Abstract
IntroductionWhether clinically implementable exercise interventions in people receiving hemodialysis (HD) therapy improve health-related quality of life (HRQoL) remains unknown. The PrEscription of intraDialytic exercise to improve quAlity of Life (PEDAL) study evaluated the clinical benefit and cost-effectiveness of a 6-month intradialytic exercise program.MethodsIn a multicenter, single-blinded, randomized, controlled trial, people receiving HD were randomly assigned to (i) intradialytic exercise training (exercise intervention group [EX]) and (ii) usual care (control group [CON]). Primary outcome was change in Kidney Disease Quality of Life Short-Form Physical Component Summary (KDQOL-SF 1.3 PCS) from baseline to 6 months. Cost-effectiveness was determined using health economic analysis; physiological impairment was evaluated by peak oxygen uptake; and harms were recorded.ResultsWe randomized 379 participants; 335 and 243 patients (EX n = 127; CON n = 116) completed baseline and 6-month assessments, respectively. Mean difference in change PCS from baseline to 6 months between EX and CON was 2.4 (95% confidence interval [CI]: −0.1 to 4.8) arbitrary units (P = 0.055); no improvements were observed in peak oxygen uptake or secondary outcome measures. Participants in the intervention group had poor compliance (47%) and poor adherence (18%) to the exercise prescription. Cost of delivering intervention ranged from US$598 to US$1092 per participant per year. The number of participants with harms was similar between EX (n = 69) and CON (n = 56). A primary limitation was the lack of an attention CON. Many patients also withdrew from the study or were too unwell to complete all physiological outcome assessments.ConclusionsA 6-month intradialytic aerobic exercise program was not clinically beneficial in improving HRQoL as delivered to this cohort of deconditioned patients on HD.
Highlights
Whether clinically implementable exercise interventions in people receiving hemodialysis (HD) therapy improve health-related quality of life (HRQoL) remains unknown
Higher levels of physical activity are associated with better scores in HRQoL measures, physical functioning, depression, and burden of kidney disease symptoms.[8]
The aim of the PEDAL trial was to evaluate the clinical value of a 6-month intradialytic exercise program on QoL, compared with usual care, for patients receiving HD therapy
Summary
Whether clinically implementable exercise interventions in people receiving hemodialysis (HD) therapy improve health-related quality of life (HRQoL) remains unknown. Kidney International Reports (2021) 6, 2159–2170 patients receiving HD therapy globally, but disability and associated symptoms remain highly prevalent accounting for more life years lost to disability.[1] In the UK, 48% of the HD population report severe functional dependencies,[2] which impact on HRQoL.[3] Components of HRQoL, the domain of physical functioning, stand out as the strongest predictor of survival, hospitalizations, and morbidity.[4] Knight et al.[5] and Lowrie et al.[6] report multiple symptoms that affect the physical component of HRQoL.[7] higher levels of physical activity are associated with better scores in HRQoL measures, physical functioning, depression, and burden of kidney disease symptoms.[8]
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