO(2max) in HERITAGE whites were replicated in HERITAGE blacks (n = 247). These genomic predictors of the response of Vo(2max) to regular exercise provide new targets for the study of the biology of fitness and its adaptation to regular exercise. Large-scale replication studies are warranted.

Project description:Oxygen consumption ([Formula: see text]) provides established clinical and physiological indicators of cardiorespiratory function and exercise capacity. However, [Formula: see text] monitoring is largely limited to specialized laboratory settings, making its widespread monitoring elusive. Here we investigate temporal prediction of [Formula: see text] from wearable sensors during cycle ergometer exercise using a temporal convolutional network (TCN). Cardiorespiratory signals were acquired from a smart shirt with integrated textile sensors alongside ground-truth [Formula: see text] from a metabolic system on 22 young healthy adults. Participants performed one ramp-incremental and three pseudorandom binary sequence exercise protocols to assess a range of [Formula: see text] dynamics. A TCN model was developed using causal convolutions across an effective history length to model the time-dependent nature of [Formula: see text]. Optimal history length was determined through minimum validation loss across hyperparameter values. The best performing model encoded 218 s history length (TCN-VO2 A), with 187, 97, and 76 s yielding <3% deviation from the optimal validation loss. TCN-VO2 A showed strong prediction accuracy (mean, 95% CI) across all exercise intensities (-22 ml min-1, [-262, 218]), spanning transitions from low-moderate (-23 ml min-1, [-250, 204]), low-high (14 ml min-1, [-252, 280]), ventilatory threshold-high (-49 ml min-1, [-274, 176]), and maximal (-32 ml min-1, [-261, 197]) exercise. Second-by-second classification of physical activity across 16,090 s of predicted [Formula: see text] was able to discern between vigorous, moderate, and light activity with high accuracy (94.1%). This system enables quantitative aerobic activity monitoring in non-laboratory settings, when combined with tidal volume and heart rate reserve calibration, across a range of exercise intensities using wearable sensors for monitoring exercise prescription adherence and personal fitness.

Project description:Skeletal muscle metabolic function is known to respond positively to exercise interventions. Developing non-invasive techniques that quantify metabolic adaptations and identifying interventions that impart successful response are ongoing challenges for research. Healthy non-athletic adults (18-35 years old) were enrolled in a study investigating physiological adaptations to a minimum of 16 weeks endurance training prior to undertaking their first marathon. Before beginning training, participants underwent measurements of skeletal muscle oxygen consumption using near-infrared spectroscopy (NIRS) at rest (resting muscle[Formula: see text]O2) and immediately following a maximal exercise test (post-exercise muscle[Formula: see text]O2). Exercise-related increase in muscle[Formula: see text]O2 (Δm[Formula: see text]O2) was derived from these measurements and cardio-pulmonary peak[Formula: see text]O2 measured by analysis of expired gases. All measurements were repeated within 3 weeks of participants completing following the marathon and marathon completion time recorded. Muscle[Formula: see text]O2 was positively correlated with cardio-pulmonary peak[Formula: see text]O2 (r = 0.63, p < 0.001). Muscle[Formula: see text]O2 increased at follow-up (48% increase; p = 0.004) despite no change in cardio-pulmonary peak[Formula: see text]O2 (0% change; p = 0.97). Faster marathon completion time correlated with higher cardio-pulmonary peak[Formula: see text]O2 (rpartial = -0.58, p = 0.002) but not muscle[Formula: see text]O2 (rpartial = 0.16, p = 0.44) after adjustment for age and sex [and adipose tissue thickness (ATT) for muscle[Formula: see text]O2 measurements]. Skeletal muscle metabolic adaptions occur following training and completion of a first-time marathon; these can be identified non-invasively using NIRS. Although the cardio-pulmonary system is limiting for running performance, skeletal muscle changes can be detected despite minimal improvement in cardio-pulmonary function.

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Response of the oxygen uptake efficiency slope to exercise training in patients with chronic kidney disease.

Publications

Response of the oxygen uptake efficiency slope to exercise training in patients with chronic kidney disease.

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