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Martins MA, Ghisi GLM, da Silva KB, Leopoldino G, Pakosh M, Bundchen DC. Psychometrically validated questionnaires to measure the effects and benefits/barriers to physical exercise in hemodialysis patients: a systematic review. Disabil Rehabil 2024; 46:1459-1470. [PMID: 37052210 DOI: 10.1080/09638288.2023.2198258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/25/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE To provide a critical assessment, summarize, and synthesize the evidence from studies using psychometrically validated questionnaires to assess the effects and benefits/barriers of physical exercise in hemodialysis patients. METHODS The search was performed on six electronic databases. It was conducted following the PRISMA statement and the PICO framework. The methodological quality was assessed using the MMAT. Were used the quality criteria for psychometric properties developed by Terwee et al. RESULTS Overall, 70 studies were included, and 39 questionnaires identified, evaluating 13 outcomes. The quality of the psychometric properties of the questionnaires was not always described; only 13 presented positive ratings on > =6/9 properties. The most assessed measure was criterion validity, and the least assessed criteria was responsiveness. The most outcome measured by these questionnaires was quality of life using SF-36, followed by psychological health using the BDI. The DPEBBS was the only instrument identified that assessed the benefits and barriers of exercise. CONCLUSION Quality of life and depression were the most frequent outcomes. Other measures contemplating physical, mental, cognitive performance, and especially of the perceptions benefits and barriers to exercise should be further investigated. We have clearly identified the need for more studies evaluating psychometric measures that have not been tested satisfactorily or hardly been tested at all.
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Affiliation(s)
- Marcieli A Martins
- Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina, Araranguá, Brazil
| | - Gabriela L M Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Kenia B da Silva
- Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina, Araranguá, Brazil
| | - Gabriela Leopoldino
- Postgraduate Program in Cardiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maureen Pakosh
- Library and Information Services, University Health Network, Toronto, Canada
| | - Daiana C Bundchen
- Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina, Araranguá, Brazil
- Department for Health Sciences, Federal University of Santa Catarina, Araranguá, Brazil
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Lee DW, Han HS, Lee MC, Ro DH. Prediction of postoperative gait speed change after bilateral primary total knee arthroplasty in female patients using a machine learning algorithm. Orthop Traumatol Surg Res 2024:103842. [PMID: 38382881 DOI: 10.1016/j.otsr.2024.103842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND An important aim of total knee arthroplasty is to achieve functional recovery, which includes post-operative increase in walking speed. Therefore, predicting whether a patient will walk faster or slower after surgery is important in TKA, which has not been studied in previous literatures. Who walks faster and who walks slower after TKA? Can we predict these kinds of patients before surgery? HYPOTHESIS Whether or not a patient walk faster after total knee arthroplasty can be predicted with preoperative characteristics. PATIENTS AND METHODS In this retrospective cohort study, 128 female patients who underwent staged bilateral total knee arthroplasty were analyzed with gait analysis preoperatively and at postoperative two years. These patients were divided into three different groups according to the percentage of gait speed change after total knee arthroplasty: 1) V(+), more than 10% gait speed increase; 2) V(-), more than 10% gait speed decrease; and 3) V(0), those in-between. Gait parameters, mechanical axis angles, WOMAC pain score and Knee Society scores of the two groups (V(+) and V(-)) were compared. Furthermore, a classification model predicting whether a patient walks faster after total knee arthroplasty was designed using a machine learning algorithm. RESULTS After total knee arthroplasty, average gait speed increased by 0.07m/s from 0.87m/s to 0.94m/s (p<0.001) and gait speed increased in 43.8% of the patients (n=56). However, gait speed decreased in a significant number of patients (n=17, 13.3%). When V(+) and V(-) groups were compared, gait speed, cadence, sagittal/coronal knee range of motion, and Knee Society Function score were lower in the V(+) group before surgery, but became higher after surgery. Gait speed change could be predicted using three variables (preoperative gait speed, age, and the magnitude of mechanical axis angle). The area under the receiver operating characteristic curve of the machine learning model was 0.86. DISCUSSION After total knee arthroplasty, gait speed was maintained or increased in most patients. However, gait speed decreased in a significant number of patients. The machine learning classification model showed a good predictive performance, which could aid in the decision-making and the timing of total knee arthroplasty. LEVEL OF EVIDENCE III; retrospective cohort study.
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Affiliation(s)
- Do Weon Lee
- Department of Orthopedic Surgery, Korean Armed Forces Yangju Hospital, Kyunggi province, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea; CONNECTEVE Co., Ltd, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea.
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Li WY, Yeh JC, Cheng CC, Huang SH, Yeh HC, Cheng BW, Lin JW, Yang FJ. Digital health interventions to promote healthy lifestyle in hemodialysis patients: an interventional pilot study. Sci Rep 2024; 14:2849. [PMID: 38310128 PMCID: PMC10838291 DOI: 10.1038/s41598-024-53259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 01/30/2024] [Indexed: 02/05/2024] Open
Abstract
Low physical activity has been associated with poor prognosis in hemodialysis (HD) patients. Interventions to maintain healthy lifestyle in this population are important to reduce mortality. This study aimed to evaluate the effectiveness of digital health interventions (DHIs) for improving the physical activity and health-related quality of life (HRQoL) in HD patients. The 24-week prospective study enrolled 31 clinically stable HD patients. All participants were assigned home exercises and provided with wearable devices. Dietary and exercise information was uploaded to a health management platform. Suggestions about diet and exercise were provided, and a social media group was created. Physical performance testing was performed at baseline and during weeks 4, 8, 12, 16 and 24. HRQoL and nutritional status were evaluated. A total of 25 participants completed the study. After the interventions, the daily step count increased 1658 steps. The 10-time-repeated sit-to-stand test reduced by 4.4 s, the sit-to-stand transfers in 60 s increased 12 repetitions, the distance of six-minute walk test (6MWT) increased by 55.4 m. The mental health components and burden of kidney disease of the Kidney Disease Quality of Life survey, and subjective global assessment (SGA) scores improved. By Spearman correlation, the monthly step count correlated positively with 6MWT and SGA. DHIs that combined wearable devices, a health management platform, and social media could strengthen physical activity and improve the HRQoL and nutrition of maintenance HD patients. The results outline a new model to promote healthy lifestyle behaviors in HD patients.
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Affiliation(s)
- Wen-Yi Li
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, No. 579, Sec. 2, Yunlin Rd., Douliu, Yunlin County, 640, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiang-Chou Yeh
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Cheng-Chih Cheng
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Su-Hua Huang
- Department of Dietetics, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan
| | - Hui-Chin Yeh
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
- Department of Applied Foreign Languages, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Bor-Wen Cheng
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Jou-Wei Lin
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan
| | - Feng-Jung Yang
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, No. 579, Sec. 2, Yunlin Rd., Douliu, Yunlin County, 640, Taiwan.
- College of Medicine, National Taiwan University, Taipei, Taiwan.
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Battaglia Y, Amicone M, Mantovani A, Combe C, Mitra S, Basile C. Home-based exercise in patients on maintenance dialysis: a systematic review and meta-analysis of randomized clinical trials. Nephrol Dial Transplant 2023; 38:2550-2561. [PMID: 37202219 DOI: 10.1093/ndt/gfad102] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The impact of home-based exercise on physical performance and quality of life (QoL) in patients on maintenance dialysis has not yet been fully established. METHODS We searched four large electronic databases to identify randomized controlled trials (RCTs) reporting the impact of home-based exercise interventions vs. usual care or intradialytic exercise interventions, on physical performance and QoL in patients on dialysis. The meta-analysis was performed using fixed effects modeling. RESULTS We included 12 unique RCTs involving 791 patients of various ages on maintenance dialysis. Home-based exercise interventions were associated with an improvement of walking speed at the 6 Minutes Walking Test [6MWT; nine RCTs; pooled weighted mean differences (WMD): 33.7 m, 95% confidence interval (CI) 22.8-44.5; P < 0.001; I2 = 0%) and in aerobic capacity as assessed by the peak oxygen consumption (VO2 peak; 3 RCTs; pooled WMD: 2.04 ml/kg/min, 95% CI 0.25-3.83; P = 0.03; I2 = 0%). They were also associated with improved QoL, as assessed by the Short Form (36) Health (SF-36) score. Stratifying the RCTs by control groups, no significant difference was found between home-based exercise and intradialytic exercise interventions. Funnel plots did not reveal any significant publication bias. CONCLUSIONS Our systematic review and meta-analysis showed that home-based exercise interventions for 3-6 months were associated with significant improvements in physical performance in patients on maintenance dialysis. However, further RCTs with a longer follow-up should be conducted to assess the safety, adherence, feasibility, and effects on QoL of home-based exercise programs in dialysis patients.
