Abstract
BackgroundPhysical activity (PA) is typically lower on hemodialysis (HD) days. Albeit intradialytic inactivity is expected, it is unknown whether recovery after HD contributes to low PA. We investigated the impact of HD and post-HD period on granular PA relative to HD timing.MethodsWe used baseline data from the HDFIT trial conducted from August 2016 to October 2017. Accelerometry measured PA over 1 week in patients who received thrice-weekly high-flux HD (vintage 3 to 24 months), were clinically stable, and had no ambulatory limitations. PA was assessed on HD days (0 to ≤24 h after start HD), first non-HD days (> 24 to ≤48 h after start HD) and second non-HD day (> 48 to ≤72 h after start HD). PA was recorded in blocks/slices: 4 h during HD, 0 to ≤2 h post-HD (30 min slices), and > 2 to ≤20 h post-HD (4.5 h slices). Blocks/slices of PA were captured at concurrent/parallel times on first/second non-HD days compared to HD days.ResultsAmong 195 patients (mean age 53 ± 15 years, 71% male), step counts per 24-h were 3919 ± 2899 on HD days, 5308 ± 3131 on first non-HD days (p < 0.001), and 4926 ± 3413 on second non-HD days (p = 0.032). During concurrent/parallel times to HD on first and second non-HD days, patients took 1308 and 1128 more steps (both p < 0.001). Patients took 276 more steps and had highest rates of steps/hour 2-h post-HD versus same times on first non-HD days (all p < 0.05). Consistent findings were observed on second non-HD days.ConclusionsPA was higher within 2-h of HD versus same times on non-HD days. Lower PA on HD days was attributable to intradialytic inactivity. The established PA profiles are of importance to the design and development of exercise programs that aim to increase activity during and between HD treatments.Trial registrationHDFIT was prospectively registered 20 April 2016 on ClinicalTrials.gov (NCT02787161)
Highlights
Physical activity (PA) is typically lower on hemodialysis (HD) days
Studies in hemodialysis (HD) populations using pedometers/accelerometers report average PA levels range from 2446 to 8454 steps/day; PA is lower on HD days versus non-HD days [6, 7, 18,19,20,21,22,23,24,25]. and PA decreases with longer vintage [18, 24]
Trial design HDFIT was a prospective, multi-center, unblinded, randomized controlled trial (RCT) studying the impact of modality on objective PA [28]
Summary
Physical activity (PA) is typically lower on hemodialysis (HD) days. Albeit intradialytic inactivity is expected, it is unknown whether recovery after HD contributes to low PA. A limitation of most studies conducted to date is they assessed PA by calendar days (i.e. 0:00–23:59 h) and have not assessed PA relative to the timing of HD [2, 5,6,7, 18,19,20,21,22,23,24,25,26,27]. It is unknown if recovery after HD may influence PA on HD days in addition to requirements of sitting/lying during HD. With the potential impacts of HD on PA, granular assessments are needed to find timepoints for risk assessment and interventions
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