Intradialytic Exercise Program Research Articles

Effectiveness of a resistance exercise program for lower limbs in chronic renal patients on hemodialysis: A randomized controlled trial.

Physical inactivity in hemodialysis patients is associated with increased mortality. The objective of this study was evaluated the effect of an intradialytic resistance exercise program on chronic kidney disease (CKD) patients on hemodialysis. One hundred seven patients were included in the study. They were aged 18-60 years, of both sexes, had undergone hemodialysis treatment for at least 1 year, sedentary. Patients were randomly divided into two groups: stretching (STG) and resistance exercise (REG). Intervention programs were performed for 8 weeks, three times a week. The evaluations were performed before and after the training programs. The primary outcome was functional capacity using the 6-minute walk test (6MWT). Secondary outcomes were peripheral muscle strength, respiratory muscle strength, spirometric respiratory function, and laboratory data. Comparisons between groups revealed the following clinically relevant results in favor of REG: lower limb muscle strength (mean difference [MD] = -1.99, 95% confidence interval [CI] = -2.77 to -1.21; d = -0.53), distance walked in the 6MWT (MD = -26.27, 95% CI = -45.40 to -7.14; d = -0.46), creatinine (MD = -1.52, 95% CI = -2.49 to -0.54; d = -0.66), and calcium (MD = -0.44, 95% CI = -0.78 to -0.10; d = -0.49). CKD patients on hemodialysis have reduced functional capacity compared to healthy sedentary individuals. In turn, this reduction appears to be associated with a lower survival rate and affects the performance of their daily living activities. Thus, resistance exercise performed in the intradialytic phase is an effective therapeutic strategy for CKD patients, mainly because it increases functional capacity and lower limb muscle strength.

Reasons for Nonparticipation in a Sustained Hemodialysis Intradialytic Exercise Program

Patients with end-stage kidney disease requiring hemodialysis suffer frailty and poor physical function. Exercise can improve physical function; however, barriers exist to intradialytic exercise programs. The objective of this study was to explore patients' reasons for not exercising in an extant intradialytic exercise program. We conducted a retrospective analysis reporting the reasons for not exercising in an intradialytic exercise program in two hemodialysis centers over a 4-week period. We explored whether patient characteristics and the presence of an exercise professional were associated with missed exercise sessions. Seventy-five patients participating in the intradialytic exercise program completed 57% of prescribed intradialytic exercise sessions. The three most frequently reported reasons from patients not exercising were refusal (24%), followed by fatigue (19%) and symptoms (14%). Patients were more than twice as likely to exercise if a kinesiologist was present (odds ratio [OR]: 2.26, confidence interval [CI]: 1.5, 3.4 P=.03). They were less likely to exercise if they were women (OR: 0.66, CI: 0.45, 0.95 P=.002), had been on dialysis greater than 60months (OR: 0.55, CI: 0.37, 0.80 P<.002), or had more than two comorbid conditions (OR: 0.63, CI: 0.43, 0.90, P=.01). Patient adherence to intradialytic exercise programs is strongly associated with the presence of exercise professionals.

BENEFITS OF INTRADIALYTIC EXERCISE TO INCREASE MUSCLE STRENGTH, PREVENT MUSCLE MASS LOSS ON CHRONIC RENAL FAILURE PATIENTS ON HEMODIALYSIS: REVIEW

Introduction:Prolonged exposure to hemodialysis treatments has a catabolic effect on muscles also compounding this expedited muscle loss associated decrease quality of life. The aim of this study is to investigate the benefits of intradialytic exercise programs, specifically on increase muscle strength and physical function. Methods: search in PubMed, ProQuest, and MEDLINE (EBSCO) about intervention intradialytic exercise program of CRF patients impairment muscle strength. Studies included intradialytic exercise program randomized controlled trials study design. Result: Most studies included in this review focused on intradialytic exercise program. These intervention program seems to increase muscle strength and improved physical function, and less decline in muscle cramp. Conclusion: Patients with CRF on hemodialysis need to do intradialytic exercise program. In addition, standardization of intradialytic exercise program, outcome and evaluation for patients with CRF on hemodialysis especially on muscle strength and muscle cramp, muscle mass, physically function is needed for further studies.

