**Muscles**

Skeletal muscle is not a simple homogenous group of fibers. Type I fibers are characterized by slow speed of contraction, low activity of myosin ATPase and are well suited for prolonged aerobic exercise. Type II fibers have the ability to generate energy for quick and forceful contractions. At training there is an increase in both muscle fibre size and muscle number, the largest effect being increase of muscle size. The number of mitochondria and the small vessels in the muscles increase. Interestingly, even very old people could increase the strength. In an interesting study it was shown that 90-year old persons living at a nursing home could double the muscle strength, increase the quadriceps muscular volume with 10 % as well as increase the daily function after 8 weeks of bodybuilding (Fiatarone et al 1990).

### **Cardiosvascular system**

The cardiac output will increase. The normal pulse will be reduced. The small arteries will dilate which contribute to decreasing blood pressure. The blood circulation to the heart and muscles will increase and both the blood volume and the haemoglobin level will increase.

Many patients with CKD have hypertension. In dialysis the hypertension is most linked to salt and water over load. After kidney transplantation the immunosuppressive drugs CNI (calcineurin inhibitors such as tacrolimus and ciclosporin) and corticosteroids contribute to hypertension. In transplants patients with CAN (chronic allograft nephropathy) ischemia in the kidneys aggravate the situation and give severe hypertension with often therapy resistant blood pressure.

The basis of treatment in hypertension is life style changes, exercise, stop smoking habits and decrease of the sodium chloride in the diet. These are basic advice applicable also to the CKD patients. Many patients have treatment with diuretics to decrease salt and water. Betablockers protect the heart from stress and lower the pulse rate, sometimes hamper maximal training efforts. Calcium blockers are frequently used, cause relaxation of the muscles and vasodilatation.

ACE-inhibitors block the angiotensin system and are often well tolerated. It could however be important to be aware of the fact that severe dehydration could be dangerous due to risk of high serum potassium and loss of blood pressure which is a severe condition. This information is important to give to the patient in case of any situation with loss of water like gastrointestinal acute diseases.

Regular physical activity lowers the blood pressure but the blood pressure increases during exercise, mostly the systolic blood pressure. With a stress ECG the individual patient could get information about the level of blood pressure and ECG changes during efforts. There are recommended levels not to exceed.

### **Nerve system**

430 Progress in Hemodialysis – From Emergent Biotechnology to Clinical Practice

Hence, this chapter is chosen with the intention to provide the reader with information concerning exercise capacity and level of physical activity in adults with chronic kidney disease. It also has the aim to make health-care providers within renal medicine aware of exercise training as an evidence-based intervention to improve health and well-being in adults with CKD. Despite the fact that exercise training is easy, cost effective and preventive, exercise training has not been implemented into clinical practice. We hope that this chapter will stimulate to action and provide some knowledge about these patients and their problems in order to understand why exercise training should be included in the standard care for adults with CKD. The chapter also contains general information about

It is important to consider the training models, methodology, and expected changes that happen at regular physical activity in general. We consider different measures to describe

*Frequency* - That means how often we do the training. A daily dosage of effort like

 *Intensity* - This is how the levels of efforts are. A common used definition is RM that is repetition maximum. One RM is the weight or load you are able to lift once but not twice. It has been shown that 60-70% of 1 RM could be enough for the starter to give an increase of muscle strength. For the well-trained it is necessary with almost 70-84% for

 *Duration* - It is the length of the exercise period at a time. A 30 minute period of physical exercise is nowadays a common, recommended duration. A simple and common instrument is the pedometer, which could quantify the number of steps and

Skeletal muscle is not a simple homogenous group of fibers. Type I fibers are characterized by slow speed of contraction, low activity of myosin ATPase and are well suited for prolonged aerobic exercise. Type II fibers have the ability to generate energy for quick and forceful contractions. At training there is an increase in both muscle fibre size and muscle number, the largest effect being increase of muscle size. The number of mitochondria and the small vessels in the muscles increase. Interestingly, even very old people could increase the strength. In an interesting study it was shown that 90-year old persons living at a nursing home could double the muscle strength, increase the quadriceps muscular volume with 10 % as well as increase

The cardiac output will increase. The normal pulse will be reduced. The small arteries will dilate which contribute to decreasing blood pressure. The blood circulation to the heart and muscles will increase and both the blood volume and the haemoglobin level will increase.

calculate the calories, the walking distance one could obtain during a period. Concerning intensity this could be varied by adding different muscle groups. The level of effort and the muscle groups involved are important for the results. If you add walking with sticks, the shoulder and arm muscles become involved and increase the results. In these

The general effects of training are many. Below are some aspects and findings.

exercise and expected effects in healthy individuals.

taking walks, taking stair-cases is basic.

the activities.

**Muscles** 

**Cardiosvascular system** 

**2. What is a training program for grown-up people?** 

the increase of muscle mass and strength (Kramer et al 1997).

moments also the important coordination becomes involved.

the daily function after 8 weeks of bodybuilding (Fiatarone et al 1990).

Regular physical activity affects the nerves. The coordination, the balance and the ability to react becomes better. Most of the persons who do regular exercise have better sleep, less depressions and more self-esteem.

### **Hormone system**

The exercise increases the insulin sensitivity in the skeletal muscle and decreases the insulin in the blood. This means less adiposities and a more healthy profile of the lipids with increased HDL-cholesterol and decreased triglycerides. For body builders the growth hormone may increase. Also testosterone levels have been found to increase and androgen receptors which increase the effect of testosterone (Kraemer et al 2005). Added testosterone has a much stronger effect, both increasing the muscle mass and adding new cells. However, this substance is classified as doping preparation. Cortisol is a catabolic substance and could be increased at stress caused by some exercises and exercisers. However, cortisol is a life-necessary substance. Catecholamine (noradrenalin and adrenalin) are also produced in the moments of stress, fight and flight response. There is probably an anabolic effect on the skeletal muscles which has been shown in certain animal studies. That is why these preparations are on the doping list. Insulin-like growth factor (IGF-1) could also be produced locally in the muscle but the systemic effect is unclear.
