Intradialytic Exercise Training Research Articles

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.

Metabolic bone changes after intradialytic resistive exercise in regular haemodialysis patients

IntroductionMineral bone disease is a crucial factor that contributes to mortality and morbidity in haemodialysis patients. Intradialytic resistance exercise training can be valuable in stimulating bone formation. The aim of this study was to evaluate the metabolic bone changes after intradialytic resistive exercise training in regular haemodialysis patients.MethodsThe study involved 60 patients on regular haemodialysis, aged 20–60 years. The patients were divided into 2 groups: a high parathyroid hormone group (parathyroid hormone over 800 pg/ml) and a low parathyroid hormone group (parathyroid hormone below 200 pg/ml), both groups randomly assigned into study and control groups. They received intradialytic resistive exercise 3 times per week for 3 months. Calcium, phosphorus, and parathyroid hormone were evaluated before and after the exercise period.ResultsThe training protocol proved to be effective in improving bone metabolism parameters, as there were statistically significant differences in the high parathyroid hormone exercise group. Parathyroid hormone and phosphorus decreased and calcium increased (<i>p</i> = 0.001, <i>p</i> = 0.012, and <i>p</i> = 0.025, respectively). In the low parathyroid hormone exercise group, phosphorus decreased significantly (<i>p</i> = 0.030) and calcium increased, although not significantly (<i>p</i> = 0.111), while parathyroid hormone non-significantly increased in the exercise group (<i>p</i> = 0.770), with a significant increase in the control group (<i>p</i> = 0.007). These results supported the positive effects of intradialytic resistive exercise in improving bone metabolism.ConclusionsIntradialytic resistive exercise training improves bone metabolism in haemodialysis patients.

Separate and combined effects of cold dialysis and intradialytic exercise on the thermoregulatory responses of hemodialysis patients: a randomized-cross-over study

BackgroundThe separate and combined effects of intradialytic exercise training (IET) and cold dialysis (CD) on patient thermoregulation remain unknown. This study assessed the thermoregulatory responses of hemodialysis patients under four different hemodialysis protocols: a) one typical dialysis (TD) protocol (dialysate temperature at 37 °C), b) one cold dialysis (CD) protocol (dialysate temperature at 35 °C), c) one typical dialysis protocol which included a single exercise bout (TD + E), d) one cold dialysis protocol which included a single exercise bout (CD + E).MethodsTen hemodialysis patients (57.2 ± 14.9 years) participated in this randomized, cross-over study. Core and skin temperatures were measured using an ingestible telemetric pill and by four wireless iButtons attached on the skin, respectively. Body heat storage (S) calculated using the thermometric method proposed by Burton.ResultsThe TD and TD + E protocols were associated with increased S leading to moderate effect size increases in core body temperature (as high as 0.4 °C). The low temperature of the dialysate during the CD and the CD + E protocols prevented the rise in S and core temperature (p > 0.05), even during the period that IET took place.ConclusionsTD and IET are accompanied by a moderate level of hyperthermia, which can be offset by CD. We recommended that CD or with IET can prevent the excessive rise of S.Trial registrationClinical Trial Registry number: NCT03905551 (clinicaltrials.gov), DOR: 05/04/2019,

Intradialytic Cardiovascular Exercise Training Alters Redox Status, Reduces Inflammation and Improves Physical Performance in Patients with Chronic Kidney Disease.

Redox status (RS) perturbations and inflammation are fundamental features of chronic kidney disease (CKD) that are substantially exacerbated in end-stage renal disease (ESRD). This study aimed at investigating the efficacy of a 6-month intradialytic exercise training program on RS, inflammation and physical performance in patients with ESRD. Twenty hemodialysis (HD) patients (17 males, three females) were randomly assigned to either an intradialytic training (bedside cycling) group (TR; n = 10) or a control group (CON; n = 10) for 6 months. Anthropometrics [body mass and height, body mass index (BMI), body composition], physical performance (VO2peak), functional capacity [North Staffordshire Royal Infirmary (NSRI) walk test, sit-to-stand test (STS-60)], quality of life (short form-36 (SF-36) as well as RS [thiobarbituric acid reactive substances (TBARS), protein carbonyls (PC), reduced (GSH) and oxidized (GSSG) glutathione, GSH/GSSG, total antioxidant capacity (TAC), catalase activity (CAT)] and high-sensitivity C-reactive protein (hs-CRP) were assessed at baseline and after the 6-month intervention. Peak oxygen consumption (VO2peak) increased by 15% only in TR (p < 0.01). Performance in NSRI, STS-60 and SF-36 improved by 4–13% only in TR (p < 0.01). Exercise training reduced TBARS (by 28%), PC (by 31%) and hs-CRP (by 15%), and elevated GSH (by 52%), GSH/GSSG (by 51%), TAC (by 59%) and CAT (by 15%) (p < 0.01). These findings suggest that engagement in chronic intradialytic cardiovascular exercise alters RS, reduces inflammation and improves performance in patients with ESRD.

