Abstract
Background: Tunisia has the highest prevalence of hemodialysis patients compared to the other countries in North Africa. Dialysis centers rarely offer an exercise program to prevent physiological and psychological dialysis therapy-related alterations in chronic hemodialysis patients.Aim: To examine the effect of combined endurance-resistance training program on physiological and psychological outcomes in patients undergoing hemodialysis.Methods: We designed a single blinded, randomized, controlled study for a period of 4 months. Patients were randomized to intervention group or control group. Intervention group patients received 4 training sessions per week, held on non-hemodialysis days for a period of 4 months, whereas control group patients continued their regular lifestyle practice without direct intervention from the personnel of this investigation. Patients were evaluated at baseline (initial assessment) and after the four-month study period (final assessment) by the same investigator blinded to treatment group assignment using physical, physiological, and psychological measurements.Results: Compared with control group, intervention group showed significant improvement in physical performance during the sit-to-stand-to-sit tests (STS-10: −16.2%, ES = −1.65; STS-60: +23.43%, ES = 1.18), handgrip force task (+23.54%, ES = 1.16), timed up and go test (−13.86%, ES = −1.13), and 6-min walk test (+15.94%, ES = 2.09). Likewise, mini nutritional assessment long form scores after intervention period were significantly higher in the intervention group compared to the control group (ES = 1.43). Physical and mental component scores of SF-36 questionnaire increased significantly in the intervention group (ES = 1.10 and ES = 2.06, respectively), whereas hospital anxiety and depression scale scores decreased significantly (ES = −1.65 and ES = −2.72, respectively). Regarding biological parameters, intervention group displayed improvement in systolic and diastolic blood pressures (ES = −2.77 and ES = −0.87, respectively), HDL-cholesterol, LDL-cholesterol, and triglycerides systematic levels (ES = 1.15, ES = −0.98, and ES = −1.01, respectively); however no significant effect of intervention period was observed on C-reactive protein, hemoglobin, albumin, and total cholesterol levels (P > 0.05).Conclusion: The current study showed that combined endurance-resistance training program had a beneficial effect on physical capacity and quality of life in chronic hemodialysis patients.
Highlights
Chronic kidney disease is characterized by a progressive loss of renal function and considered as a serious public health problem worldwide with incidence much higher in the developing world
The deconditioning spiral associated with end-stage renal disease (Painter, 1994) arises from inactivity which has a major impact on normal physical function and will result in disability associated with an increased mortality risk in people undergoing HD (Moore et al, 1993; Johansen et al, 2003; Sietsema et al, 2004)
Post-hoc test revealed a significant improvement in performance during the sit tests (STS)-10 (−16.2%), STS60 (+23.43%), handgrip force (+23.54%), TUG (−13.86%), and 6-min walk test (6MWT) (+15.94%) tests for the intervention group compared to the control group (P < 0.001, Figure 2)
Summary
Chronic kidney disease is characterized by a progressive loss of renal function and considered as a serious public health problem worldwide with incidence much higher in the developing world. In North Africa, Tunisia has the highest prevalence of HD patients with 680 patients per million population compared with the other countries (Benghanem Gharbi, 2010) It is well-known that deconditioning infers the loss of physical capacity in response to physical inactivity or chronic disease and refers to a decreased aerobic fitness, muscle force, and endurance (Verbunt et al, 2005). The deconditioning spiral associated with end-stage renal disease (Painter, 1994) arises from inactivity which has a major impact on normal physical function and will result in disability associated with an increased mortality risk in people undergoing HD (Moore et al, 1993; Johansen et al, 2003; Sietsema et al, 2004) These patients have a reduced aerobic fitness with a decreased peak oxygen uptake and skeletal muscle wasting. Dialysis centers rarely offer an exercise program to prevent physiological and psychological dialysis therapy-related alterations in chronic hemodialysis patients
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