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Affiliation(s)
- Yuri Battaglia
- University of Verona, Department of Medicine, Verona, Italy
- Pederzoli Hospital, Nephrology and Dialysis Unit, Peschiera del Garda, Italy
| | - Maria Amicone
- Department of Public Health, Chair of Nephrology, University of Naples Federico II, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Christian Combe
- Department of Nephrology, CHU de Bordeaux and INSERM U1026, University of Bordeaux, Bordeaux, France
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre (MAHSC), University Hospitals, Oxford Road, Manchester, UK
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
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Huang M, Lv A, Yang F, Tang Y, Li Y, Hua Y, Gao J, Ni C. Impacts of cognition of exercise on physical activity participation in hemodialysis patients. Semin Dial 2023; 36:366-373. [PMID: 36597274 DOI: 10.1111/sdi.13138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/14/2022] [Accepted: 12/24/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Physical inactivity is a strong predictor of mortality in hemodialysis patients. Although regular physical activity reduces mortality, patients remain inactive. Comparing the cognition of exercise in hemodialysis patients with different physical activity status could highlight domains where inactive people experience heightened barriers to physical activity. We therefore assessed patients' perceived benefits and barriers to exercise using a standardized way, thereby informing future exercise interventions to address these barriers experienced by inactive patients. METHODS ESRD patients undergoing hemodialysis were recruited and asked to complete a human activity profile, wear a pedometer for seven consecutive days, and complete the Dialysis Patient-perceived Exercise Benefits and Barriers Scale (DPEBBS). Binominal Logistic regression analysis was conducted to determine which benefits and barriers are associated with physical activity. This cross-sectional observational study was registered as NCT05189795. RESULTS A total of 505 patients completed the survey, most of whom were male (67.1%), with an average age of 49.69 ± 13.96 years. And 52.67-76.63% patients on HAP questionnaire were inactive. The co-benefits in active patients were improving mood and prevention of muscle wasting but did not reach significance in physical activity level. Tiredness, muscle fatigue, and lack of knowledge of exercise were common barriers to patients, and all have a significant impact on a patient's physical activity level. CONCLUSIONS For inactive patients, exercise during hemodialysis can not only improve physical activity but also reduce family burden. And improving physical activity is a long-term project that cannot be separated from the support of hemodialysis medical staff.
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Affiliation(s)
- Mei Huang
- School of Nursing, Air Force Medical University, Xi'an, Shaan Xi, China
| | - Aili Lv
- Health Science Center, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Feng Yang
- Department of Nephrology, Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaan Xi, China
| | - Yuning Tang
- Department of Nephrology, Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaan Xi, China
| | - Yang Li
- School of Nursing, Air Force Medical University, Xi'an, Shaan Xi, China
| | - Yan Hua
- School of Nursing, Air Force Medical University, Xi'an, Shaan Xi, China
| | - Julin Gao
- Blood Purification Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Chunping Ni
- School of Nursing, Air Force Medical University, Xi'an, Shaan Xi, China
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Nitta K, Hanafusa N, Kawaguchi Y, Tsuchiya K. Physical function management for elderly dialysis patients: prevention and improvement of frailty and disability. RENAL REPLACEMENT THERAPY 2023. [DOI: 10.1186/s41100-023-00459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AbstractFrailty has become an emerging public health problem in the aging society and is regarded as a state of vulnerability to developing increased dependency and/or mortality when exposed to a stressor. As the proportion of elderly dialysis patients is increasing worldwide, frailty has recently influenced on the clinical outcomes among those patients also caused great attention. The prevalence of frailty among dialysis patients has ranged from 3.0- to 10-fold higher than in community-dwelling elderly. Since frailty has been found to be associated with higher mortality, independent of clinical characteristics and comorbidity, interventions to improve frailty have the potential to contribute to better quality of life and lower mortality among dialysis patients. Moreover, clinical research should be focused on the possibility that early rehabilitation of dialysis patients might improve poor outcomes. Current clinical question should aim to take an appropriate strategy to address frailty, including identifying the optimal timing for intervention.
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Song Y, Chen L, Wang M, He Q, Xue J, Jiang H. The optimal exercise modality and intensity for hemodialysis patients incorporating Bayesian network meta-analysis and systematic review. Front Physiol 2022; 13:945465. [PMID: 36200055 PMCID: PMC9527310 DOI: 10.3389/fphys.2022.945465] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Physical inactivity is highly prevalent in patients with hemodialysis, and a large body of evidence reported the positive effect of different exercise modalities on their health outcomes. However, the effective dosage of exercise for hemodialysis patients still requires verification. Objective: We aimed to determine the most effective exercise intensity and modality for improvements in physical function, blood pressure control, dialysis adequacy, and health-related quality of life for hemodialysis patients. Design: Systematic review with network meta-analysis of randomized trials. Data sources: Five electronic databases (PubMed, EMBASE, Web of Science, Cochrane CENTRAL, and Scopus) were searched for randomized controlled trials. Data extraction and quality appraisal were conducted by two authors independently. Data were analyzed by the R (version.3.6.2) and the Stata (version.15.0). Result: We included 1893 patients involving four exercise modalities and six exercise intensities. Combined training (aerobic exercise plus resistance exercise) has been the top-ranking exercise modality for improving the 6-min walk test (6MWT) (surface under the cumulative ranking curve analysis (SUCRA) score, 90.63), systolic blood pressure control (SUCRA score, 77.35), and diastolic pressure control (SUCRA score, 90.56). Moreover, the top-ranking exercise intensity was moderate–vigorous for 6MWT (SUCRA score, 82.36), systolic blood pressure (SUCRA score, 77.43), and diastolic blood pressure (SUCRA score, 83.75). Regarding dialysis adequacy and health-related quality of life, we found no exercise modality or intensity superior to the placebo. Conclusion: This network meta-analysis indicated that combined training and moderate–vigorous intensity might be the most effective interventions to improve 6MWT and blood pressure control. This finding helps further guide clinical exercise prescriptions for hemodialysis patients. Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021268535].
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Yoo J, Ruppar T, Wilbur J, Miller A, Westrick JC. Effects of Home-Based Exercise on Frailty in Patients With End-Stage Renal Disease: Systematic Review. Biol Res Nurs 2021; 24:48-63. [PMID: 34296640 DOI: 10.1177/10998004211033031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND New or worsening frailty is a common problem in patients with end-stage renal disease (ESRD) during the prolonged time awaiting kidney transplantation. Structured physical activity in the dialysis setting has been shown to mitigate frailty, but little is known about the benefits of home-based exercise. The purpose of this systematic review was to summarize the effects of home-based exercise interventions on indicators of frailty (weakness, slowness, low physical activity, perceived exhaustion, and shrinking) among patients diagnosed with ESRD. METHODS We searched PubMed, MEDLINE, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar using Medical Subject Heading terms and free text keywords including kidney failure, exercise, and frailty. We identified 13 relevant articles (eight randomized controlled trials, five quasi-experimental studies). RESULTS Our review found potential effectiveness of home-based exercise interventions on mitigating or preventing selected indicators of frailty (e.g., weakness, slowness, low physical activity, perceived exhaustion), particularly when the interventions combined aerobic walking, resistance exercise, and behavioral components and were delivered for at least 6 months. However, no published studies measured the effect of home-based exercise interventions on frailty as a whole. CONCLUSIONS While existing studies suggest likely benefits of home-based exercise interventions among patients with ESRD, future research is warranted to develop and test home-based physical activity interventions that address all indicators of frailty.