Long-term intradialytic hybrid exercise training on fatigue symptoms in patients receiving hemodialysis therapy

Hemodialysis (HD) patients suffer from generalized weakness, exercise intolerance and muscle atrophy, all leading to generalized fatigue and lack of energy. HD patients spend at least 50% of their time in a functionally "switch off" mode with their fatigue sensations reaching a peak in the immediate hours after the dialysis session. The purpose of the current study was to assess the effectiveness of a nine-month hybrid intradialytic exercise program on fatigue symptoms occurring during and after hemodialysis session. Twenty stable hemodialysis patients were included in the study (59 ± 13.7 years; 16 males). All patients completed a 9-month supervised exercise training program composed of both aerobic cycling and resistance training during HD. Aspects related to physical and generalized fatigue were assessed via validated questionnaires, while physical performance was assessed by a battery of tests, before and after the intervention period. Exercise capacity and physical performance were increased by an average of 65 and 40%, respectively. Patients reported feeling better during post-dialysis hours in question 1 (p = 0.000), question 3 (p = 0.009) and question 4 (p = 0.003) after the 9-month intervention. In addition, exercise training improved scores in cognitive function (p = 0.037), vitality (p = 0.05), depression (p = 0.000) and fatigue (p = 0.039). The present study showed that a 9-month hybrid (aerobic + resistance) exercise training program improved symptoms of post-dialysis fatigue and overall general perception of fatigue. Hybrid exercise training is a safe and effective non-pharmacological approach to ameliorate fatigue symptoms in HD patients. Trial registration number The study is registered at ClinicalTrials.gov (NCT01721551, 2012) as a clinical trial.

Effect of Muscle Stretching and Range of Motion Exercises on Sleep Quality and Anxiety among Hemodialysis Patients

Background: Sleep disturbance and anxiety are more common observed in hemodialysis patients than in healthy people and affect patients' clinical outcomes. Aim: determine the effect of muscle stretching and range of motion exercises on sleep quality and anxiety among hemodialysis patients. Design: A quasi experimental research design (pre posttest control group) was employed. Setting: The study was accomplished at the hemodialysis unit at El Fayoum General Hospital. The unit worked three shifts per day /week expect Friday. Subjects: specific eligibility criteria were applied to purposively select a sample of 60 adult patients/both genders on maintenance hemodialysis. They further were partitioned into two groups 30 patients in each (study and control groups). Tools: three tools were handled: A structured interview questionnaire, The Pittsburgh Sleep Quality Index (PSQI) Scale and Spielberger State-Trait Anxiety Inventory scale/STAI: Results: a statistically significant difference was observed between the study and control groups in favor of the former concerning the Global Pittsburgh Sleep Quality Index(PSQI) score and anxiety level after 6 weeks of intervention in which more than half (60.0%) in the study group have no difficulty comparing to more than three quarters(76.7%) in the control group had somewhat difficulty with P = 0 .00. Also 70.0% in the study group had mild anxiety while, in the control group 53.3% had moderate anxiety. Conclusion: The study concluded that; muscle stretching and range of motion exercises have significant positive effect on sleep quality and anxiety level among patients on maintenance hemodialysis. Recommendation: The developed booklet with its simple instructions and illustrations should be utilized in hemodialysis unit as a teaching aid for hemodialysis patients. Intradialytic exercise programs should be incorporated into routine clinical practice.

Effects of intradialytic cycling exercise on daily physical activity, physical fitness, body composition, and clinical parameters in high-volume online hemodiafiltration patients: a pilot randomized-controlled trial.

The mortality of dialysis patients treated with high-volume online hemodiafiltration (OL-HDF) is better than hemodialysis, but is still higher than healthy population. Low daily physical activity increases cardiovascular mortality. Addition of intradialytic exercise (IDX) program might improve physical activity and health status in OL-HDF patients. This pilot open-labeled randomized-controlled trial was conducted to evaluate the effects of IDX on physical activity and other clinical parameters in OL-HDF patients. Twelve OL-HDF patients were randomized into control (n = 6) or IDX (n = 6) groups. The subjects in IDX group were trained to exercise using a cycle ergometer for 60min during each OL-HDF session. Physical activity measured as daily step count using a wrist-worn triaxial accelerometer, physical fitness, or cardiorespiratory fitness assessed by VO2max and other physical performance tests, lean body mass determined by the Dual-energy X-ray absorptiometry (DXA), quality of life (QOL), and various parameters were compared between baseline and 6months. The baseline physical activity status was comparable. Following 6-month IDX, the physical activity was significantly improved in IDX group [+ 1048.79 (+ 741.50, + 2792.54) vs. -362.06 (-1626.82, -167.47) steps/day, p = 0.01], while physical fitness and QOL were unchanged. The lean body mass parameters were preserved in the IDX group while seemed to decrease in the control group. Serum albumin was significantly increased in the IDX group (p = 0.01). The hemoglobin changes were significantly better (p = 0.01) and the erythropoietin resistance index was significantly lower in the IDX group (p = 0.03). Phosphate reduction was significantly greater in the IDX group (p = 0.04). IDX could improve physical activity and other metabolic parameters in OL-HDF patients and these might contribute to further improvement in clinical and survival outcomes. ClinicalTrials.gov Registration: NCT03353844.

