Exercise improves anemia?

[Janicetay]

Is there any good and credible studies done on impact of exercise on managing anemia in hemodialysis patients? There are loads on effect of anemia on exercise tolerance, performance, etc, but I've not been able to find any on how exercise may improve the management of anemia.

[Beth Witten MSW ACSW]

Here are some abstracts of early studies on the effects of exercise on anemia and other factors when anabolic steroids were used to treat anemia and EPO had not yet been bioengineered.

American Journal of Clinical Nutrition, Vol 33, 1620-1628, 1980.
The metabolic and psychological effects of exercise training in hemodialysis patients
AP Goldberg, J Hagberg, JA Delmez, RM Carney, PM McKevitt, AA Ehsani and HR Harter

The effect of exercise training on metabolic abnormalities and psychological function was assessed in seven hemodialysis patients. Their initial work capacity was low and improved after 8 months of training. Exercise was associated with a reduction in the dose of antihypertensive medications in four patients and a decrease in phosphate binder therapy in three patients. There was also a rise in hematocrit levels (% delta = 34 +/- 20%, P less than 0.03) and the hemoglobin concentration (% delta = 37 +/- 23%, P less than 0.05) of five males. Plasma glucose levels fell (-5 +/- 2%, P less than 0.05, n = 5) and the glucose disappearance rate improved (20 +/- 7%, P less than 0.02), while hyperinsulinism decreased (-36 +/- 20%, P less than 0.02, n = 5) during training. There was no change in body weight or diet. Exercise lowered plasma triglyceride levels (-41 +/- 28%, P less than 0.02, n = 6) and raised the high-density lipoprotein cholesterol concentration (20 +/- 21%, P less than 0.05, n = 6). Psychological testing (n = 4) demonstrated that exercise training was associated with an improvement in depression, hostility, anxiety, social interaction, and outlook for the future. These results suggest that exercise can improve some of metabolic abnormalities and psychological dysfunction which exists in some dialysis patients.

Full text at http://www.ajcn.org/cgi/reprint/33/7/1620

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Nephron. 1986;42(4):311-6.

Exercise training reduces coronary risk and effectively rehabilitates
hemodialysis patients.

Goldberg AP, Geltman EM, Gavin JR 3rd, Carney RM, Hagberg JM, Delmez JA, Naumovich A, Oldfield MH, Harter HR.

This study examines the effects of 12 months of endurance exercise training (cycling, walking and jogging) on lipid profiles, glucose metabolism, blood pressure, anemia and psychological function in 14 hemodialysis patients. Maximal aerobic capacity (VO2max) increased 18% in the exercisers (p less than 0.01), but did not change in 11 controls. This was associated with a reduction in depression, a decrease in dosages of antihypertensive medications, a significant increase in hematocrit and hemoglobin levels (red cell mass rose, plasma volume
did not change), a decrease in plasma triglyceride by 23% (p less than 0.05) and an increase in high-density lipoprotein cholesterol (HDL-C) levels by 21% (p less than 0.01) (both HDL-C and triglyceride levels worsened in the sedentary controls), and an 18% increase in glucose disappearance rates (p less than 0.05) in spite of a 52% decrease in fasting insulin levels (p less than 0.01), suggesting that insulin sensitivity improved. These results demonstrate that some of the complications present in hemodialysis patients may be caused by their sedentary life-style, rather than endstage renal disease itself. This suggests that rehabilitation through exercise is possible for these patients. By reducing coronary risk factors in hemodialysis patients, exercise training may also decrease their heightened morbidity and mortality from atherosclerotic
complications. These possibilities need to be examined in a longitudinal study.