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Affiliation(s)
- Jongwon Yoo
- Rush University Medical Center, Chicago, IL, USA.,Advanced Practice Nurse, Transplant Nephrology, Loyola University Medical Center, Maywood, IL, USA
| | - Todd Ruppar
- Rush University Medical Center, Chicago, IL, USA
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Greenwood SA, Koufaki P, Macdonald JH, Bulley C, Bhandari S, Burton JO, Dasgupta I, Farrington K, Ford I, Kalra PA, Kumwenda M, Macdougall IC, Messow CM, Mitra S, Reid C, Smith AC, Taal MW, Thomson PC, Wheeler DC, White C, Yaqoob M, Mercer TH. Exercise programme to improve quality of life for patients with end-stage kidney disease receiving haemodialysis: the PEDAL RCT. Health Technol Assess 2021; 25:1-52. [PMID: 34156335 PMCID: PMC8256322 DOI: 10.3310/hta25400] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Whether or not clinically implementable exercise interventions in haemodialysis patients improve quality of life remains unknown. OBJECTIVES The PEDAL (PrEscription of intraDialytic exercise to improve quAlity of Life in patients with chronic kidney disease) trial evaluated the clinical effectiveness and cost-effectiveness of a 6-month intradialytic exercise programme on quality of life compared with usual care for haemodialysis patients. DESIGN We conducted a prospective, multicentre randomised controlled trial of haemodialysis patients from five haemodialysis centres in the UK and randomly assigned them (1 : 1) using a web-based system to (1) intradialytic exercise training plus usual-care maintenance haemodialysis or (2) usual-care maintenance haemodialysis. SETTING The setting was five dialysis units across the UK from 2015 to 2019. PARTICIPANTS The participants were adult patients with end-stage kidney disease who had been receiving haemodialysis therapy for > 1 year. INTERVENTIONS Participants were randomised to receive usual-care maintenance haemodialysis or usual-care maintenance haemodialysis plus intradialytic exercise training. MAIN OUTCOME MEASURES The primary outcome of the study was change in Kidney Disease Quality of Life Short Form, version 1.3, physical component summary score (from baseline to 6 months). Cost-effectiveness was determined using health economic analysis and the EuroQol-5 Dimensions, five-level version. Additional secondary outcomes included quality of life (Kidney Disease Quality of Life Short Form, version 1.3, generic multi-item and burden of kidney disease scales), functional capacity (sit-to-stand 60 and 10-metre Timed Up and Go tests), physiological measures (peak oxygen uptake and arterial stiffness), habitual physical activity levels (measured by the International Physical Activity Questionnaire and Duke Activity Status Index), fear of falling (measured by the Tinetti Falls Efficacy Scale), anthropometric measures (body mass index and waist circumference), clinical measures (including medication use, resting blood pressure, routine biochemistry, hospitalisations) and harms associated with intervention. A nested qualitative study was conducted. RESULTS We randomised 379 participants; 335 patients completed baseline assessments and 243 patients (intervention, n = 127; control, n = 116) completed 6-month assessments. The mean difference in change in physical component summary score from baseline to 6 months between the intervention group and control group was 2.4 arbitrary units (95% confidence interval -0.1 to 4.8 arbitrary units; p = 0.055). Participants in the intervention group had poor compliance (49%) and very poor adherence (18%) to the exercise prescription. The cost of delivering the intervention ranged from £463 to £848 per participant per year. The number of participants with harms was similar in the intervention (n = 69) and control (n = 56) groups. LIMITATIONS Participants could not be blinded to the intervention; however, outcome assessors were blinded to group allocation. CONCLUSIONS On trial completion the primary outcome (Kidney Disease Quality of Life Short Form, version 1.3, physical component summary score) was not statistically improved compared with usual care. The findings suggest that implementation of an intradialytic cycling programme is not an effective intervention to enhance health-related quality of life, as delivered to this cohort of deconditioned patients receiving haemodialysis. FUTURE WORK The benefits of longer interventions, including progressive resistance training, should be confirmed even if extradialytic delivery is required. Future studies also need to evaluate whether or not there are subgroups of patients who may benefit from this type of intervention, and whether or not there is scope to optimise the exercise intervention to improve compliance and clinical effectiveness. TRIAL REGISTRATION Current Controlled Trials ISRCTN83508514. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 40. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sharlene A Greenwood
- King's College Hospital NHS Foundation Trust, London, UK
- School of Renal Medicine, King's College London, London, UK
| | - Pelagia Koufaki
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Jamie H Macdonald
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Catherine Bulley
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | | | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Indranil Dasgupta
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | | | - Iain C Macdougall
- King's College Hospital NHS Foundation Trust, London, UK
- School of Renal Medicine, King's College London, London, UK
| | | | | | - Chante Reid
- King's College Hospital NHS Foundation Trust, London, UK
| | - Alice C Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Maarten W Taal
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - David C Wheeler
- School of Medicine, University College London, London, UK
- George Institute for Global Health, Sydney, NSW, Australia
| | - Claire White
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Thomas H Mercer
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
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Dobronravov VA, Vasilieva IA. Health-related quality of life and long-term mortality in young and middle-aged hemodialysis patients. Int Urol Nephrol 2021; 53:2377-2384. [PMID: 34028642 DOI: 10.1007/s11255-021-02894-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/16/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The relationship of health-related quality of life (HRQoL) with mortality in young and middle-aged hemodialysis (HD) patients has scarcely been studied and remains unclear. The aim of the study was to examine whether physical and mental components of HRQoL are related to long-term risks of all-cause and cardiovascular (CV) death in this particular HD population. METHODS A long-term observational prospective study included 238 prevalent HD patients aged 18-64 years. The median follow-up was 50 (22, 96) months (maximum 13.9 years). HRQoL variables of the Short Form 36 Health Survey (SF-36), clinical, and demographic data were assessed at the time of inclusion. Associations of baseline HRQoL scores with all-cause and CV mortality were assessed using Kaplan-Meier survival plots and Cox regression analysis adjusted for clinical and demographic confounders. RESULTS The majority of HRQoL parameters were associated with outcomes in univariable analyses. In multivariable regression models adjusted for clinical and demographic confounders, Physical Functioning (PF) and Physical Component Summary Score (PCS) remained independently related to all-cause mortality [hazard ratio (HR) for a 1-point increase in PF and PCS were 0.981, 95% confidence interval (CI) 0.972-0.989 and 0.954, CI 0.929-0.980, respectively] and CV death (HR for a 1-point increase in PF and PCS were 0.975, CI 0.962-0.988 and 0.950, CI 0.915-0.985, respectively). CONCLUSION PF and PCS assessment seems to be relevant for refining the prognosis and clinical decision-making in young and middle-aged HD patients.
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Affiliation(s)
- Vladimir A Dobronravov
- Research Institute of Nephrology, Pavlov University, L'va Tolstogo str. 6-8, Saint Petersburg, 197022, Russian Federation
| | - Irina A Vasilieva
- Research Institute of Nephrology, Pavlov University, L'va Tolstogo str. 6-8, Saint Petersburg, 197022, Russian Federation.
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Yuenyongchaiwat K, Namdang P, Vasinsarunkul P, Phongsukree P, Chaturattanachaiyaporn K, Pairojkittrakul S, Traitanon O. Effectiveness of inspiratory muscle training on respiratory fitness and breathlessness in chronic renal failure: A randomized control trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 26:e1879. [PMID: 32929841 DOI: 10.1002/pri.1879] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/30/2020] [Accepted: 08/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND People with chronic renal failure (CRF) show decreased respiratory fitness and poor quality of life (QOL). Exercise during hemodialysis has been suggested to improve the cardio-respiratory fitness. However, results of effects of respiratory muscle (RM) training on respiratory fitness and QOL are inconsistent. In addition, very few studies explored the association between inspiratory muscle (IM) training and sensation of breathlessness. OBJECTIVES To examine the effects of IM training in hemodialysis patients on respiratory fitness QOL and breathlessness. METHOD A randomized control trial with 50 CRF, who underwent hemodialysis (25 individuals in each group; IM training and sham group) was designed. Pulmonary function, RM strength, QOL (measured by Kidney Disease Quality of Life-36), and sensation of breathlessness were measured before and after an 8-week intervention. RESULTS Compared to the sham group, the IM strength increased in the intervention group after an 8-week program (Δ25.92 ± 8.73 cmH2 O, p = 0.005). Significantly increased IM and forced vital capacity values in training groups was observed after an 8-week intervention (Δ12.44 ± 3.07 cmH2 O and Δ0.097 ± 0.046 L, respectively), but not the sham group. Neither, the training group, nor the sham group were significantly different in the QOL. However, feeling of shortness of breath improved after the training program among inspiratory muscle training group, but not the sham group. CONCLUSION IM training during hemodialysis could lead to an improvement of respiratory fitness and reduce breathlessness in people with CRF who are receiving hemodialysis. However, QOL was not different after the training program. The study suggests that after 8-week intervention program, IM training (loading exercise) could improve IM strength, pulmonary function without any complications during the intervention program within 1-2 h.
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Affiliation(s)
- Kornanong Yuenyongchaiwat
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Khlong Nueng, Pathumthani, Thailand
| | - Phuwarin Namdang
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Khlong Nueng, Pathumthani, Thailand
| | - Phatsara Vasinsarunkul
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Khlong Nueng, Pathumthani, Thailand
| | - Phoomipat Phongsukree
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Khlong Nueng, Pathumthani, Thailand
| | | | | | - Opas Traitanon
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Khlong Nueng, Pathumthani, Thailand
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Liu CK, Afezolli D, Seo J, Syeda H, Zheng S, Folta SC. Perceptions of Physical Activity in African American Older Adults on Hemodialysis: Themes From Key Informant Interviews. Arch Rehabil Res Clin Transl 2020; 2:100056. [PMID: 33543083 PMCID: PMC7853361 DOI: 10.1016/j.arrct.2020.100056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To determine key themes underlying the perceptions of older (≥65y) adults on hemodialysis regarding physical activity using qualitative methodology. DESIGN Semistructured key informant interviews. SETTING Academic medical center. PARTICIPANTS Convenience sample of older adults on hemodialysis (N=10). INTERVENTIONS None. MAIN OUTCOME MEASURES Interview transcripts were coded and analyzed using the framework method to extract themes and subthemes. Participants also answered Likert statements regarding their perceptions of physical activity, and the responses were tallied. RESULTS Ten older adults on hemodialysis participated (mean age 73±5y; 60% women); all were African American. All participants stated physical activity would make them feel better. The major themes that emerged were barriers and facilitators. Facilitators included internal motivators, family and friend support, and feasibility of incorporating physical activity into routine activities. Barriers were lack of motivation, health issues, and environmental restrictions. CONCLUSIONS Physical activity potentially could prevent the physical decline commonly seen in older adults on hemodialysis. Yet information regarding the perceptions of this population toward physical activity is sparse. Although the study is limited by selection bias, our study presents qualitative evidence that black older adults on hemodialysis desire physical activity for their health. Future interventions to increase physical activity in this population should consider leveraging existing facilitators, such as the support of family and friends, and use strategies to address barriers like minimal motivation.