The PrEscription of intraDialytic exercise to improve quAlity of Life in patients with chronic kidney disease trial: study design and baseline data for a multicentre randomized controlled trial.

BackgroundExercise interventions designed to improve physical function and reduce sedentary behaviour in haemodialysis (HD) patients might improve exercise capacity, reduce fatigue and lead to improved quality of life (QOL). The PrEscription of intraDialytic exercise to improve quAlity of Life study aimed to evaluate the effectiveness of a 6-month intradialytic exercise programme on QOL and physical function, compared with usual care for patients on HD in the UK.MethodsWe conducted a prospective, pragmatic multicentre randomized controlled trial in 335 HD patients and randomly (1:1) assigned them to either (i) intradialytic exercise training plus usual care maintenance HD or (ii) usual care maintenance HD. The primary outcome of the study was the change in Kidney Disease Quality of Life Short Form (KDQOL-SF 1.3) Physical Component Score between baseline and 6 months. Additional secondary outcomes included changes in peak aerobic capacity, physical fitness, habitual physical activity levels and falls (International Physical Activity Questionnaire, Duke’s Activity Status Index and Tinetti Falls Efficacy Scale), QOL and symptom burden assessments (EQ5D), arterial stiffness (pulse wave velocity), anthropometric measures, resting blood pressure, clinical chemistry, safety and harms associated with the intervention, hospitalizations and cost-effectiveness. A nested qualitative study investigated the experience and acceptability of the intervention for both participants and members of the renal health care team.ResultsAt baseline assessment, 62.4% of the randomized cohort were male, the median age was 59.3 years and 50.4% were white. Prior cerebrovascular events and myocardial infarction were present in 8 and 12% of the cohort, respectively, 77.9% of patients had hypertension and 39.4% had diabetes. Baseline clinical characteristics and laboratory data for the randomized cohort were generally concordant with data from the UK Renal Registry.ConclusionThe results from this study will address a significant knowledge gap in the prescription of exercise interventions for patients receiving maintenance HD therapy and inform the development of intradialytic exercise programmes both nationally and internationally.Trial RegistrationISRCTN N83508514; registered on 17 December 2014.

Addition Of A Kinesiologist-guided Functional Exercise To Intradialytic Cycling Program: A Randomized Controlled Trial

PURPOSE: Intradialytic cycling is a widely used workout mode for hemodialysis patients whereas added benefit of other exercise modalities remains unknown. This is the first randomized controlled trial on the effects and sustainability of the functional training and exercise counseling in addition to a standard basic intradialytic cycling exercise program. METHODS: Patients were randomly assigned to a kinesiologist-guided functional training in addition to intradialytic cycling (n = 20, experimental group) or intradialytic cycling only (n = 20, control group) over 16 weeks. The experimental group attended predialysis guided functional exercise and counseling session in the first 8-week induction phase. In the second 8-week maintenance phase, the experimental group was encouraged to perform functional training at home on non-dialysis days. The main study endpoint was 10-repetition-sit-to-stand test time at 8 weeks. RESULTS: In the 10-repetition-sit-to-stand test at 8 weeks, the experimental group improved significantly better than controls (-4.5±1.9 s, 95% CI -8.4 to -0.7; P=0.021), which was maintained at week 16 (-4.7±2.1 s, 95% CI -9.0 to -0.3; P=0.037). For the secondary endpoints at week 8, the experimental group significantly outperformed controls at handgrip strength for 3.7±1.2 kg (95% CI 1.3 to 6.2; P=0.004), sit-and-reach lower body flexibility test for 5.8±1.4 cm (95% CI 2.9 to 8.6; P<0.001), Stork balance test for 0.7±0.2 s (95% CI 0.4 to 1.1; P<0.001), and back scratch upper body flexibility test for 5.8±1.8 cm (95% CI 2.2 to 9.5; P=0.003). At week 16, superior results of the experimental group in secondary end-points remained preserved for handgrip strength, balance, and back scratch flexibility tests (p<0.05 for all). No major exercise-related adverse events were observed. CONCLUSIONS: Functional training with exercise counseling added to basic intradialytic cycling program meaningfully improves physical performance and successfully prepares dialysis patients for sustainable home exercise.

