Effects of intradialytic exercise in combination with melatonin supplementation on functional capacity, postural balance, and quality of life in hemodialysis patients
Houssem Marzougui
Research Laboratory Molecular Bases of Human Pathology LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
Search for more papers by this authorRami Maaloul
Research Laboratory Molecular Bases of Human Pathology LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
Search for more papers by this authorImen Ben Dhia
High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
Research Laboratory of Evaluation and Management of Musculoskeletal System Pathologies LR20ES09, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Search for more papers by this authorSalma Toumi
Nephrology Department, CHU Hedi Chaker, University of Sfax, Sfax, Tunisia
Research Laboratory of Renal Pathology LR19ES11, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Search for more papers by this authorKhawla Kammoun
Nephrology Department, CHU Hedi Chaker, University of Sfax, Sfax, Tunisia
Research Laboratory of Renal Pathology LR19ES11, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Search for more papers by this authorMohamed Ben Hmida
Nephrology Department, CHU Hedi Chaker, University of Sfax, Sfax, Tunisia
Research Laboratory of Renal Pathology LR19ES11, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Search for more papers by this authorFatma Ayadi
Research Laboratory Molecular Bases of Human Pathology LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Biochemistry Laboratory, CHU Habib Bourguiba, University of Sfax, Sfax, Tunisia
Search for more papers by this authorMouna Turki
Research Laboratory Molecular Bases of Human Pathology LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Biochemistry Laboratory, CHU Habib Bourguiba, University of Sfax, Sfax, Tunisia
Search for more papers by this authorMohamed Habib Elleuch
Research Laboratory of Evaluation and Management of Musculoskeletal System Pathologies LR20ES09, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Search for more papers by this authorSameh Ghroubi
Research Laboratory of Evaluation and Management of Musculoskeletal System Pathologies LR20ES09, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Search for more papers by this authorCorresponding Author
Omar Hammouda
Research Laboratory Molecular Bases of Human Pathology LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS, UPL, Paris Nanterre University, Nanterre, France
Correspondence
Omar Hammouda, Research Laboratory Molecular Bases of Human Pathology, LR19ES13, Faculty of medicine, University of Sfax, Sfax, Tunisia and Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS, UPL, Paris Nanterre University, Nanterre, France.
Email: [email protected]
Search for more papers by this authorHoussem Marzougui
Research Laboratory Molecular Bases of Human Pathology LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
Search for more papers by this authorRami Maaloul
Research Laboratory Molecular Bases of Human Pathology LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
Search for more papers by this authorImen Ben Dhia
High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
Research Laboratory of Evaluation and Management of Musculoskeletal System Pathologies LR20ES09, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Search for more papers by this authorSalma Toumi
Nephrology Department, CHU Hedi Chaker, University of Sfax, Sfax, Tunisia
Research Laboratory of Renal Pathology LR19ES11, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Search for more papers by this authorKhawla Kammoun
Nephrology Department, CHU Hedi Chaker, University of Sfax, Sfax, Tunisia
Research Laboratory of Renal Pathology LR19ES11, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Search for more papers by this authorMohamed Ben Hmida
Nephrology Department, CHU Hedi Chaker, University of Sfax, Sfax, Tunisia
Research Laboratory of Renal Pathology LR19ES11, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Search for more papers by this authorFatma Ayadi
Research Laboratory Molecular Bases of Human Pathology LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Biochemistry Laboratory, CHU Habib Bourguiba, University of Sfax, Sfax, Tunisia
Search for more papers by this authorMouna Turki
Research Laboratory Molecular Bases of Human Pathology LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Biochemistry Laboratory, CHU Habib Bourguiba, University of Sfax, Sfax, Tunisia
Search for more papers by this authorMohamed Habib Elleuch
Research Laboratory of Evaluation and Management of Musculoskeletal System Pathologies LR20ES09, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Search for more papers by this authorSameh Ghroubi
Research Laboratory of Evaluation and Management of Musculoskeletal System Pathologies LR20ES09, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Search for more papers by this authorCorresponding Author
Omar Hammouda
Research Laboratory Molecular Bases of Human Pathology LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS, UPL, Paris Nanterre University, Nanterre, France
Correspondence
Omar Hammouda, Research Laboratory Molecular Bases of Human Pathology, LR19ES13, Faculty of medicine, University of Sfax, Sfax, Tunisia and Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS, UPL, Paris Nanterre University, Nanterre, France.
