Effects of the Inspiratory Muscle Training and Aerobic Training on Respiratory and Functional Parameters, Inflammatory Biomarkers, Redox Status and Quality of Life in Hemodialysis Patients: A Randomized Clinical Trial

PLoS One. 2018 Jul 26;13(7):e0200727. doi: 10.1371/journal.pone.0200727. eCollection 2018.


Objective: Evaluate and compare the isolated and combined effects of Inspiratory Muscle Training (IMT) and Aerobic Training (AT) on respiratory and functional parameters, inflamatory biomarkers, redox status and health-related quality of life (HRQoL) in hemodialysis patients.

Methods: A randomised controlled trial with factorial allocation and intention-to-treat analysis was performed in hemodialysis patients. Volunteers were randomly assigned to performe 8-weeks of IMT at 50% of maximal inspiratory pressure (MIP), low intensity AT or combined training (CT). Before the interventions, all the volunteers went 8-weeks through a control period (without training). Measures are taken at baseline, 8-week (after control period) and 16-week (after the interventions). Primary outcomes were functional capacity (incremental shuttle walk test), MIP and lower limbs strength (Sit-to-Stand test of 30 seconds). Plasma levels of interleukin-6 (IL-6), soluble tumor necrosis factor receptor 1 (sTNFR1) and 2 (sTNFR2), adiponectin, resistin and leptin, redox status parameters and HRQoL (KDQOL-SF questionnaire) were the scondary outcomes. Data analyses were performed by two-way repeated measurements ANOVA.

Results: 37 hemodialysis patients aged 48.2 years old (IC95% 43.2-54.7) were randomized. Increase of MIP, functional capacity, lower limbs strength and resistin levels, and reduction of sTNFR2 levels in 16-week, compared to baseline and 8-week, were observed in all the groups (p<0.001). IMT improved functional capacity, MIP and lower limbs strength in 96.7m (IC95% 5.6-189.9), 34.5cmH2O (IC95% 22.4-46.7) and 2.2repetitions (IC95% 1.1-3.2) respectively. Increase in resistin leves and reduction in sTNFR2 leves after IMT was 0.8ng/dL (IC95% 0.5-1.1) and 0.8ng/dL (IC95% 0.3-1.3), respectively, without between-group differences. Compared to baseline and 8-week, adiponectin levels (p<0.001) and fatigue domain of the HRQoL (p<0.05) increased in 16-week only in CT.

Conclusion: IMT, AT and CT improved functional parameters and modulated inflammatory biomarkers, in addition, IMT provoked a similar response to low intensity AT in hemodialysis patients.

Trial registration: Registro Brasileiro de Ensaios clínicos RBR-4hv9rs.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers / analysis
  • Breathing Exercises / methods*
  • Fatigue / blood
  • Fatigue / etiology
  • Fatigue / physiopathology
  • Fatigue / rehabilitation*
  • Female
  • Humans
  • Inflammation / blood
  • Inflammation / etiology
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / therapy*
  • Male
  • Maximal Respiratory Pressures
  • Middle Aged
  • Muscle Strength
  • Quality of Life
  • Renal Dialysis / adverse effects*
  • Respiratory Muscles / physiopathology*
  • Surveys and Questionnaires
  • Treatment Outcome


  • Biomarkers

Grant support

This work was supported by Fundação de Amparo à Pesquisa do Estado de Minas gerais, APQ-03093-15; Authors who received the funding: MMOL; http://www.fapemig.br/arquivos/site/chamadas/analise/20151215114952-2015-01-universal-aprovados.pdf.