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Affiliation(s)
- Christine Kee Liu
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Debora Afezolli
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Janet Seo
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Haniya Syeda
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Shenglin Zheng
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Sara C. Folta
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
- Jonathan M. Tisch College of Citizenship and Public Service, Tufts University, Boston, Massachusetts
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Moorthi RN, Fadel WF, Cranor A, Hindi J, Avin KG, Lane KA, Thadhani RI, Moe SM. Mobility Impairment in Patients New to Dialysis. Am J Nephrol 2020; 51:705-714. [PMID: 32781443 DOI: 10.1159/000509225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Impaired mobility is associated with functional dependence, frailty, and mortality in prevalent patients undergoing dialysis. We investigated risk factors for mobility impairment, (poor gait speed) in patients incident to dialysis, and changes in gait speed over time in a 2-year longitudinal study. METHODS One hundred eighty-three patients enrolled within 6 months of dialysis initiation were followed up 6, 12, and 24 months later. Grip strength, health-related quality of life, and comorbidities were assessed at baseline. Outcomes were (a) baseline gait speed and (b) change in gait speed over time. Gait speed was assessed by 4-meter walk. Multivariate linear regression was used to identify risk factors for low gait speed at baseline. For longitudinal analyses, linear mixed effects modeling with gait speed modeled over time was used as the outcome. RESULTS Participants were 54.7 ± 12.8 years old, 52.5% men, 73.9% black with mean dialysis vintage of 100.1 ± 46.9 days and median gait speed 0.78 (0.64-0.094) m/s. Lower health utility and grip strength, diabetic nephropathy, and walking aids were associated with lower baseline gait speed. Loss of 0.1 m/s gait speed occurred in 24% of subjects at 1 year. In multivariate mixed effects models, only age, walking aid use, lower health utility, and lower handgrip strength were significantly associated with gait speed loss. CONCLUSIONS In our cohort of incident dialysis patients, overall gait speed is very low and 54.2% of the subjects continue to lose gait speed over 2 years. Older age, lower handgrip strength, and quality of life are risk factors for slowness. Patients at highest risk of poor gait speed can be identified at dialysis initiation to allow targeted implementation of therapeutic options.
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Affiliation(s)
- Ranjani N Moorthi
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA,
| | - William F Fadel
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alissa Cranor
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Judy Hindi
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Keith G Avin
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- School of Health & Human Sciences, Indiana University, Indianapolis, Indiana, USA
| | - Kathleen A Lane
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Sharon M Moe
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA
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Sheshadri A, Kittiskulnam P, Lai JC, Johansen KL. Effect of a pedometer-based walking intervention on body composition in patients with ESRD: a randomized controlled trial. BMC Nephrol 2020; 21:100. [PMID: 32178648 PMCID: PMC7074998 DOI: 10.1186/s12882-020-01753-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/28/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A randomized trial of a pedometer-based intervention with weekly activity goals led to a modest increase in step count among dialysis patients. In a secondary analysis, we investigated the effect of this intervention on body composition. METHODS Sixty dialysis patients were randomized to standard care or a 6-month program consisting of 3 months of pedometers and weekly step count targets and 3 months of post-intervention follow-up. We obtained bioelectrical impedance spectroscopy (BIS) data on 54 of these patients (28 control, 26 intervention) and used linear mixed-modeling (adjusted for sex and dialysis modality) to estimate differences in change in total-body muscle mass (TBMM) adjusted for height2, fat mass (kg), and body mass index (BMI) (kg/m2) between control and intervention groups. RESULTS The median age of participants was 57.5 years (53-66), and 76% were men. At baseline, there was no significant difference between groups in age, BMI, race, or body composition, but there were more men in the intervention group. After 3 months, patients in the intervention group increased their average daily steps by 2414 (95% CI 1047, 3782) more than controls (p < 0.001), but there were no significant differences in body composition. However, at 6 months, participants in the intervention had a significantly greater increase from baseline in TBMM of 0.7 kg/m2 (95% CI 0.3, 1.13), decrease in fat mass (- 4.3 kg [95% CI -7.1, - 1.5]) and decrease in BMI (- 1.0 kg/m2 [95% CI -1.8, - 0.2]) relative to controls. In post-hoc analysis, each increase of 1000 steps from 0 to 3 months was associated with a 0.3 kg decrease in fat mass (95% CI 0.05, 0.5) from 0 to 6 months, but there was no dose-response relationship with TBMM/ht2 or BMI. CONCLUSION A pedometer-based intervention resulted in greater decreases in fat mass with relative preservation of muscle mass, leading to a greater decrease in BMI over time compared with patients not in the intervention. These differences were driven as much by worsening in the control group as by improvement in the intervention group. Step counts had a dose-response relationship with decrease in fat mass. TRIAL REGISTRATION ClinicalTrials.gov (NCT02623348). 02 December 2015.
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Affiliation(s)
- Anoop Sheshadri
- Division of Nephrology, Department of Medicine, University of California, San Francisco, USA.
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
| | - Piyawan Kittiskulnam
- Division of Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Special Task Force for Activating Research in Renal Nutrition, (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand
| | - Jennifer C Lai
- Division of Gastroenterology/Hepatology, Department of Medicine, University of California, San Francisco, USA
| | - Kirsten L Johansen
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA
- Division of Nephrology, University of Minnesota, Minneapolis, MN, USA
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Hargrove N, Tays Q, Storsley L, Komenda P, Rigatto C, Ferguson T, Tangri N, Bohm C. Effect of an exercise rehabilitation program on physical function over 1 year in chronic kidney disease: an observational study. Clin Kidney J 2020; 13:95-104. [PMID: 32082557 PMCID: PMC7025337 DOI: 10.1093/ckj/sfz037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/12/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Exercise rehabilitation may help maintain physical function in chronic kidney disease (CKD), but long-term clinical effectiveness is unknown. We evaluated the effect of an exercise rehabilitation program on physical function over 1 year in individuals with CKD. METHODS This clinical program evaluation included adults with CKD (any stage) registered in a provincial renal program from 1 January 2011 to 31 March 2016. Attenders were referred to and attended a 10-week exercise rehabilitation program (n = 117). Nonattenders were referred, but did not attend the program (n = 133). Individuals enrolled in a longitudinal frailty study (n = 318) composed a second control group. Primary outcome: Change in physical function [short physical performance battery (SPPB) score]. Secondary outcomes included change in health-related quality of life, physical activity, exercise behaviour, hospitalization over 1 year. Predictors of improved SPPB were assessed using logistic regression. RESULTS In sum, 53, 40 and 207 participants completed 1-year follow-up in attender, nonattender and second control groups, respectively. Baseline median SPPB [interquartile range (IQR)] scores were 10.5 (9-12), 10 (8-12) and 9 (7-11) in attender, nonattender and second control groups, respectively (P = 0.02). Mean change in SPPB score over 1 year was not significantly different between groups (P = 0.7). Attenders with baseline SPPB score <12, trended toward increased likelihood of improved SPPB score at 1 year [odds ratio (OR) 2.18; 95% confidence interval (CI) 0.95-5.02; P = 0.07]. More attenders (60%) exercised regularly at 1 year than nonattenders (35%) (P = 0.03). CONCLUSIONS The impact of clinical exercise rehabilitation programs on physical function at 1 year needs further delineation. However, our observation of improved exercise behaviour at 1 year suggests sustained benefits with such programs in CKD.
