Intradialytic Modified Tai Chi Exercise among End-Stage Renal Disease Patients Undergoing Hemodialysis: An Exploratory Pilot Study

Abstract

Background: Evidence suggests that intradialytic exercise benefits end-stage renal disease (ESRD) patients. We examined the feasibility of intradialytic modified Tai Chi (IMTC) among ESRD undergoing hemodialysis and assessed IMTC’s impact on risk of falls, bone metabolism, oxidative stress damage, and quality of life in ESRD patients. Methods: Forty-five ESRD patients were randomized to either non-exercising control group (CON, n=25) or IMTC group (n=20) who performed IMTC exercise 3/week, 45 min/session while sitting in a recliner with one arm connected to the dialysis machine for 12 weeks. At baseline and 12 weeks, we measured risk-of-falls related parameters (balance, gait, and functioning strength), biomarkers of bone metabolism and oxidative stress damage, and quality of life. Results: Thirty-four participants completed the study. The feedback from participants suggests that IMTC exercise is easy to learn and feasible. After 12 weeks, IMTC tended to lower tartrate- resistant acid phosphatase (bone resorption biomarker) and improved quality of life (role physical and vitality) compared to CON. There was no significant difference in balance, gait, and functional strength, possibly due to a ceiling effect. There was no significant difference in serum bone-specific alkaline phosphatase, calcium, phosphorus and intact parathyroid hormone levels, plasma 8-hydroxy-2’-deoxyguanosine levels, and other domains of quality of life. The CON group experienced a 20% decrease in 25-hydroxy vitamin D at the end of study. Conclusions: IMTC exercise was safe and well accepted by ESRD patients. It improved quality of life, tended to suppress bone resorption, and helped maintain 25-hydroxy vitamin D levels in ESRD patients. These findings need to be confirmed in a larger, more sufficiently powered efficacy study.