Email: [email protected]
Search for more papers by this authorSameh Ghroubi and Omar Hammouda participated equally in the study.
Abstract
Introduction
We evaluated the effect of intradialytic concurrent (resistance-endurance) training combined with melatonin (MEL) supplementation on functional capacity, muscle strength, postural balance, and quality of life (QoL) in hemodialysis (HD) patients.
Methods
Thirty-three HD patients were randomized into three groups: Exercise (EX)-MEL (n = 11); EX-Placebo (PLA) (n = 11) and Control (C)-PLA (n = 11). Participants included in the EX-MEL and EX-PLA groups were submitted to concurrent training for 12 weeks.
Results
EX-MEL and EX-PLA improved functional capacity, muscle strength, QoL, and postural balance parameters in eyes open and eyes closed conditions. Parameters of postural balance in the dual task condition were improved only in EX-MEL. EX-MEL induced better results in some domains of QoL compared with EX-PLA.
Conclusion
Intradialytic concurrent training induced beneficial effects on physical function, muscle strength, postural balance, and QoL in HD patients. MEL supplementation combined with intradialytic exercise lead to better improvements in postural balance and QoL.
CONFLICT OF INTEREST
The authors declare that they have no conflict of interest.
REFERENCES
- 1Johansen KL, Kaysen GA, Dalrymple LS, Grimes BA, Glidden DV, Anand S, et al. Association of physical activity with survival among ambulatory patients on dialysis: the comprehensive dialysis study. Clin J Am Soc Nephrol. 2013; 8(2): 248–53.
- 2Johansen KL. Exercise in the end-stage renal disease population. J Am Soc Nephrol. 2007; 18(6): 1845–54.
- 3Blake C, O'Meara YM. Subjective and objective physical limitations in high-functioning renal dialysis patients. Nephrol Dial Transplant. 2004; 19(12): 3124–9.
- 4Sheng K, Zhang P, Chen L, Cheng J, Wu C, Chen J. Intradialytic exercise in hemodialysis patients: a systematic review and meta-analysis. Am J Nephrol. 2014; 40(5): 478–90.
- 5Chan D, Cheema BS. Progressive resistance training in end-stage renal disease: systematic review. Am J Nephrol. 2016; 44(1): 32–45.
- 6Heiwe S, Jacobson SH. Exercise training in adults with CKD: a systematic review and meta-analysis. Am J Kidney Dis. 2014; 64(3): 383–93.
- 7van Vilsteren MC, de Greef MH, Huisman RM. The effects of a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counselling for sedentary haemodialysis patients in The Netherlands: results of a randomized clinical trial. Nephrol Dial Transplant. 2005; 20(1): 141–6.
- 8Grigoriou SS, Krase AA, Karatzaferi C, Giannaki CD, Lavdas E, Mitrou GI, et al. Long-term intradialytic hybrid exercise training on fatigue symptoms in patients receiving hemodialysis therapy. Int Urol Nephrol. 2021; 53(4): 771–84.
- 9Vaziri ND, Oveisi F, Reyes GA, Zhou XJ. Dysregulation of melatonin metabolism in chronic renal insufficiency: role of erythropoietin-deficiency anemia. Kidney Int. 1996; 50(2): 653–6.
- 10Koch BC, van der Putten K, Van Someren EJ, et al. Impairment of endogenous melatonin rhythm is related to the degree of chronic kidney disease (CREAM study). Nephrol Dial Transplant. 2010; 25(2): 513–9.