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Affiliation(s)
- Nicholas Hargrove
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Quinn Tays
- Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada
| | - Leroy Storsley
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Renal Program, Winnipeg, Manitoba, Canada
| | - Paul Komenda
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada
- Manitoba Renal Program, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Claudio Rigatto
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada
- Manitoba Renal Program, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thomas Ferguson
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada
| | - Navdeep Tangri
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada
- Manitoba Renal Program, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Clara Bohm
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada
- Manitoba Renal Program, Winnipeg, Manitoba, Canada
- Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
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Torres E, Aragoncillo I, Moreno J, Vega A, Abad S, García‐Prieto A, Macias N, Hernandez A, Godino MT, Luño J. Exercise training during hemodialysis sessions: Physical and biochemical benefits. Ther Apher Dial 2020; 24:648-654. [DOI: 10.1111/1744-9987.13469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 11/21/2019] [Accepted: 12/27/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Esther Torres
- Department of Nephrology, Hospital General Universitario Gregorio Marañon Madrid Spain
| | - Ines Aragoncillo
- Department of Nephrology, Hospital General Universitario Gregorio Marañon Madrid Spain
- Spanish Research Network (REDINREN) Madrid Spain
| | - Jorge Moreno
- Servicio de Rehabilitación Hospital General Universitario Gregorio Maranón Madrid Spain
| | - Almudena Vega
- Department of Nephrology, Hospital General Universitario Gregorio Marañon Madrid Spain
- Spanish Research Network (REDINREN) Madrid Spain
| | - Soraya Abad
- Department of Nephrology, Hospital General Universitario Gregorio Marañon Madrid Spain
- Spanish Research Network (REDINREN) Madrid Spain
| | - Ana García‐Prieto
- Department of Nephrology, Hospital General Universitario Gregorio Marañon Madrid Spain
| | - Nicolas Macias
- Department of Nephrology, Hospital General Universitario Gregorio Marañon Madrid Spain
- Spanish Research Network (REDINREN) Madrid Spain
| | - Andres Hernandez
- Department of Nephrology, Hospital General Universitario Gregorio Marañon Madrid Spain
| | - Maria Teresa Godino
- Servicio de Rehabilitación Hospital General Universitario Gregorio Maranón Madrid Spain
| | - Jose Luño
- Department of Nephrology, Hospital General Universitario Gregorio Marañon Madrid Spain
- Spanish Research Network (REDINREN) Madrid Spain
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Sheshadri A, Kittiskulnam P, Lazar AA, Johansen KL. A Walking Intervention to Increase Weekly Steps in Dialysis Patients: A Pilot Randomized Controlled Trial. Am J Kidney Dis 2019; 75:488-496. [PMID: 31679747 DOI: 10.1053/j.ajkd.2019.07.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022]
Abstract
RATIONALE & OBJECTIVE Patients receiving dialysis report very low physical activity. We implemented a pilot trial to assess the feasibility of a pedometer-based intervention to gather preliminary evidence about its impact on physical activity, symptoms, and surrogates of cardiovascular risk. STUDY DESIGN Pilot randomized controlled trial. SETTING & PARTICIPANTS 60 dialysis patients from San Francisco dialysis clinics. INTERVENTION Participants were randomly assigned 1:1 to receiving pedometers with weekly step goals or usual care for 3 months. OUTCOMES The primary outcome was step counts, measured using pedometers. Secondary outcomes included physical performance using the Short Physical Performance Battery, the Physical Function and Vitality scales of the 36-Item Short Form Health Survey, the Dialysis Symptoms Index, and the Center for Epidemiologic Studies-Depression Scale, with endothelial function as a secondary and heart rate variability as an exploratory surrogate measure of cardiovascular risk. Targeted enrollment was 50% and targeted completion was 85%. RESULTS 49% of approached patients were enrolled, and 92% completed the study. After 3 months, patients randomly assigned to the intervention (n=30) increased their average daily steps by 2,256 (95% CI, 978-3,537) more than the 30 controls (P<0.001). Heart rate variability (standard deviation of N-N intervals) increased by 14.94 (95% CI, 0.31-33.56) millisecondsin the intervention group as compared with controls (P = 0.05). There were no statistically significant differences across intervention groups in symptoms, physical performance, or endothelial function. Participants in the intervention group reverted to baseline steps during the postintervention follow-up. LIMITATIONS The Northern California study setting may limit generalizability. Walking does not capture the full spectrum of physical activity. CONCLUSIONS A short-term pedometer-based intervention led to increased step counts in dialysis patients, but the increase was not sustained. Pedometer-based interventions are feasible for dialysis patients, but future studies are needed to address whether more prolonged interventions can improve physical function or symptoms. FUNDING Supported by grants from the American Kidney Fund, National Institutes of Health-National Institute of Diabetes and Digestive and Kidney Diseases, and International Society of Nephrology. TRIAL REGISTRATION Registered at ClinicalTrials.gov with study identifier NCT02623348.
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Affiliation(s)
- Anoop Sheshadri
- Division of Nephrology, University of California, San Francisco, San Francisco, CA.
| | - Piyawan Kittiskulnam
- Division of Internal Medicine-Nephrology, Chulalongkorn University, Bangkok, Thailand; Special Task Force for Activating Research in Renal Nutrition, (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand
| | - Ann A Lazar
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Kirsten L Johansen
- Division of Nephrology, University of California, San Francisco, San Francisco, CA
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Kim HJ, Lee JY, Lee ES, Jung HJ, Ahn HJ, Kim BI. Improvements in oral functions of elderly after simple oral exercise. Clin Interv Aging 2019; 14:915-924. [PMID: 31190777 PMCID: PMC6529034 DOI: 10.2147/cia.s205236] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/06/2019] [Indexed: 12/16/2022] Open
Abstract
Purpose: Conventional oral exercises in previous studies are considered impractical for continuous use in the elderly because of the extended duration needed for effective outcomes. Therefore, in the present study, a simple oral exercise (SOE) was developed to reduce performance time, focusing on improvements in mastication, salivation, and swallowing functions. The aim of this study was to determine the short-term effects of the SOE with respect to improving mastication, salivation, and swallowing function in elderly subjects ≥65 years of age. Patients and methods: The study included 84 subjects, all of whom performed the SOE 2 times per day for 1 week. Masticatory performance was assessed using the mixing ability index (MAI). Unstimulated saliva and the degree of moisture of the tongue/buccal mucosa were evaluated, and the repetitive saliva swallowing test was performed. On the basis of each of these four measurements, subjects were dichotomized into two groups with high (good) and low (poor) conditions. The same evaluations were conducted before and immediately after intervention, as well as after 1 week of intervention. A subjective evaluation with questionnaires was performed after 1 week of intervention. The changes were analyzed using repeated-measures ANOVA, Cochran’s Q test, and McNemar’s test. Results: The mean MAI increased by 6% immediately after the intervention, and by 16% in the poor-chewing group. Similarly, the amount of unstimulated saliva increased by 0.1 ml/min immediately after the SOE, and by 29% in the poor-salivation group. The degree of tongue moisture increased by 3% and was maintained. In the poor-swallowing group, 25% and 40% of the subjects were upgraded to the good-swallowing group immediately after intervention, as well as after 1 week of intervention, respectively. The subjects experienced less discomfort as their oral function improved. Conclusion: The SOE was effective in immediately improving oral functions, and improvement was maintained for 1 week.
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Affiliation(s)
- Hyo-Jung Kim
- Department of Preventive Dentistry & Public Oral Health, Brain Korea 21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Joo-Young Lee
- Department of Preventive Dentistry & Public Oral Health, Brain Korea 21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Eun-Song Lee
- Department of Preventive Dentistry & Public Oral Health, Brain Korea 21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Hyo-Jung Jung
- Department of Orofacial pain & Oral medicine, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Hyung-Joon Ahn
- Department of Orofacial pain & Oral medicine, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Baek-Il Kim
- Department of Preventive Dentistry & Public Oral Health, Brain Korea 21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea
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Abstract
Clinical manifestations of functional and morphological muscular abnormalities in dialysis patients are muscle weakness and low exercise capacity, possibly leading to a sedentary life style with low physical activity. Low cardiorespiratory fitness and muscle atrophy and weakness contribute to the development of frailty and affect patients' ability to physically navigate their environment. While many dialysis patients may appear too frail to participate in moderate-to-vigorous aerobic exercise training, those who can complete such programs appear to derive substantial benefit. Less vigorous aerobic exercise, resistance training, and alternative forms of exercise can also be beneficial. Most patients on dialysis are not too frail to perform resistance exercise of adequate intensity to achieve increases in muscle size and strength, therefore, frailty should not be considered a contraindication to exercise.
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Affiliation(s)
- Connie J Wang
- Division of Nephrology, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota
| | - Kirsten L Johansen
- Division of Nephrology, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota.,Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
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Abstract
BACKGROUND People with Chronic Kidney Disease (CKD) often present with prevalent gait impairment and high fall rates, particularly in advanced CKD stages. Gait impairment and its consequences is associated with increased hospital admission, institutionalization, and greater need for health care. The objective of this systematic review was to evaluate the quality of studies investigating CKD patients' gait characteristics at different CKD stages, to highlight areas of agreement and contradiction between studies reporting aspects of gait in CKD, and to discuss and emphasize gait parameters associated with fall risk. METHODS We performed a literature search of trials in CINAHL (EBSCO), Cochrane Library, EMBASE, Medline (EBSCO), PEDro, PubMed, and Scopus databases from their inception to June 30th 2018 using a two-stage process for the identification of studies. We retrieved English-, German-, Italian-, Spanish-, Portuguese and Dutch-language articles for review. Methodological quality of randomized and non-randomized studies was assessed with an adapted version of the Downs and Black checklist. RESULTS Thirty-one studies (22 cross-sectional with 3901 participants) and 9 longitudinal intervention studies (1 randomized control trial, 5 controlled clinical trials and 3 one-group pre-post-test; with 659 participants) were considered. The studies revealed a primary emphasis on gait speed measures within clinical tests, and a neglect of spatiotemporal gait variables. Most of the studies showed that CKD progression is associated with slowing of walking speed. No studies analysed the relation between gait parameters and fall risk. CONCLUSIONS There was a paucity of studies investigating aspects of gait quality in patients with CKD. In the majority of studies, only gait speed is analysed as a performance indicator. The relation between gait parameters and fall risk in CKD is not investigated. We formulate several recommendations to fill the current research gap, encourage the use of standardized gait analysis protocols that include assessment of spatiotemporal parameters in clinical care of patients with CKD, aimed at prevention of mobility decline and falls risk.