Evaluating Acceptability Domain Of An Intradialytic Exercise Program-Patient Adherence And Nursing Documentation

For patients with end stage renal disease, exercise during hemodialysis (HD), intradialytic exercise (IDE), may mitigate treatment related symptoms including cramping, restless legs, and fatigue. In Alberta Kidney Care North, IDE is supervised by a clinical exercise physiologist (CEP) and dialysis unit staff assist with program delivery. PURPOSE: The aim of this study was to examine program responsiveness to the patients' needs (acceptability) by evaluating documentation of patient adherence. METHODS: 1,752 exercise sessions were audited at 6 hemodialysis units. Patient reported participation was collected directly from patients within 10 days of the audit. Baseline and subsequent physical reassessments were examined to verify the validity of patient recall, relative to the required exercise dose. Data points were divided into 2 categories: active IDE participants(A-IDE) and non-active IDE(NA-IDE) participants. A-IDE were defined as patients who completed at least 1 IDE session/week for 4 weeks. NA-IDE participants were defined as those previously assessed and programmed but recently discharged, on a medical hold, or participating in a home exercise program at the time of the audit. RESULTS: Of the 1,332 A-IDE sessions audited, nurses documented patient participation 28.08%, no participation 49.4%, and did not document 22.52%. Patients reported adherence 63.74%. Physical reassessment data showed improved outcome measures thereby, validating patient recall of adherence. Of 420 NA-IDE HD data sheet analyzed, nurses documented patient participation 1.9%, no participation 70.24%, and did not document 27.85%. Patient report and documentation agreed 2.7%. CONCLUSIONS: Assessment of IDE participation is an integral component to the evaluation of an IDE program. Discrepancies between patient report and documented adherence exist. We found that patient report is valid, based on improved measures at reassessments; however, we must establish feasible methods for dialysis staff to collect adherence when CEPs are not present. Staff training, including regular surveys to assess staff knowledge of processes, may provide valuable information on units with a high staff turnover. Implementing an IDE prescription confirmation, as a standard practice in HD treatment preparation, may affirm participation.

The Effect of a 12-Week Intradialytic Exercise on Patients’ Blood Indices, Physical Performance, and Quality of Life

This study aims to examine the effect of a 12-week intradialytic exercise program on patients’ blood indices, physical performance, and quality of life. Forty-six outpatients who were diagnosed with end-stage renal failure by a nephrologist and received hemodialysis therapy for six months or longer were recruited. The data were analyzed using SPSS and Kruskal-Wallis test was employed to analyze the continuous variables. Among blood indices, Hematocrit decreased significantly after aerobic and complex exercise; hemoglobin dropped only after complex exercise; P and Ca×P increased for a considerable amount only after complex exercise, but the postexamination results show no significant difference. As for physical performance, sit-to-stand (STS)-5 decreased with resistance and complex exercise (p &lt; .01), while there was a significant increase in STS-30 after aerobic, resistance, and complex exercise (p &lt; .01). 6-minute walk test (MWT) grew significantly in all groups (p &lt; .01), but alongside gait speed, and grip strength, it diminished significantly in the non-exercise group (p&lt; .05). When it comes to SF-36, there was a significant rise in the physical component score (PCS) (p&lt; .01) with resistance and complex exercise. In the meantime, mental component summary (MCS) went up significantly after all types of exercises (p &lt; .01). In contrast, Beck depression inventory (BDI) showed a significant decline only with complex exercise (p &lt; .01). To sum up, this study suggests intradialytic complex exercise appears to be effective in enhancing Short Form (SF)-36 and BDI as well as physical performance, which is why we recommend this type of complex exercise program for hemodialysis patients.