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.

Interventions Made to Preserve Cognitive Function Trial (IMPCT) study protocol: a multi-dialysis center 2x2 factorial randomized controlled trial of intradialytic cognitive and exercise training to preserve cognitive function

BackgroundKidney disease and dialysis significantly impact cognitive function across the age spectrum. Cognitive training (CT) and/or exercise training (ET) are promising approaches to preserve cognitive function among community-dwelling older adults, but have not been tested for cognition preservation in hemodialysis patients of all ages. In this manuscript, we summarize the protocol for the Interventions Made to Preserve Cognitive Function Trial (IMPCT).MethodsWe will perform a 2 × 2 factorial randomized controlled trial (RCT) of eligible adult (≥18 years) hemodialysis initiates (n = 200) to test whether intradialytic CT (brain games on a tablet PC), ET (foot peddlers) and combined CT + ET while undergoing hemodialysis preserves executive function compared to standard of care (SC). Participants will engage in the interventions to which they are randomized for 6 months. The primary objective is to compare, among interventions, the 3-month change in executive function measured using the Trail Making Test A (TMTA) and B (TMTB); specifically, executive function is calculated as TMTB-TMTA to account for psychomotor speed. This primary outcome was selected based on findings from our pilot study. The secondary objectives are to compare the risk of secondary cognitive outcomes, ESKD-specific clinical outcomes, and patient-centered outcomes at 3-months and 6-months. All data collection and interventions are conducted in the dialysis center.DiscussionWe hypothesize that receiving intradialytic CT or ET will better preserve executive function than SC but receiving combined CT + ET, will be the most effective intervention. The current trial will be an important step in understanding how intradialytic interventions might preserve cognitive health.Trial RegistrationClinicaltrials.Gov (Date: 8/6/18): # NCT03616535. Protocol Version: 10 (April 2020). Funding: NIDDK R01DK114074.

Effects of 12months of detraining on health-related quality of life in patients receiving hemodialysis therapy.

PurposeLimited data exist regarding the effects of detraining on functional capacity and quality of life (QoL) in the hemodialysis population. The aim of the current study was to assess whether the discontinuation from a systematic intradialytic exercise training program will affect aspects of health-related QoL and functional capacity in hemodialysis patients.MethodsSeventeen hemodialysis patients (12 Males/5 Females, age 60.8 ± 13.6 year) participated in this study. Patients were assessed for functional capacity using various functional capacity tests while QoL, daily sleepiness, sleep quality, depression and fatigue were assessed using validated questionnaires at the end of a 12-month aerobic exercise program and after 12 months of detraining.ResultsThe detraining significantly reduced patients’ QoL score by 20% (P = 0.01). More affected were aspects related to the physical component summary of the QoL (P < 0.001) rather than those related to the mental one (P = 0.096). In addition, the performance in the functional capacity tests was reduced (P < 0.05), while sleep quality (P = 0.020) and daily sleepiness scores (P = 0.006) were significantly worse after the detraining period. Depressive symptoms (P = 0.214) and the level of fatigue (P = 0.163) did not change significantly.ConclusionsDetraining has a detrimental effect in patients’ QoL, functional capacity and sleep quality. The affected physical health contributed significantly to the lower QoL score. It is crucial for the chronic disease patients, even during emergencies such as lockdowns and restrictions in activities to maintain a minimum level of activity to preserve some of the acquired benefits and maintain their health status.

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.