- 11Geron R, Shurtz-Swirski R, Sela S, Gurevitch Y, Tanasijtchouk T, Orr ZS, et al. Polymorphonuclear leucocyte priming in long intermittent nocturnal haemodialysis patients—is melatonin a player? Nephrol Dial Transplant. 2006; 21(11): 3196–201.
- 12Sanger D, Soubrane C, Scatton B. New perspectives for the treatment of disorders of sleep and arousal. Ann Pharm Fr. 2007; 65: 268–74.
- 13Koch BC, Nagtegaal JE, Hagen EC, et al. The effects of melatonin on sleep–wake rhythm of daytime haemodialysis patients: a randomized, placebo-controlled, cross-over study (EMSCAP study). Br J Clin Pharmacol. 2009; 67(1): 68–75.
- 14Kamoun A, Hammouda O, Yahia A, Dhari O, Ksentini H, Driss T, et al. Effects of melatonin ingestion before nocturnal sleep on postural balance and subjective sleep quality in older adults. J Aging Phys Act. 2019; 27(3): 316–24.
- 15Russcher M, Koch BC, Nagtegaal JE, et al. Long-term effects of melatonin on quality of life and sleep in haemodialysis patients (Melody study): a randomized controlled trial. Br J Clin Pharmacol. 2013; 76(5): 668–79.
- 16Beck W, Scariot P, Gobatto C. Melatonin is an ergogenic aid for exhaustive aerobic exercise only during the wakefulness period. Int J Sports Med. 2016; 37(1): 71–6.
- 17Beck TW. The importance of a priori sample size estimation in strength and conditioning research. J Strength Cond Res. 2013; 27(8): 2323–37.
- 18Faul F, Erdfelder E, Lang A-G, Buchner A. G* power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007; 39(2): 175–91.
- 19 Association WM. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013; 310(20): 2191–4.
- 20Gellish RL, Goslin BR, Olson RE, McDonald A, Russi GD, Moudgil VK. Longitudinal modeling of the relationship between age and maximal heart rate. Med Sci Sports Exerc. 2007; 39(5): 822–9.
- 21Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982; 14(5): 377–81.
- 22Johansen KL, Painter PL, Sakkas GK, Gordon P, Doyle J, Shubert T. Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis: a randomized, controlled trial. J Am Soc Nephrol. 2006; 17(8): 2307–14.
- 23 American Thoracic Society. Statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002; 166: 111–7.
- 24Fitts SS, Guthrie MR. Six-minute walk by people with chronic renal failure. Assessment of effort by perceived exertion. Am J Phys Med Rehabil. 1995; 74(1): 54–8.
- 25Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992; 30(6): 473–83.
- 26Mingardi G, Cornalba L, Cortinovis E, Ruggiata R, Mosconi P, Apolone G. Health-related quality of life in dialysis patients. A report from an Italian study using the SF-36 health survey. DIA-QOL group. Nephrol Dial Transplant. 1999; 14(6): 1503–10.
- 27Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Lawrence Erlbaum Associates: Hillsdale, NJ; 1988.
10.1046/j.1526-4610.2001.111006343.x Google Scholar
- 28de Moura RM, Henrique DMN, de Souza FR, Chaoubah A, Bastos MG, de Paula RB. Exercise training during hemodialysis reduces blood pressure and increases physical functioning and quality of life. Artif Organs. 2010; 34(7): 586–93.
- 29Fernandes AO, Sens YADS, Xavier VB, Miorin LA, Alves VLS. Functional and respiratory capacity of patients with chronic kidney disease undergoing cycle ergometer training during hemodialysis sessions: a randomized clinical trial. Int J Nephrol. 2019; 2019:7857824.
- 30Ferrucci L, Guralnik JM, Buchner D, Kasper J, Lamb SE, Simonsick EM, et al. Departures from linearity in the relationship between measures of muscular strength and physical performance of the lower extremities: the Women's health and aging study. J Gerontol A Biol Sci Med Sci. 1997; 52(5): M275–85.
