Respiratory and muscular effects of a physiotherapy protocol carried out during hemodialysis in individuals with chronic renal failure: preliminary results.

Mayara Simões,Michele Lima Gregório,Moacir Fernandes De Godoy,Marilita Falângola Accioly

doi:10.1590/s1980-6574202000030001

Abstract

Abstract Aim: To analyze whether the proposed physiotherapy protocol during hemodialysis (HD) increases knee extensor muscle strength, palmar grip strength, respiratory muscle strength, lung function, and functional capacity of individuals with Chronic Renal Insufficiency (CRI) on HD. Methods: A preliminary results study, in which physical therapy intervention was performed in 11 subjects (49.2 ± 8.6 years) with CRI on HD treatment. Initially, Heart Rate Variability (HRV) was collected, with the individual at rest, for 15 minutes, and later, HRV linear and non-linear analyses were performed using HRV Kubios Premium Software. The protocol was performed in the first two hours of the HD session, three times a week for eight weeks, consisting of respiratory exercises, aerobic exercises, and electrical stimulation associated with progressive resistive exercises. The variables evaluated were respiratory muscle strength, knee extensor muscle strength, palmar grip strength, lung function, and functional capacity. Student's t-tests for paired samples and Wilcoxon's tests for non-parametric samples were used considering a significance level of 5%. Results: There was a significant increase in expiratory muscle strength (p = 0,012; Cohen’s d = 0,59), knee extensor muscle strength (p = 0,025; Cohen’s d = 0,77), palmar grip strength (P = 0,001; Cohen’s d = 0,52) and functional capacity (P = 0,009; Cohen’s d = 0,83). Conclusion: The proposed protocol is effective in increasing knee extensor muscle strength, palmar grip strength, expiratory muscle strength, and functional capacity of individuals with CRI on HD.

Highlights

Chronic Kidney Disease (CKD) consists of lesions of the kidney and progressive and irreversible loss of kidney function
The variables of maximal expiratory pressure (MEP) (Cohen’s d = 0.59, 95% CI 100.3 to 139.7), palmar grip strength (Cohen’s d = 0.52, 95% CI 26.32 to 42.68), left quadriceps strength (Cohen’s d = 0.77, 95% CI 44.3 to 56.72), and distance walked in the 6MWT’(Cohen’s d = 0.83, 95% CI 398.7 to 526.39) demonstrated statistically significant increases as well as large to very large effect sizes
The participants with Chronic Renal Failure (CRF) on HD showed low Heart Rate Variability (HRV), which is the main feature related to increased risk of cardiovascular events and responsible for the growing number of hospitalizations in this population with CRF35

Summary

Introduction

Chronic Kidney Disease (CKD) consists of lesions of the kidney and progressive and irreversible loss of kidney function. CRF has direct effects on the respiratory system, characterized by alterations, such as airflow limitation, obstructive disorders, reduced pulmonary diffusion capacity, decreased endurance, and respiratory muscle strength[3]. These respiratory alterations are related to muscle fibrous atrophy type I and type II, alterations in oxygen transport, extraction and consumption, vitamin D deficiency, increased protein catabolism, and energy metabolism dysfunction[4,5]. According to some studies[6,7], respiratory muscle strength and lung function of individuals with CRF on HD are lower than in the general population. Pulmonary dysfunction is considered an independent predictor of increased mortality in patients with CKD8

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