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Salhab N, Karavetian M, Kooman J, Fiaccadori E, El Khoury CF. Effects of intradialytic aerobic exercise on hemodialysis patients: a systematic review and meta-analysis. J Nephrol 2019; 32:549-566. [PMID: 30659520 PMCID: PMC6588711 DOI: 10.1007/s40620-018-00565-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/19/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Intradialytic exercise (IDE) is not yet a routine practice for hemodialysis patients, the lack of guidelines supporting it being a major reason. This systematic review and meta-analysis of aerobic IDE interventions examined the efficacy of IDE regarding quality of life (QOL), serum phosphorus, dialysis efficiency, inflammatory status, vitamin D3, parathyroid hormone, intake of phosphate binders, mortality and hospitalization rate. METHODS Pubmed, Medline (Ovid), Embase (Ovid), Cochrane, and Cinahl (EBSCO) databases were searched to retrieve studies up to June 12, 2018. A manual reference search was also performed. Studies were included if they evaluated (a) aerobic IDE effect on at least one of our study parameters, (b) adult hemodialysis patients, (c) patients for > 1 month. RESULTS Twenty-two studies were retrieved (706 participants), of which 12 were eligible for meta-analysis. Aerobic IDE had a significant positive effect on the QOL physical component score (QOL-PSC) and on mental component score (QOL-MCS) of SF36, but not on serum phosphorus or Kt/V. CONCLUSIONS IDE incorporation into clinical practice has a significant positive effect on QOL-PSC and QOL-MCS. In the reviewed studies, IDE did not result in any health hazard in hemodialysis patients. Nevertheless, future research should assess the long-term effectiveness and safety of IDE. The limitations of this review include the lack of quality analysis of the studies, the limited number of studies that could be included in the meta-analysis, the diversity in the exercise intensity, duration and modality, and the limited data for several outcomes. PROSPERO REGISTRATION ID CRD42016052062.
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Affiliation(s)
- Nada Salhab
- School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Mirey Karavetian
- Department of Health Sciences, College of Natural Health Sciences, Zayed University, Dubai, United Arab Emirates
| | - Jeroen Kooman
- Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Enrico Fiaccadori
- Internal Medicine and Nephrology Department, Parma University Medical School, Parma, Italy
| | - Cosette F El Khoury
- School of Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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22
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de Castro APA, Barbosa SR, Mansur HN, Ezequiel DGA, Costa MB, de Paula RB. Intradialytic resistance training: an effective and easy-to-execute strategy. J Bras Nefrol 2018; 41:215-223. [PMID: 30421780 PMCID: PMC6699434 DOI: 10.1590/2175-8239-jbn-2018-0134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/05/2018] [Indexed: 11/22/2022] Open
Abstract
Chronic kidney disease (CKD) alters the morphology and function of skeletal muscles, thereby decreasing patient physical capacity (PC) and quality of life (QoL). Intradialytic resistance training (IRT) is a pragmatic tool used to attenuate these complications. However, IRT has not been strongly adopted in nephrology care centers. This study aimed to assess the efficacy and safety of a low-cost, easy-to-use IRT protocol. METHODS The study enrolled 43 patients (52.8 ± 13.85 years) on HD for five to 300 months followed from April 2014 to July 2017. The efficacy of IRT was assessed based on PC - derived from muscle strength (MS) and preferred walking speed (PWS) - and QoL. The occurrence of adverse events was used as a measure of safety. The IRT protocol consisted of exercises of moderate to high intensity for the main muscle groups performed three times a week. RESULTS The mean follow-up time was 9.3 ± 3.24 months, for a total of 4,374 sessions of IRT. Compliance to the protocol was 96.5 ± 2.90%, and patients presented significant improvements in MS (from 27.3 ± 11.58 Kgf to 34.8 ± 10.77 Kgf) and PWS (from 0.99 ± 0.29 m/s to 1.26 ± 0.22 m/s). Physical and emotional components of QoL also increased significantly. CONCLUSION IRT led to significant increases in PC and higher scores in all domains of QoL. Important adverse events were not observed during intradialytic resistance training.
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Affiliation(s)
- Antônio Paulo André de Castro
- Universidade Federal de Juiz de
ForaFaculdade de MedicinaPrograma de Pós-graduação em SaúdeJuiz de ForaMGBrasilUniversidade Federal de Juiz de Fora, Programa
de Pós-graduação em Saúde da Faculdade de Medicina, Juiz de Fora, MG,
Brasil.
- Centro de Ensino Superior de
ValençaValençaRJBrasilCentro de Ensino Superior de Valença, Valença,
RJ, Brasil.
- Faculdade do Sudeste MineiroJuiz de ForaMGBrasilFaculdade do Sudeste Mineiro, Juiz de Fora, MG,
Brasil.
| | - Sergio Ribeiro Barbosa
- Faculdade de São LourençoSão LourençoMGBrasilFaculdade de São Lourenço, São Lourenço, MG,
Brasil.
| | - Henrique Novais Mansur
- Instituto Federal do Sudeste de Minas
GeraisRio PombaMGBrasilInstituto Federal do Sudeste de Minas Gerais,
Rio Pomba, MG, Brasil.
| | | | - Mônica Barros Costa
- Universidade Federal de Juiz de
ForaJuiz de ForaMGBrasilUniversidade Federal de Juiz de Fora, Juiz de
Fora, MG, Brasil.
| | - Rogério Baumgratz de Paula
- Universidade Federal de Juiz de
ForaFaculdade de MedicinaPrograma de Pós-graduação em SaúdeJuiz de ForaMGBrasilUniversidade Federal de Juiz de Fora, Programa
de Pós-graduação em Saúde da Faculdade de Medicina, Juiz de Fora, MG,
Brasil.
- Universidade Federal de Juiz de
ForaJuiz de ForaMGBrasilUniversidade Federal de Juiz de Fora, Juiz de
Fora, MG, Brasil.
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23
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Segura‐Ortí E, Pérez‐Domínguez B, Ortega‐Pérez de Villar L, Meléndez‐Oliva E, Martínez‐Gramage J, García‐Maset R, Gil‐Gómez JA. Virtual reality exercise intradialysis to improve physical function: A feasibility randomized trial. Scand J Med Sci Sports 2018; 29:89-94. [DOI: 10.1111/sms.13304] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/08/2018] [Accepted: 09/14/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Eva Segura‐Ortí
- Department of PhysiotherapyUniversidad Cardenal Herrera‐CEU, CEU Universities Valencia Spain
| | - Borja Pérez‐Domínguez
- Department of PhysiotherapyUniversidad Cardenal Herrera‐CEU, CEU Universities Valencia Spain
| | | | - Erika Meléndez‐Oliva
- Department of PhysiotherapyUniversidad Cardenal Herrera‐CEU, CEU Universities Valencia Spain
| | - Javier Martínez‐Gramage
- Department of PhysiotherapyUniversidad Cardenal Herrera‐CEU, CEU Universities Valencia Spain
| | | | - José Antonio Gil‐Gómez
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València Valencia Spain
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24
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Afsar B, Siriopol D, Aslan G, Eren OC, Dagel T, Kilic U, Kanbay A, Burlacu A, Covic A, Kanbay M. The impact of exercise on physical function, cardiovascular outcomes and quality of life in chronic kidney disease patients: a systematic review. Int Urol Nephrol 2018; 50:885-904. [DOI: 10.1007/s11255-018-1790-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/07/2018] [Indexed: 12/18/2022]
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25
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Nitta K, Hanafusa N, Tsuchiya K. Frailty and mortality among dialysis patients. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0122-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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26
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Bučar Pajek M, Leskošek B, Vivoda T, Svilan K, Čuk I, Pajek J. Integrative Examination of Motor Abilities in Dialysis Patients and Selection of Tests for a Standardized Physical Function Assessment. Ther Apher Dial 2017; 20:286-94. [PMID: 27312917 DOI: 10.1111/1744-9987.12439] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 01/04/2023]
Abstract
To reduce the need for a large number of executed physical function tests we examined inter-relations and determined predictive power for daily physical activity of the following tests: 6-min walk, 10 repetition sit-to-stand, time up-and-go, Storke balance, handgrip strength, upper limb tapping and sitting forward bend tests. In 90 dialysis and 140 healthy control subjects we found high correlations between all tests, especially those engaging lower extremities. Sit-to-stand, forward bend and handgrip strength were selected for the test battery and composite motor performance score. Sit-to-stand test was superior in terms of sensitivity to uremia effects and association with daily physical function in adjusted analyses. There was no incremental value in calculating the composite performance score. We propose to standardize the physical function assessment of dialysis patients for cross-sectional and longitudinal observations with three simple, cheap, well-accessible and easily performed test tools: sit-to-stand test, handgrip strength and Human Activity Profile questionnaire.
