Effect of Exercise Training on Interdialytic Ambulatory and Treatment‐Related Blood Pressure in Hemodialysis Patients

Abstract

Background: Exercise training improves blood pressure (BP) in the general population, but prior studies in hemodialysis (HD) patients only used pill counts or treatment‐related BPs. We evaluated the effect of 3 to 6 months of intradialytic exercise training on ambulatory blood pressure (ABP) and treatment‐related pre‐ and postdialysis BP. Patients and Methods: Nineteen chronic HD patients trained with an exercise bicycle for 30 to 60 min in the first 1 to 2 hr of each of thrice weekly HD. Interdialytic 44‐hr ABP was performed a week before training began and repeated at 3 and 6 months. Pre‐ and post‐HD systolic and diastolic BP and pre‐ and post‐HD weight were recorded for 2 months prior to training, throughout the training, and, if available, for the 2 months after training ended. BP medications were recorded throughout. Body composition by bioimpedance, and norepinephrine and epinephrine levels by RIA were done at 0, 3, and 6 months. Results: Thirteen subjects who completed at least 3 months of training exercised 90% of HD sessions for 56 min ± 23 SD each. Systolic and diastolic 44‐hr interdialytic ABP fell during training (systolic 138.4 mmHg ± 19.6 vs. 125.7 mmHg ± 20.0 vs. 125.9 mmHg ± 22.9; diastolic 83.2 mmHg ± 10.2 vs. 74.7 mmHg ± 9.0 vs. 73.9 mmHg ± 11.8 at 0, 3, and 6 months; p < .05 ANOVA). Norepinephrine and epinephrine levels did not independently predict systolic BP. Pre‐HD systolic BP was stable during the pretraining period, fell significantly during the training period (p < .03), and returned toward preexercise levels during the posttraining period (p < .001). Pre‐ or postweight, erythropoietin dose, total body water, and number of BP meds were unchanged. Conclusion: Exercise training during HD significantly improves both interdialytic ABP and treatment‐related BP.