Cardiac autonomic function during intradialytic exercise training

ABSTRACTObjectives: Cardiac autonomic nervous system (ANS) dysfunction is a common feature in patients receiving hemodialysis (HD) therapy, whilst is associated with an increased risk of ventricular arrhythmias and sudden cardiac death. The aim of this study is to investigate and compare the hemodynamic changes and responses of ANS function in HD patients using pupillometry and Heart Rate Variability (HRV) parameters.Methods: Sixteen chronic kidney diseases (CKD) patients receiving HD (52.18 ± 17.7 years) underwent both pupillometric measurements using a portable handheld pupil-measuring device and standard HRV analysis pre HD, every hour and 30 min post-HD session under two different scenarios: at rest while the patient resting at HD bed and when the patient performed a single bout of intradialytic aerobic exercise lasting for 45 min during the second hour of the HD therapy.Results: No significant changes in ANS values were observed in neither of the pupillometric and the HRV values pre HD, for each hour and post-HD session. HRV parameters were significantly correlated with pupillometric parameters at pre HD and immediately after the single bout of intradialytic exercise. ANS activity did not differ during the conventional HD session and during the session included intradialytic exercise. Moreover, sympatho-vagal balance indices deriving from pupillometric assessment showed beneficial changes after the exercise event.Conclusion: Pupillometry is a promising and robust technique with fewer artifacts compared to HRV especially in studies involving exercise sessions. Thus, pupillometry can be used as a complementary tool in the evaluation of cardiac autonomic dysfunction.

PENGARUH LATIHAN FISIK TERHADAP KUALITAS HIDUP PASIEN HEMODIALISIS

Patient with chronic kidney disease (CKD), especially those on dialysis, often suffer from muscle wasting and excessive fatique. Patient continue to experience significant impairment of quality of life. Exercise in patient receiving reguler dialysis treatment is still only offered in a minority of renal units. The current study was designed to determine the effect of exercise training (intradialytic) related quality of life among patient with haemodialysis at PMI hospital Bogor. Design of the research was experiment quasi with pretest-posttest design. Thirty subjects voluntereed to participate in the study following 10 weeks (20 times) exercise training programme. Short Form-36 (SF-36) questionnaire was evaluated at beginning and end of the study. After training patient demonstrated a significant improvement in the physical component scaleof the SF-36 (from 56,6 to 64,56, P &lt; 0,05). Intradialytic exercise training improves quality oflife (physical component scale)

Association between exercise training in haemodialysis patients and burden of their family caregivers: A cross-sectional study.

Considering that exercise programmes are related with a range of benefits for end-stage renal disease patients, we evaluated the association between haemodialysis (HD) patients' involvement in intradialytic exercise training with the burden of their family caregivers. In this cross-sectional study, 60 caregivers of HD patients were recruited, 30 of them who cared for patients that regularly participated in an exercise programme during dialysis sessions and 30 caregivers who looked after patients undergoing usual HD treatment without intradialytic exercise. The caregivers were submitted to the Caregiver Burden Scale (CBS) and their quality of life (short-form-36 (SF-36)), anxiety and depression levels were assessed. Data were expressed as mean ± SD or median (interquartile range). Multiple linear regression showed that the global CBS score was significantly associated with the exercise training after adjusting for age, educational level and anxiety level of caregivers, and dependency level of patients measured by the Lawton scale (coefficient of determination = 0.53; adjusted coefficient of determination = 0.48). Additionally, the caregivers of HD patients submitted to intradialytic exercise (42.0 ± 12.9 years, 33.3% male) compared to caregivers of patients undergoing usual treatment (50.7 ± 17.5 years, 26.7% male) exhibited less caregiver burden (global CBS score = 1.2 (0.2) vs 1.9 (0.7), P < 0.001), better quality of life (physical component score = 53.7 (9.6) vs 49.7 (16.2) and mental component score = 50.6 (17.5) vs 28.2 (32.5), P < 0.05) and lower anxiety (7.2 ± 4.2 vs 10.8 ± 4.1, P = 0.001) and depression levels (3.0 (3.3) vs 6.0 (5.3), P = 0.034), respectively. Intradialytic exercise training in HD patients was associated with lower burden of their family caregivers.

Exercise and cognitive function in patients with end-stage kidney disease.