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Affiliation(s)
| | - Bojan Leskošek
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Tjaša Vivoda
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katarina Svilan
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ivan Čuk
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Jernej Pajek
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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27
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Li YN, Shapiro B, Kim JC, Zhang M, Porszasz J, Bross R, Feroze U, Upreti R, Martin D, Kalantar-Zadeh K, Kopple JD. Association between quality of life and anxiety, depression, physical activity and physical performance in maintenance hemodialysis patients. Chronic Dis Transl Med 2016; 2:110-119. [PMID: 29063031 PMCID: PMC5643749 DOI: 10.1016/j.cdtm.2016.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Maintenance hemodialysis (MHD) patients often have impaired quality of life (QOL), anxiety, depression, and reduced daily physical activity (DPA) and physical performance. The contributions of these latter factors to reduced QOL in MHD are poorly understood. We examined the association of QOL with anxiety, depression, DPA, and physical performance. METHODS Seventy-two relatively healthy adult MHD patients, vintage ≥6 months, and 39 normals of similar age range and gender distribution were studied. QOL was assessed using the Kidney Disease Quality of Life-Short Form (KDQOL-SF). Anxiety and depression were each evaluated with two questionnaires. DPA and physical performance were assessed with a physical activity monitor, Human Activity Profile, and 6-minute walk, sit-to-stand, and stair-climbing tests. RESULTS Most KDQOL components were reduced in MHD patients versus normals. KDQOL components in patients were commonly inversely correlated with measures of anxiety and depression (P < 0.05) and were more reduced in patients with both anxiety and depression. KDQOL was often impaired in patients with either anxiety or depression. However, most KDQOL scores did not differ between patients and normals without anxiety or depression. DPA, Human Activity Profile, and physical performance often correlated with KDQOL scores in adjusted models, but after further adjustment for anxiety and depression, DPA, Human Activity Profile, and physical performance correlated less frequently with KDQOL scores. This reduction in significant correlations after adjustment for anxiety and depression was particularly pronounced for the association between KDQOL and DPA. CONCLUSION In relatively healthy MHD patients, KDQOL scores are usually decreased in those with anxiety and/or depression but are usually normal in those without anxiety or depression. Lower DPA in MHD patients with reduced KDQOL scores often appears to be associated with anxiety and depression. The relationship between QOL and physical performance appears to be less influenced by anxiety and/or depression. These data suggest that treatment of anxiety and depression in MHD patients may improve their QOL, DPA, and possibly physical performance.
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Affiliation(s)
- Yi-Nan Li
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor - UCLA Medical Center, Torrance, CA 90502, USA.,Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, China
| | - Bryan Shapiro
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor - UCLA Medical Center, Torrance, CA 90502, USA
| | - Jun Chul Kim
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor - UCLA Medical Center, Torrance, CA 90502, USA.,Division of Nephrology, CHA Gumi Medical Center, CHA University, Kyungsangbuk-do 730728, South Korea
| | - Min Zhang
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor - UCLA Medical Center, Torrance, CA 90502, USA.,Division of Nephrology, Tianjin Union Medical Center, Tianjin 300121, China
| | - Janos Porszasz
- Rehabilitation Clinical Trials Center, Division of Respiratory & Critical Care Physiology & Medicine, Los Angeles Biomedical Research Institute at Harbor - UCLA Medical Center, Torrance, CA 90502, USA
| | - Rachelle Bross
- UCLA Clinical and Translational Science Institute, Los Angeles Biomedical Research Institute at Harbor - UCLA Medical Center, Torrance, CA 90502, USA.,Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor - UCLA Medical Center, Torrance, CA 90502, USA
| | - Usama Feroze
- George Washington University/Inova Fairfax Hospital Psychosomatic Fellowship Program, Washington, DC 20052, USA
| | - Rajeev Upreti
- Max Super Specialty Hospital, New Delhi, Delhi 110092, India
| | - David Martin
- Division of Psychology, Department of Psychiatry, Harbor - UCLA Medical Center, Torrance, CA 90502, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor - UCLA Medical Center, Torrance, CA 90502, USA.,Division of Nephrology and Hypertension, University of California at Irvine, Irvine, CA 92697, USA.,UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
| | - Joel David Kopple
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor - UCLA Medical Center, Torrance, CA 90502, USA.,UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA 90502, USA
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Abstract
Dietary modification is recommended in the management of chronic kidney disease (CKD). Individuals with CKD often have multiple comorbidities, such as high blood pressure, diabetes, obesity, and cardiovascular disease, for which dietary modification is also recommended. As CKD progresses, nutrition plays an important role in mitigating risk for cardiovascular disease and decline in kidney function. The objectives of nutrition interventions in CKD include management of risk factors, ensuring optimal nutritional status throughout all stages of CKD, preventing buildup of toxic metabolic products, and avoiding complications of CKD. Recommended dietary changes should be feasible, sustainable, and suited for patients' food preferences and clinical needs.
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Affiliation(s)
- Cheryl A M Anderson
- Department of Family Medicine and Public Health, UC San Diego School of Medicine, 9500 Gilman Drive, MC 0725, La Jolla, CA 92093-0725, USA.
| | - Hoang Anh Nguyen
- Department of Nephrology and Hypertension, UCSD Medical Center, 200 West Arbor Drive, San Diego, CA 92102, USA
| | - Dena E Rifkin
- Department of Nephrology and Hypertension, VA San Diego Healthcare System, 3350 La Jolla Drive, San Diego, CA 92161, USA
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29
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Araújo Filho JCD, Amorim CTD, Brito ACNDL, Oliveira DSD, Lemos A, Marinho PÉDM. Nível de atividade física de pacientes em hemodiálise: um estudo de corte transversal. FISIOTERAPIA E PESQUISA 2016. [DOI: 10.1590/1809-2950/14160723032016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Este estudo avaliou o nível de atividade física de pacientes em tratamento hemodialítico, verificando sua relação com variáveis sociodemográficas e laboratoriais. Foi realizado estudo de corte transversal composto por 108 sujeitos com doença renal crônica sob hemodiálise, sendo constituídos os grupos "ativo" e "sedentário". Foram avaliados dados socioeconômicos (questionário semiestruturado), características da doença renal, nível de atividade física (International Physical Activity Questionnaire - IPAQ) e dados laboratoriais (hematócrito, hemoglobina, creatinina, albumina, ureia) dos últimos exames registrados em prontuários. 8% dos pacientes da amostra foram identificados como sedentários, e 70,4% não receberam orientação para a realização de atividade física (p=0,013). Não foram observadas correlações entre o nível de atividade física e os dados socioeconômicos, clínicos e os parâmetros bioquímicos. Concluiu-se que indivíduos doentes renais crônicos em terapia renal substitutiva do tipo hemodiálise apresentam baixo nível de atividade física. Este achado está relacionado com a frequência de orientações a esse respeito para a população em diálise, não estando relacionado a dados sociodemográficos, clínicos e bioquímicos avaliados.
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30
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Hristea D, Deschamps T, Paris A, Lefrançois G, Collet V, Savoiu C, Ozenne S, Coupel S, Testa A, Magnard J. Combining intra-dialytic exercise and nutritional supplementation in malnourished older haemodialysis patients: Towards better quality of life and autonomy. Nephrology (Carlton) 2016; 21:785-90. [DOI: 10.1111/nep.12752] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/06/2016] [Accepted: 02/14/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Dan Hristea
- Dialysis Unit Laënnec, ECHO Association; Nantes France
| | | | - Anne Paris
- Dialysis Unit Laënnec, ECHO Association; Nantes France
| | | | | | | | - Sophie Ozenne
- Dialysis Unit Laënnec, ECHO Association; Nantes France
| | | | - Angelo Testa
- Dialysis Unit Confluent, ECHO Association; Nantes France
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31
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Chan D, Green S, Fiatarone Singh M, Barnard R, Cheema BS. Development, feasibility, and efficacy of a customized exercise device to deliver intradialytic resistance training in patients with end stage renal disease: Non-randomized controlled crossover trial. Hemodial Int 2016; 20:650-660. [DOI: 10.1111/hdi.12432] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Danwin Chan
- School of Science and Health; Western Sydney University; Penrith New South Wales Australia
| | - Simon Green
- School of Science and Health; Western Sydney University; Penrith New South Wales Australia
| | - Maria Fiatarone Singh
- Exercise, Health & Performance Faculty Research Group, Faculty of Health Sciences and Sydney Medical School, University of Sydney; Sydney Australia
- Hebrew SeniorLife and Jean Mayer USDA Human Nutrition Center on Aging at Tufts University; Boston Massachusetts USA
| | - Robert Barnard
- Centre for Physical Activity in Ageing; Northfield South Australia Australia
| | - Birinder S. Cheema
- School of Science and Health; Western Sydney University; Penrith New South Wales Australia
- The National Institute of Complementary Medicine; Penrith New South Wales Australia
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32
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Johansen KL. The Frail Dialysis Population: A Growing Burden for the Dialysis Community. Blood Purif 2015; 40:288-92. [PMID: 26656296 DOI: 10.1159/000441575] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The dialysis population is aging worldwide. It is well known that patients on dialysis have limited functional status, but only recently has frailty been considered. SUMMARY The prevalence of frailty among patients on dialysis ranges from 3.4- to 10-fold higher than among community-dwelling elderly, depending on the method of assessing frailty and patient characteristics. Despite its high prevalence and the high overall mortality in the dialysis population, frailty is associated with higher mortality, independent of clinical and demographic characteristics and comorbidity. The prevalence of frailty among patients with non-dialysis-dependent chronic kidney disease (CKD) is also high, and cross-sectional data suggest that the prevalence may increase as CKD progresses. Thus, interventions to improve frailty have the potential to improve quality of life and mortality. Although interventions to improve physical dysfunction have been successful in the population with end-stage renal disease, no studies have specifically targeted frail individuals. Therefore, the extent to which exercise or physical activity interventions are feasible among frail patients and can improve frailty urgently needs to be examined. In the meantime, providers should refer frail patients to physical therapists and encourage them to be more active if possible. In addition, more attention should be focused on the possibility that rehabilitation among patients with earlier stages of CKD could improve dialysis outcomes. KEY MESSAGES Frailty is extremely common among patients on dialysis and is independently associated with adverse outcomes. Providers should take advantage of available resources to improve functioning in this population, and research should address the optimal strategy for addressing frailty, including timing of intervention.
