Progressive Resistance Training and Nutrition in Renal Failure Maria Chan, MND, RD,* Birinder Singh Bobby Cheema, PhD,† and Maria A. Fiatarone Singh, MD, FRACP ‡ Nutrition and exercise are an integral part of the medical management of many chronic and complex conditions. They are interrelated and share many common metabolic pathways that may affect disease processes and their management. In nephrology, nutritional interventions have been relatively well studied and are recommended in many evidence-based clinical practice guidelines for managing people with chronic kidney disease (CKD). Over the past 20 years, growing evidence has suggested that aerobic exercise interventions are efficacious, and that the rationale for progressive resistance training (PRT) is strong, particularly in this population, despite a more limited evidence base to date. In the small number of clinical trials that have included patients with CKD, PRT programs have proved safe, feasible to administer, and efficacious. They have been shown to improve clinical, physical, and functional outcomes. © 2007 by the National Kidney Foundation, Inc. P ATIENTS WITH ADVANCED chronic kid- ney disease (CKD, stages 4 to 5), regardless of the need for renal replacement therapy (RRT), are characterized by a profound decrease in muscle mass that is multifactorial in origin. This muscle wasting is associated with impaired muscle strength and a decline in physical function that is directly related to greater risks of morbidity, mortality, and hospital- ization. A number of factors contribute to myopathy 1 in renal disease (Table 1). These include uremia and sequelae of renal failure (ie, hormonal and electrolyte abnormalities, secondary hyperpara- thyroidism, catabolism), malnutrition, physical inactivity, comorbid illness, medication used (ste- roid therapy), and age-related issues such as sar- copenia and disability in older patients. Malnu- trition–inflammation is common in patients with CKD and contributes to catabolism of muscle and loss of strength. Benefits of Exercise Training The potential benefits of, and rationale for, exercise training for patients with CKD are de- scribed by Castaneda et al 2 and Cheema et al. 3 Research on exercise intervention in renal fail- ure 4 has focused on aerobic (cardiovascular en- durance) training. Some of these studies have reported improvement in aerobic capacity, blood pressure control, and lipid profiles, as well as quality-of-life scoring. However, aero- bic training is known to be minimally effective in improving muscle mass and muscle strength. Often, this treatment approach may not be feasible and safe for patients who have mobility impairment, cardiopulmonary disease, or he- modynamic instability. Clinical trials that implemented progressive re- sistance training (PRT) interventions in other chronically diseased cohorts have described im- provements in metabolism and musculoskeletal and physical performance outcomes. These in- clude muscle hypertrophy and improved oxida- tive capacity in patients with chronic heart failure (CHF) 5 and human immunodeficiency virus (HIV) 6 ; increased bone density with steroid-in- duced osteoporosis in lung transplant recipients 7 ; *Department of Nutrition and Dietetics, The St. George Hos- pital, Sydney, Australia. †Institute of Food, Nutrition, and Human Health, Massey University, Wellington, New Zealand. ‡School of Exercise and Sport Science, University of Sydney, Sydney, Australia; Hebrew SeniorLife and Jean Mayer USDA Human Nutrition Centre on Aging at Tufts University, Boston, Massachusetts. Address reprint requests to Maria Chan, MND, RD, Depart- ment of Nutrition and Dietetics, The St. George Hospital, Kogarah NSW, 2217 Australia. E-mail: maria.chan@sesiahs.health. nsw.gov.au © 2007 by the National Kidney Foundation, Inc. 1051-2276/07/1701-0016$32.00/0 doi:10.1053/j.jrn.2006.10.014 Journal of Renal Nutrition, Vol 17, No 1 ( January), 2007: pp 84-87 84