In this review we summarize the research pertaining to the role of exercise in preventing cognitive decline in patients with end-stage kidney disease (ESKD). Impairment in cognitive function, especially in executive function, is common in patients with ESKD, and may worsen with maintenance dialysis as a result of retention of uremic toxins, recurrent cerebral ischemia, and high burden of inactivity. Cognitive impairment may lead to long-term adverse consequences, including dementia and death. Home-based and intradialytic exercise training (ET) are among the nonpharmacologic interventions identified to preserve cognitive function in ESKD. Additionally, cognitive training (CT) is an effective approach recently identified in this population. While short-term benefits of ET and CT on cognitive function were consistently observed in patients undergoing dialysis, more studies are needed to replicate these findings in diverse populations including kidney transplant recipients with long-term follow-up to better understand the health and quality of life consequences of these promising interventions. ET as well as CT are feasible interventions that may preserve or even improve cognitive function for patients with ESKD. Whether these interventions translate to improvements in quality of life and long-term health outcomes, including dementia prevention and better survival, are yet to be determined.

Management of anxiety and depression in haemodialysis patients: the role of non-pharmacological methods.

Anxiety and depression in patients undergoing haemodialysis can be reduced by a variety of treatment methods, including pharmacological therapy, cognitive-behavioural therapy, regular exercise and relaxation techniques, such as Benson's relaxation method and acupressure treatment. Additionally, intradialytic exercise training programmes have a positive effect on patients' physical and psychological functioning. Moreover, social support from family and social environment, spirituality and religiosity, tele- nursing programmes and participation in network support groups frequently lead to a reduction of anxiety and depressive symptoms in these people. Finally, the provision of education and information to dialysis patients by renal professionals and a systematic psychiatric evaluation of these individuals can lead to early diagnosis and treatment of depressive symptoms.

The Effect of Intradialytic Exercise Training on Cardiac and Arterial Health in Hemodialysis Patients

INTRODUCTION AND AIMS: Patients with kidney failure undergoing chronic hemodialysis (HD) treatment have excessively high rates of cardiovascular (CV) morbidity and mortality. Exercise training as a part of a comprehensive treatment program has been shown to reduce the risk of CV events in patients with established CV disease. However, much less is known about the CV effects of exercise training in HD patients. The aim of this study was to determine the effect of 12 months of intradialytic exercise with concomitant protein supplementation on CV health in HD patients. METHODS: This is a secondary analysis of CV parameters measured from a subset of patients participating in the IHOPE trial (NCT#01234441). This analysis includes data from 98 HD patients (54±12 yrs; 59% male) randomized either to usual care (CON) or intradialytic exercise training + protein supplementation (EX) for 12 months. Patients in the EX group performed supervised moderate intensity exercise (RPE = 12-14) on cycle ergometers for 30-45 minutes with a concomitant oral protein supplement (30g whey) during treatment. Ultrasound exams were performed to measure cardiac systolic function (ejection fraction), diastolic function (early diastolic filling pressure; E, early diastolic tissue velocity; E’) and carotid arterial wall thickness (intima-media thickness, IMT). Outcomes were assessed at baseline, 6, and 12 months. RESULTS: There were no significant changes in any CV parameter between groups at 12-months (Group x Time interaction, p > 0.05 for all measures). However, there was a significant main effect of Time for EE’ in the overall study population, indicating a general worsening of left ventricular filling capacity at 12-months that was larger in CON compared to EX (p< 0.05). There was a similar trend for an increase in carotid IMT at 12-months in CON (p<0.05), that was not evident in EX. CONCLUSION: These data indicates that declines in cardiac diastolic function and increases in carotid IMT that manifest over time in HD patients may be attenuated by intradialytic exercise training. Surprisingly few studies have investigated the effects of exercise on CV structure and function in HD patients, thus, these findings warrant further investigation.