P1477EFFECT OF INTRADIALYTIC EXERCISE IN A MEXICAN MAINTENANCE HEMODIALYSIS POPULATION

Abstract Background and Aims The use of intradialytic exercise has been associated with improved clearance, oxygen consumption, quality of life, and physical performance. The aim of this study was to describe the association between of intradialytic exercise and some outcomes in a Mexican maintenance hemodialysis (HD) population. Method Observational comparative study that included 84 maintenance HD patients from one HD center in Mexico City. The population was grouped according to the intradialytic exercise local record. The aerobic intradialytic exercise protocol includes cycling for 30-45 min during the first 2 hours of the HD according to each patient’s ability. A retrospective registry of clinical and biochemical parameters was realized. Also, the hemodynamic parameters of the last six HD sessions for each patient was included. Data analysis was carried out through descriptive and inferential statistics. Results Of the total population, 45.2% were men (n= 38) and the mean age was 53.6 + 17 years. Fifty one percent (n= 43) had diabetes mellitus (DM), which resulted more prevalent in the subgroup of patients without intradialytic exercise (p=0.03) No differences between groups were present in age, history of previous peritoneal dialysis or kidney transplant. The rest of baseline data are shown in Table 1. The subgroup of patients who underwent intradialytic exercise presented higher levels of serum albumin (p=0.03) and lower levels of parathormone (p=0.03). A total of 504 HD sessions were analysed and intradialytic exercise was performed in 64.3% (n=324). Patients in the intradialytic exercise program presented high levels of systolic and diastolic blood pressure (graphic 1). Intradialytic hypotension occurred in 5.2% (n=26) and no differences are shown between groups (p=0.78). No mayor side effects were reported. Conclusion The intradialytic exercise could improve nutritional and bone-mineral status markers. The patients in an intradialytic exercise program presented higher levels of blood pressure.

Comparison of intradialytic versus home-based exercise programs on physical functioning, physical activity level, adherence, and health-related quality of life: pilot study

Intradialytic exercise (ID) programs are effective and safe for hemodialysis (HD) patients to avoid functional deterioration. However, exercise is not routinely undertaken in most HD units, and we do not know if home-based (HB) programs are as effective as ID programs. The purpose of this study was to compare the effects of 16 weeks of ID exercise versus a HB exercise program for HD patients. A total of 46 patients were randomly assigned to the ID group (n = 24) or HB group (n = 22). They completed a 16-week combined exercise program 3 times/week. We measured physical activity level, physical functioning, depression level, and health-related quality of life at baseline and after 16 weeks. A significant time effect was found in both groups for the physical activity level (p = 0.012). There was also a significant group–time interaction effect for the one-leg standing test (OLST) (p = 0.049) and a significant time effect for the Short Physical Performance Battery (p = 0.013), timed up-and-go test (p = 0.005), sit-to-stand-10 (p = 0.027), right and left hand handgrip (p = 0.044, p < 0.001), one-heel left leg raise (p = 0.019), and 6-minute walking (p = 0.006), depression (p = 0.017). HRQoL remained unchanged. There was no difference between the two interventions on the tested outcomes (besides OLST). Both interventions were associated with positive changes of the physical activity levels and physical function.

Intradialytic Exercise and Biochemical Markers: An Experimental Study

Exercise based rehabilitation like intradialytic exercise program could improve the physical function through its contribution in maintaining electrolyte balance. The study was conducted with the aim to determine the effectiveness of intradialytic exercise on biochemical markers among patients on hemodialysis. Quasi experimental research design was embraced to conduct the study with 130 human samples who met the inclusion criteria in hemodialysis unit and samples allocated into experimental group (n=65) and control group (n=65) by convenience sampling technique. The demographic questionnaire was completed at the beginning of the study followed by pre-test for both the groups. Experimental group received intradialytic exercise during initial 2 hours of hemodialysis for 3months besides control group received the routine care. Post test was conducted at the end of 3rd month after the dialysis session. Data were analyzed using Sigma Plot 12 (Systat, USA). After 3 months of intradialytic exercise, a significant reduction was observed in serum creatinine, blood urea, serum potassium, serum phosphate and increase in serum calcium and hemoglobin at the level of p&lt;0.001 in the experimental group. The study findings concluded that intradialytic exercise programme is safe, complementary intervention and do not cost the patient extra time and this effective care can be incorporated in the regular care of patients on hemodialysis.

