Creatine supplementation plus neuromuscular electrical stimulation improves lower-limb muscle strength and quality of life in hemodialysis men

摘要

The interventions were divided into three stages: first week (first stage), consist in the assessment of clinical and anthropometric variables, food intake, muscle strength and quality of life. From the second to the fifth week (second stage) we did the intervention with the creatine supplementation and NMES, and sixth week (third stage), we repeated the first stage. All data were collected within 48 hours after the last supplementation and in the intermediary hemodialysis session (Figure 1B). Creatine supplementation was performed as previous described (first week: 20g per day of creatine plus 20g per day of maltodextrin and second to fourth weeks: 5g per day of creatine plus 5g per day of maltodextrin) (Maxtitanium?, Supley Laboratório de Alimentos e Suplementos Nutricionais, Mat?o, SP, Brazil).(4) Neuromuscular electrical stimulation was done bilaterally at the origin and insertion points of quadriceps or gastrocnemius muscles for 40 minutes during the hemodialysis sessions for three times a week for 1 month.(2) Body weight (kg), body fat and lean body mass (LBM) were obtained using the dual energy X-ray absorptiometry (DXA) (GE Hologic, Waltham, USA). Height was measured using a portable stadiometer (SECA?, Hamburg, Germany) and body mass index (BMI) was calculated based on the body weight and height. Thigh circumference was assessed by using the middle of thigh using an inelastic tape. Handgrip strength was assessed using a hydraulic dynamometer (Takei?, Japan) on the non-fistula side. One-repetition maximum (1RM) test was done in sitting position. After three warm-ups with interval of 1 minute of resting each, we performed five attempts to quantify the 1RM. Quality of life was measured using the Medical Outcomes Short-Form Health Survey (SF-36) questionnaire. Food intake assessment was recorded using three 24 hours food recalls, being measured 2 days on weekdays and 1 on the weekends. Food composition was done using the Dietpro? software (Agromi?dia Softwares, version 5.8, Vi?osa, MG, Brazil). The Shapiro-Wilk test was used to test the data normality. Paired Student t test was done to assess the difference at pre- versus post-intervention. Relationship between the physical role functioning and handgrip strength and 1RM leg extension was evaluated by the Pearson′s correlation. Cohen’s d classification was used to verify the effect sizes, such as trivial (d=0.2), medium (d=0.5), and large (d≥0.8). Statistical tests were performed using the software MedCalc? Belgium, and the statistical difference was set at 5%.