Intradialytic exercise training modalities on physical functioning and health-related quality of life in patients undergoing maintenance hemodialysis: systematic review and meta-analysis

Objective: To determine the effects of different intradialytic exercise training modalities on physical functioning and health-related quality of life of maintenance hemodialysis patients. Methods: We searched MEDLINE, Cochrane Trials Register and CINAHL for controlled trials that evaluated the effects of intradialytic exercise training for maintenance hemodialysis patients and published from the earliest available date to December 2017. Weighted mean difference and 95% confidence interval (CI) were calculated, and heterogeneity was assessed using the I2 test. Results: Fifty-six studies met the study criteria, comprising a total of 2586 patients. Compared with no exercise, combined aerobic and resistance exercise resulted in significant improvement in peak VO2 weighted mean difference (5.1 mL kg−1 min−1; 95% CI: 3.4, 6.8 mL kg−1 min−1), depression symptoms (−7.32; 95% CI −9.31, −5.33) and both physical function (10.67 points; 95% CI 1.08, 20.25 points) and vitality (10.01 points; 95% CI 4.30, 15.72 points) domains of health-related quality of life. Resistance exercise alone was significantly associated with improvement in the 6-minute walk test distance (30.2 m; 95% CI 24.6, 35.9 m), knee extensor strength (0.6 N; 95% CI 0.1, 1.0 N) and Physical Component Score of health-related quality of life (9.53 points; 95% CI −3.09, 22.15 points) when compared with control group. Aerobic exercise alone was not significantly associated with aerobic capacity and quality of life improvement. Conclusion: The results provide support to interventions that combine intradialytic aerobic and resistance exercises to improve physical functioning and quality of life in end-stage renal disease patients undergoing hemodialysis.

Hemodynamic Instability during Dialysis: The Potential Role of Intradialytic Exercise.

Acute haemodynamic instability is a natural consequence of disordered cardiovascular physiology during haemodialysis (HD). Prevalence of intradialytic hypotension (IDH) can be as high as 20–30%, contributing to subclinical, transient myocardial ischemia. In the long term, this results in progressive, maladaptive cardiac remodeling and impairment of left ventricular function. This is thought to be a major contributor to increased cardiovascular mortality in end stage renal disease (ESRD). Medical strategies to acutely attenuate haemodynamic instability during HD are suboptimal. Whilst a programme of intradialytic exercise training appears to facilitate numerous chronic adaptations, little is known of the acute physiological response to this type of exercise. In particular, the potential for intradialytic exercise to acutely stabilise cardiovascular hemodynamics, thus preventing IDH and myocardial ischemia, has not been explored. This narrative review aims to summarise the characteristics and causes of acute haemodynamic instability during HD, with an overview of current medical therapies to treat IDH. Moreover, we discuss the acute physiological response to intradialytic exercise with a view to determining the potential for this nonmedical intervention to stabilise cardiovascular haemodynamics during HD, improve coronary perfusion, and reduce cardiovascular morbidity and mortality in ESRD.

Intradialytic Cognitive and Exercise Training May Preserve Cognitive Function

IntroductionCognitive decline is common and increases mortality risk in hemodialysis patients. Intradialytic interventions like cognitive training (CT) and exercise training (ET) may preserve cognitive function.MethodsWe conducted a pilot randomized controlled trial of 20 hemodialysis patients to study the impact of 3 months of intradialytic CT (tablet-based brain games) (n = 7), ET (foot peddlers) (n = 6), or standard of care (SC) (n = 7) on cognitive function. Global cognitive function was measured by the Modified Mini Mental Status Exam (3MS), psychomotor speed was measured by Trail Making Tests A and B (TMTA and TMTB), and executive function was assessed by subtracting (TMTB − TMTA). Lower 3MS scores and slower TMTA and TMTB times reflected worse cognitive function. P values for differences were generated using analysis of variance, and 95% confidence intervals (CIs) and P values were generated from linear regression.ResultsPatients with SC experienced a decrease in psychomotor speed and executive function by 3 months (TMTA: 15 seconds; P = 0.055; TMTB: 47.4 seconds; P = 0.006; TMTB − TMTA; 31.7 seconds; P = 0.052); this decline was not seen among those with CT or ET (all P > 0.05). Compared with SC, the difference in the mean change in 3MS score was −3.29 points (95% CI: −11.70 to 5.12; P = 0.42) for CT and 4.48 points (95% CI: −4.27 to 13.22; P = 0.30) for ET. Compared with SC, the difference in mean change for TMTA was −15.13 seconds (95% CI: −37.64 to 7.39; P = 0.17) for CT and −17.48 seconds (95% CI: −41.18 to 6.22; P = 0.14) for ET, for TMTB, the difference was −46.72 seconds (95% CI: −91.12 to −2.31; P = 0.04) for CT and −56.21 seconds (95% CI: −105.86 to −6.56; P = 0.03) for ET, and for TMTB – TMTA, the difference was −30.88 seconds (95% CI: −76.05 to 14.28; P = 0.16) for CT and −34.93 seconds (95% CI: −85.43 to 15.56; P = 0.16) for ET.ConclusionPreliminary findings of our pilot study suggested that cognitive decline in psychomotor speed and executive function is possibly prevented by intradialytic CT and ET. These preliminary pilot findings should be replicated.