Intradialytic Exercise and Biochemical Markers: An Experimental Study

Exercise based rehabilitation like intradialytic exercise program could improve the physical function through its contribution in maintaining electrolyte balance. The study was conducted with the aim to determine the effectiveness of intradialytic exercise on biochemical markers among patients on hemodialysis. Quasi experimental research design was embraced to conduct the study with 130 human samples who met the inclusion criteria in hemodialysis unit and samples allocated into experimental group (n=65) and control group (n=65) by convenience sampling technique. The demographic questionnaire was completed at the beginning of the study followed by pre-test forboth the groups. Experimental group received intradialytic exercise during initial 2 hours of hemodialysis for 3months besides control group received the routine care. Post test was conducted at the end of 3rd month after the dialysis session. Data were analyzed using Sigma Plot 12 (Systat, USA). After 3 months of intradialytic exercise, a signi????icant reduction was observed in serum creatinine, blood urea, serum potassium, serum phosphate and increase in serum calcium and hemoglobin at the level of p&lt;0.001 in the experimental group. The study ????indings concluded that intradialytic exercise programme is safe, complementary intervention and do not cost the patient extra time and this effective care can be incorporated in the regular care of patients on hemodialysis.

Application of Wearables to Facilitate Virtually Supervised Intradialytic Exercise for Reducing Depression Symptoms.

Regular exercise can reduce depression. However, the uptake of exercise is limited in patients with end-stage renal disease undergoing hemodialysis. To address the gap, we designed a gamified non-weight-bearing intradialytic exercise program (exergame). The intradialytic exergame is virtually supervised based on its interactive feedback via wearable sensors attached on lower extremities. We examined the effectiveness of this program to reduce depression symptoms compared to nurse-supervised intradialytic exercise in 73 hemodialysis patients (age = 64.5 ± 8.7years, BMI = 31.6 ± 7.6kg/m2). Participants were randomized into an exergame group (EG) or a supervised exercise group (SG). Both groups received similar exercise tasks for 4 weeks, with three 30 min sessions per week, during hemodialysis treatment. Depression symptoms were assessed at baseline and the fourth week using the Center for Epidemiologic Studies Depression Scale. Both groups showed a significant reduction in depression score (37%, p < 0.001, Cohen’s effect size d = 0.69 in EG vs. 41%, p < 0.001, d = 0.65 in SG) with no between-group difference for the observed effect (p > 0.050). The EG expressed a positive intradialytic exercise experience including fun, safety, and helpfulness of sensor feedback. Together, results suggested that the virtually supervised low-intensity intradialytic exergame is feasible during routine hemodialysis treatment. It also appears to be as effective as nurse-supervised intradialytic exercise to reduce depression symptoms, while reducing the burden of administrating exercise on dialysis clinics.

The effect of a structured intradialytic exercise program on fatigue and quality of life of a patient on hemodialysis in an acute care setting: A case report

Abstract Purpose: Previous research has shown that physical activity during dialysis can improve adherence to exercise, improve physical performance, resulting in healthier outcomes. This case report aims to determine

Efectos de un programa de ejercicio intradiálisis en pacientes con enfermedad renal crónica

El objetivo de este estudio fue comprobar el grado de cumplimiento y analizar el efecto de un programa intradiálisis de ejercicio físico sobre la condición física y salud del paciente con enfermedad renal crónica (ERC) que recibe hemodiálisis. Estudio de intervención con dos periodos de 14 semanas, uno sin intervención de ejercicio y otro con intervención, combinando trabajo de resistencia aeróbica y fuerza, en sesiones de 60 minutos, 3 días/semana. La condición física se evaluó a través de la capacidad de fuerza máxima de prensión manual, fuerza resistencia en extremidades inferiores y capacidad cardiorrespiratoria. El 62% de los pacientes cumplieron el 75% del programa. Durante el periodo sin ejercicio intradiálisis se observó una disminución significativa de la condición física, que se frenó durante el periodo con intervención de ejercicio. El programa de ejercicio intradiálisis es importante para frenar la pérdida de condición física ocasionada por la ERC.