- 31Bicer M, Akil M, Avunduk MC, Kilic M, Mogulkoc R, Baltaci AK. Interactive effects of melatonin, exercise and diabetes on liver glycogen levels. Endokrynol Pol. 2011; 62(3): 252–6.
- 32Leonardo-Mendonça RC, Ocaña-Wilhelmi J, de Haro T, de Teresa-Galván C, Guerra-Hernández E, Rusanova I, et al. The benefit of a supplement with the antioxidant melatonin on redox status and muscle damage in resistance-trained athletes. Appl Physiol Nutr Metab. 2017; 42(7): 700–7.
- 33Hara M, Iigo M, Ohtani-Kaneko R, Nakamura N, Suzuki T, Reiter RJ, et al. Administration of melatonin and related indoles prevents exercise-induced cellular oxidative changes in rats. Neurosignals. 1997; 6(2): 90–100.
- 34Rahman MM, Kwon H-S, Kim M-J, Go H-K, Oak M-H, Kim D-H. Melatonin supplementation plus exercise behavior ameliorate insulin resistance, hypertension and fatigue in a rat model of type 2 diabetes mellitus. Biomed Pharmacother. 2017; 92: 606–14.
- 35Mohseni R, Zeydi AE, Ilali E, Adib-Hajbaghery M, Makhlough A. The effect of intradialytic aerobic exercise on dialysis efficacy in hemodialysis patients: a randomized controlled trial. Oman Med J. 2013; 28(5): 345–9.
- 36Booth F, Tseng B, Flück M, Carson J. Molecular and cellular adaptation of muscle in response to physical training. Acta Physiol Scand. 1998; 162(3): 343–50.
- 37Kouidi E, Albani M, Natsis K, Megalopoulos A, Gigis P, Guiba-Tziampiri O, et al. The effects of exercise training on muscle atrophy in haemodialysis patients. Nephrol Dial Transplant. 1998; 13(3): 685–99.
- 38Amstrup AK, Sikjaer T, Mosekilde L, Rejnmark L. The effect of melatonin treatment on postural stability, muscle strength, and quality of life and sleep in postmenopausal women: a randomized controlled trial. Nutr J. 2015; 14(1): 102.
- 39Öner J, Öner H, Sahin Z, Demir R, Üstünel İ. Melatonin is as effective as testosterone in the prevention of soleus muscle atrophy induced by castration in rats. Anat Rec. 2008; 291(4): 448–55.
- 40Frih B, Mkacher W, Jaafar H, Frih A, ben Salah Z, el May M, et al. Specific balance training included in an endurance-resistance exercise program improves postural balance in elderly patients undergoing haemodialysis. Disabil Rehabil. 2018; 40(7): 784–90.
- 41Shin S, Chung HR, Fitschen PJ, Kistler BM, Park HW, Wilund KR, et al. Postural control in hemodialysis patients. Gait Posture. 2014; 39(2): 723–7.
- 42Parker KP. Sleep disturbances in dialysis patients. Sleep Med Rev. 2003; 7(2): 131–43.
- 43Patel M, Gomez S, Berg S, Almbladh P, Lindblad J, Petersen H, et al. Effects of 24-h and 36-h sleep deprivation on human postural control and adaptation. Exp Brain Res. 2008; 185(2): 165–73.
- 44Knight EL, Ofsthun N, Teng M, Lazarus JM, Curhan GC. The association between mental health, physical function, and hemodialysis mortality. Kidney Int. 2003; 63(5): 1843–51.
- 45Innominato PF, Lim AS, Palesh O, Clemons M, Trudeau M, Eisen A, et al. The effect of melatonin on sleep and quality of life in patients with advanced breast cancer. Support Care Cancer. 2016; 24(3): 1097–105.
- 46Nagtegaal J, Kerkhof G, Smits M, Van Der Meer Y. Delayed sleep phase syndrome: a placebo-controlled cross-over study on the effects of melatonin administered five hours before the individual dim light melatonin onset. J Sleep Res. 1998; 7(2): 135–43.
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