Effects of Intradialytic Resistance Exercise on Protein Energy Wasting, Physical Performance and Physical Activity in Ambulatory Patients on Dialysis: A Single-Center Preliminary Study in a Japanese Dialysis Facility.

Patients under hemodialysis present protein-energy wasting (PEW), which is related with higher mortality rates. The study aimed to determine whether intradialytic resistance exercise training could improve physical performance, physical activity, and PEW in hemodialysis patients. In single center study, 75 hemodialysis patients were enrolled in an intradialytic resistance exercise training consisting of 20 min of adapted leg press, with a gymnastic ball, 3 days/week, during 9 months on the same day of hemodialysis therapy. Physical performance by short physical performance battery (SPPB), physical activity by life space assessment (LSA), and PEW score based on the nomenclature proposed by the International Society of Renal Nutrition and Metabolism in 2008 were assessed at baseline and after 9 months. Intradialytic resistance exercise training significantly improved SPPB score, LSA score, and PEW score (all, P < 0.05). In addition, intradialytic resistance exercise training improved SPPB score in patients with moderate and severe PEW subgroups (P < 0.05), associated with reduced prevalence of the patients with moderate to severe PEW (53% vs. 36%, P < 0.05). Intradialytic resistance exercise training was safe and effective to improve physical performance, physical activity, and PEW in hemodialysis patients.

Intradialytic Exercise is Medicine for Hemodialysis Patients.

When a person's kidneys fail, hemodialysis (HD) is the most common treatment modality. With a growing number of patients requiring this life-sustaining treatment, and with evidence illustrating the significant physical dysfunction of this population, encouraging exercise is essential. The use of intradialytic exercise, as a novel and efficient use of time during HD, is well established in Australia and some European nations; however, it is slower to start in North America. While a large number of small studies have demonstrated numerous benefits and safe delivery of intradialytic exercise training for patients with end-stage kidney disease, intradialytic exercise is rarely delivered as standard of care. It is of utmost importance for health care staff to overcome barriers and bring theory into practice. Included in this report are current recommendations from governing bodies, expert opinion, as well as established policies and procedures from a successful intradialytic exercise program in Canada.

Intra-Renal Hemodynamic Changes After Habitual Physical Activity in Patients with Chronic Kidney Disease.

Chronic Kidney Disease (CKD) is considered a silent epidemic with a continuously growing prevalence around the world. Due to uremia many functional and morphological abnormalities occur in almost all systems. Mostly affected, the cardiovascular system, leads to diminished cardiac function that affects patients' functional capacity and physical activity levels, reducing survival and increasing all-cause mortality. Systematic exercise training ameliorates uremia induced body deficits and significantly improves the survival of CKD patients. Intradialytic exercise training has been recommended as a complementary therapeutic modality equally important to hemodialysis. The aim of this systematic review is to provide an update on recent advances in our understanding of how exercise training improves functionality of the cardiovascular system through the hemodynamic changes induced by habitual or intradialytic and/or home-based exercise training programs. Systematic exercise training induces beneficial adaptive responses and influences many sensitive physiological biomarkers, such as oxidative stress biomarkers that are implicated in the development of atherosclerosis. Additionally, exercise training decreases the cardiovascular risk by improving the autonomic nervous system activity and the left ventricular function and by reducing nontraditional risk factors such as epicardial adipose tissue. It seems that all these central and peripheral adaptations to exercise training significantly contribute to improvements in functional capacity and exercise tolerance among CKD patients and result in the risk reduction of CKD-associated disorders. Exercise training could serve as a complimentary therapeutic strategy in CKD patients while health care providers should motivate patients to engage in any type of exercise training programs.