Abstract
Intradialytic exercise (ID) programs are effective and safe for hemodialysis (HD) patients to avoid functional deterioration. However, exercise is not routinely undertaken in most HD units, and we do not know if home-based (HB) programs are as effective as ID programs. The purpose of this study was to compare the effects of 16 weeks of ID exercise versus a HB exercise program for HD patients. A total of 46 patients were randomly assigned to the ID group (n = 24) or HB group (n = 22). They completed a 16-week combined exercise program 3 times/week. We measured physical activity level, physical functioning, depression level, and health-related quality of life at baseline and after 16 weeks. A significant time effect was found in both groups for the physical activity level (p = 0.012). There was also a significant group–time interaction effect for the one-leg standing test (OLST) (p = 0.049) and a significant time effect for the Short Physical Performance Battery (p = 0.013), timed up-and-go test (p = 0.005), sit-to-stand-10 (p = 0.027), right and left hand handgrip (p = 0.044, p < 0.001), one-heel left leg raise (p = 0.019), and 6-minute walking (p = 0.006), depression (p = 0.017). HRQoL remained unchanged. There was no difference between the two interventions on the tested outcomes (besides OLST). Both interventions were associated with positive changes of the physical activity levels and physical function.
Highlights
We found a total of twelve HB studies in HD patients17–28: 9 of them were randomized controlled trials[16,17,18,23,24,25,26,27,28], and only 316–18 implemented a combined HB exercise program comprising both aerobic and strength exercises
The study design tried to implement two different interventions balanced in exercise intensity and volume. Both programs aimed at improving lower limb muscle strength of the most commonly used muscle groups in activities of daily living, the restricted position for the Intradialytic exercise (ID) group limited how to perform strengthening exercises, and at HB group was not restricted at all regarding positions to do strength exercises
We tried to mimic the aerobic component, though ID group cycled while the HB group walked
Summary
Forty-six patients undergoing HD were recruited and randomly allocated into the ID or HB exercise groups. There was a significant time effect but a non-significant interaction effect and both groups had increased their physical activity levels by the end of the intervention (ID group pre = 62.4 ± 16.6, post = 67.3 ± 15.6; HB group pre=51.1 ± 18.1, post=54.3 ± 19.3; F = 7.642, p = 0.012) Both interventions were effective at increasing physical activity levels among the participants after 16 weeks of ID or HB exercise, without differences between groups. We observed a significant time effect, indicating that performance improved in both intervention groups
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