The Effectiveness of Strengthening Exercise on Improving Physical Function in Chronic Dialysis with Comorbidity: A Case Study

Abstract

BACKGROUND: Individuals living with End stage renal disease (ESRD) on long term hemodialysis (HD) generally has a sedentary life style. This leads to reduction of physical function and poor quality of life. Exercise intervention improves muscular strength, physical fitness and Quality of life (QOL) in maintained hemodialysis Individuals. CASE SCENARIO: A 67-year-old female presented with chronic hemodialysis period was carried on wheelchair with the help of relative as she was referred to physiotherapy department with chief complain of weakness in both lower limb and difficulty in walking for 1 year. In this case along with chronic dialysis related dysfunction, patient had atherosclerosis had an acute coronary event and she was on AKT since last one year as she was having pott’s spine. METHODOLOGY: In our evaluation, she had full range of motion of lower limb with muscle weakness by manual muscle testing (MMT=3-4/5), Reduced balance and physical performance by short physical performance battery (SPPB=4/12), and partially dependent for functional activity by functional independent measure (FIM= 81/126). In Physiotherapy intervention: Exercise program started with active exercise, cycling, balance and gait training. Progressively in active exercise increased weight with weight cuff, increase cycling time and task specific balance activities with independent walking each week. RESULT: After four week of intervention improvement in muscle strength (MMT=4-5/5), balance (SPPB=7/12), minimal assistance in functional activities (FIM=109/126). CONCLUSION: Individualized strengthening exercise program improve physical function and muscle strength in chronic dialysis patient. Keywords: Hemodialysis, physical function, muscle strength.