Intradialytic versus home based exercise training in hemodialysis patients: a randomised controlled trial

Kirsten P Koh,Robert G Fassett,James E Sharman,Andrew D Williams,Jeff S Coombes

doi:10.1186/1471-2369-10-2

Abstract

BackgroundExercise training in hemodialysis patients improves fitness, physical function, quality of life and markers of cardiovascular disease such as arterial stiffness. The majority of trials investigating this area have used supervised exercise training during dialysis (intradialytic), which may not be feasible for some renal units. The aim of this trial is to compare the effects of supervised intradialytic with unsupervised home-based exercise training on physical function and arterial stiffness.Methods and designThis is a randomised, controlled clinical trial. A total of 72 hemodialysis patients will be randomised to receive either six months of intradialytic exercise training, home-based exercise training or usual care. Intradialytic patients will undergo three training sessions per week on a cycle ergometer and home-based patients will be provided with a walking program to achieve the same weekly physical activity. Primary outcome measures are six-minute walk distance (6 MWD) and aortic pulse wave velocity (PWV). Secondary outcome measures include augmentation index, peripheral and central blood pressures, physical activity and self-reported health. Measures will be made at baseline, three and six months.DiscussionThe results of this study will help determine the efficacy of home-based exercise training in hemodialysis patients. This may assist in developing exercise guidelines specific for these patients.Trial RegistrationACTRN12608000247370

Highlights

Exercise training in hemodialysis patients improves fitness, physical function, quality of life and markers of cardiovascular disease such as arterial stiffness
The results of this study will help determine the efficacy of home-based exercise training in hemodialysis patients
Stiffening results in more rapid propagation of the arterial pulse pressure wave through the conductance arteries and can be readily assessed by measuring aortic pulse wave velocity (PWV; a marker of regional large artery stiffness) and central augmentation index (AIx; a composite marker of systemic arterial stiffness and left ventricular systolic loading)

Summary

Introduction

Exercise training in hemodialysis patients improves fitness, physical function, quality of life and markers of cardiovascular disease such as arterial stiffness. In addition to the characteristic lesions of atherosclerosis, dialysis patients experience thickening and fibrosis of the arterial wall in response to pressure and volume overload, loss of elastic fibres and medial fibrosis [7]. Such arterial remodelling, along with medial calcification, causes arteries to stiffen, thereby exacerbating left ventricular dysfunction [8]. There is a clear evidence base that measures of arterial stiffness are independent predictors of cardiovascular morbidity and mortality in different patient populations [10] but in ESKD patients [11,12,13]

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