Effect of Intradialytic Exercise on Physical Performance and Cardiovascular Risk Factors in Patients Receiving Maintenance Hemodialysis: A Pilot and Feasibility Study

Introduction: Although intradialytic exercise is considered a form of “nonpharmacological medicine” for patients receiving maintenance hemodialysis (MHD), this practice has not been widely implemented in most dialysis centers because of clinical limitations. We, therefore, aimed to design an intradialytic exercise training program to improve the implementation of this practice and determine its impact on physical performance and cardiovascular risk factors in patients receiving MHD. Methods: A total of 132 MHD patients at 4 outpatient dialysis units were enrolled and assigned randomly into exercise (n = 67) and control groups (n = 65). During a 2-year period, patients in the exercise group participated in 20-min exercise training sessions within dialysis sessions on 3 days per week. All patients underwent assessments of physical function (6-min walk test) and cardiovascular risk factors (blood pressure [BP], total cholesterol [TC], low-density lipoprotein [LDL], high-sensitivity C-reactive protein [hsCRP], albumin [Alb], hemoglobin [Hb], and erythropoietin [EPO] dose) at the baseline and annually thereafter. Results: Of the participants, 50.8% had completed the study after 2 years. No statistically significant intragroup or intergroup differences were observed in the measures of 6MD, BP, TC, hsCRP, Alb, Hb, and EPO dose. Conclusion: The results suggest that although this low-intensity, nonprogressive intradialytic exercise program may be practical, it was not sufficient to improve physiological function and reduce cardiovascular disease risk factors in patients receiving MHD.

The effect of intradialytic exercise twice a week on the physical capacity, inflammation, and nutritional status of dialysis patients: A randomized controlled trial.

Inactivity, uremia, and malnutrition in dialysis patients may lead to decreased muscle mass and physical capacity. As a preventative measure, dialysis patients are provided with an intradialytic exercise program. Our study aimed to determine the role of intradialytic exercise performed 2 times per week on physical capacity, inflammation, and nutritional status in dialysis patients and to determine which exercises are more suitable for this population. A randomized clinical trial in which participants were randomly assigned to 1 of 3 groups, i.e., a group of patients performing aerobic exercise, a group of patients performing a combination of aerobic and resistance exercise and the control group. The study was conducted at the Dialysis Unit of Dr. Cipto Mangunkusumo General Hospital, Jakarta for 12 weeks from February to May 2018. The inclusion criteria were dialysis patients aged over 18 years who had undergone routine dialysis for over 3 months. A total of one hundred twenty patients were included in the study. There was a significant increase in lower extremity strength in the group performing aerobic exercise and in the combined exercise group compared to the lower extremity strength of the control group. There was also a significant increase in the physical component score (PCS) of the KDQOL-SF™ instrument in the aerobic training and combination exercise groups compared to the PCS of the control group. No significant differences were found between the combination exercise group and the aerobic training group in any outcome. Both types of exercise programs significantly increased the lower extremity muscle strength and the PCS of the quality of life index. Combination exercise was not more effective than aerobic exercise for dialysis patients.

Effect of intradialytic aerobic exercise on patients with diabetic nephropathy

BackgroundDiabetes is a major health problem in nowadays’ society, as the number of patients with diabetes is growing continuously with their diabetic complications, especially kidney diseases, which is the most feared complication because of its substantial comorbidity, cost, and mortality.PurposeThe aim of this study was to determine the effect of intradialytic aerobic exercise on kidney functions tests [serum calcium, serum creatinine, urine creatinine, urine albumin, and estimated glomerular filtration rate (GFR)] in patients with diabetic nephropathy.Materials and methodsThirty patients of both sexes (19 male and 11 female) under hemodialysis with a mean age of 54.13±4.32 years were selected from the renal rehabilitation unit of Edfou General Hospital. They were assigned randomly to two groups of equal number. Group A received a moderate-intensity intradialytic aerobic exercise program (12–13 on rate of perceived exertion scale), and group B received their regular dialysis program only. The treatment program continued for 8 weeks (three exercise sessions per week). Laboratory investigations for serum calcium, serum creatinine, urine creatinine, urine albumin, and estimated GFR were carried out at the beginning and after the end of the treatment program in both groups.ResultsThe results of this study revealed a significant increase in serum calcium in group A compared with group B, and a significant decrease in serum creatinine and urine creatinine in group A compared with group B (P=0.03 and 0.04, respectively). There was no significant change in urine albumin and estimated GFR between the two groups.ConclusionModerate-intensity intradialytic aerobic exercise (12–13 rate of perceived exertion scale) is beneficial in modulating serum calcium, serum creatinine, and urine creatinine in diabetic nephropathy patients.