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Affiliation(s)
- Kirsten L Johansen
- Division of Nephrology, University of California, San Francisco, CA, USA
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33
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Bagheri Z, Jafari P, Faghih M, Allahyari E, Dehesh T. Testing measurement equivalence of the SF-36 questionnaire across patients on hemodialysis and healthy people. Int Urol Nephrol 2015; 47:2013-21. [PMID: 26329745 DOI: 10.1007/s11255-015-1092-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Differential item functioning (DIF) occurs when members from different groups respond differently to particular items in a health-related quality of life (HRQoL) questionnaire after controlling for underlying HRQoL construct. This study aimed to assess DIF in the SF-36 questionnaire and its effect on comparing HRQoL scores across patients on HD and healthy people. METHODS One hundred fifty patients on maintenance hemodialysis (HD) and 642 healthy individuals filled out the Persian version of the SF-36 questionnaire. Multiple-group multiple-indicator multiple-causes (MG-MIMIC) model was used to assess DIF across patients on HD and healthy population. RESULTS Sixteen out of 36 (44.4 %) items were flagged with DIF. Six out of 16 items (37.5 %) were flagged with uniform DIF, nine items (56.2 %) with non-uniform DIF, and one item (6.2 %) with both uniform DIF and non-uniform DIF. DIF items were associated with all subscales with the exception of the limitation due to physical problems and bodily pain subscales. The significant lower HRQoL scores of patients on HD in comparison with healthy people in the physical functioning and vitality subscales did not change after removing the items with uniform DIF. CONCLUSIONS Our findings revealed that patients on HD and healthy people perceived the meaning of the items in SF-36 questionnaire differently. Although the impact of DIF is minimal, the cross-group comparison across patients on HD and healthy people should be performed with caution.
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Affiliation(s)
- Zahra Bagheri
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Jafari
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Marjan Faghih
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elahe Allahyari
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tania Dehesh
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
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34
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Anding K, Bär T, Trojniak-Hennig J, Kuchinke S, Krause R, Rost JM, Halle M. A structured exercise programme during haemodialysis for patients with chronic kidney disease: clinical benefit and long-term adherence. BMJ Open 2015; 5:e008709. [PMID: 26316654 PMCID: PMC4554901 DOI: 10.1136/bmjopen-2015-008709] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Long-term studies regarding the effect of a structured physical exercise programme (SPEP) during haemodialysis (HD) assessing compliance and clinical benefit are scarce. STUDY DESIGN A single-centre clinical trial, non-randomised, investigating 46 patients with HD (63.2 ± 16.3 years, male/female 24/22, dialysis vintage 4.4 years) performing an SPEP over 5 years. The SPEP (twice/week for 60 min during haemodialysis) consisted of a combined resistance (8 muscle groups) and endurance (supine bicycle ergometry) training. Exercise intensity was continuously adjusted to improvements of performance testing. Changes in endurance and resistance capacity, physical functioning and quality of life (QoL) were analysed over 1 year in addition to long-term adherence and economics of the programme over 5 years. Average power per training session, maximal strength tests (maximal exercise repetitions/min), three performance-based tests for physical function, SF36 for QoL were assessed in the beginning and every 6 months thereafter. RESULTS 78% of the patients completed the programme after 1 year and 43% after 5 years. Participants were divided--according to adherence to the programme--into three groups: (1) high adherence group (HA, >80% of 104 training sessions within 12 months), (2) moderate adherence (MA, 60-80%), and 3. Low adherence group (LA, <60%)) with HA and MA evaluated quantitatively. One-year follow-up data revealed significant (p<0.05) improvement for both groups in all measured parameters: exercise capacity (HA: 55%, MA: 45%), strength (HA: >120%, MA: 40-50%), QoL in three scores of SF36 subscales and physical function in the three tests taken between 11% and 31%. Moreover, a quantitative correlation analysis revealed a close association (r=0.8) between large improvement of endurance capacity and weak physical condition (HA). CONCLUSIONS The exercise programme described improves physical function significantly and can be integrated into a HD routine with a high long-term adherence.
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Affiliation(s)
- Kirsten Anding
- KfH Kidney Center, Bischofswerda, Germany
- ReNi-German Society of Sports Rehabilitation in CKD, Berlin, Germany
| | - Thomas Bär
- KfH Kidney Center, Bischofswerda, Germany
| | | | | | - Rolfdieter Krause
- ReNi-German Society of Sports Rehabilitation in CKD, Berlin, Germany
| | - Jan M Rost
- Max Planck-Institute for the Physics of Complex Systems, Dresden, Germany
- PULSE Institute, Stanford University, Palo Alto, USA
| | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der, Isar, Technische Universität München, Munich, Germany
- Partner site Munich Heart Alliance, DZHK (German Center for Cardiovascular Research), Munich, Germany
- Else-Kröner-Fresenius-Zentrum, Munich, Germany
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35
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Simó VE, Jiménez AJ, Oliveira JC, Guzmán FM, Nicolás MF, Potau MP, Solé AS, Gallego VD, González IT, de Arellano Serna MR. Efficacy of neuromuscular electrostimulation intervention to improve physical function in haemodialysis patients. Int Urol Nephrol 2015; 47:1709-17. [DOI: 10.1007/s11255-015-1072-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/27/2015] [Indexed: 12/01/2022]
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36
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Toulabi T, Kalaveh SM, Ghasemi F, Anbari K. The impact of multidisciplinary rehabilitation on the quality of life of hemodialysis patients in Iran. J Formos Med Assoc 2015; 115:553-9. [PMID: 26100468 DOI: 10.1016/j.jfma.2015.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 03/30/2015] [Accepted: 05/14/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/PURPOSE Hemodialysis contributes to changes in lifestyle and the health status of patients. The aim of this study was to evaluate the impact of participatory rehabilitation on the quality of life of patients. METHODS This quasi-experimental before and after study was conducted on 30 patients in the hemodialysis center at Hazrat-e-Rasoul Hospital in Javanrood during 2013. The rehabilitation program was executed with participation of experts in the fields of nursing, physiotherapy, and clinical psychology for 8 weeks. The instrument used for data collection was the hemodialysis version of Ferrans and Powers Quality of Life Index (QLI) which was completed by the research assistant by interview before and after the rehabilitation program. RESULTS The mean age of patients was 55.8 ± 14.3 years, 60% were male, and 93.3% were married. The average duration of hemodialysis was 3 ± 2.4 years. The quality of life score of all patients before the intervention was between 10 and 19 (moderate level), which after intervention, improved to a good level in half of the patients (p < 0.001). CONCLUSION Rehabilitation programs improve the quality of life of hemodialysis patients. By this finding, implementation of rehabilitation programs is recommended in hemodialysis centers with participation of experts from different fields including nurses, physiotherapists, and clinical psychologists.
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Affiliation(s)
- Tahereh Toulabi
- Department of Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Shirin Mohammadi Kalaveh
- Department of Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Fatemeh Ghasemi
- Department of Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Khatereh Anbari
- Department of Social Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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Parker K, Zhang X, Lewin A, MacRae JM. The association between intradialytic exercise and hospital usage among hemodialysis patients. Appl Physiol Nutr Metab 2015; 40:371-8. [DOI: 10.1139/apnm-2014-0326] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Hemodialysis (HD) patients have high hospitalization rates. Benefits of intradialytic exercise have been proven in numerous studies yet exercise programs are still rarely used in the treatment of end-stage kidney disease (ESKD). Our objective was to determine if there was an association between a 6-month intradialytic bicycling program and hospitalization rates and length of stay (LOS) in ESKD patients. This was a retrospective cohort study that took place 6 months prior to and 6 months during an intradialtyic exercise program at an outpatient HD unit in Calgary, Alberta, Canada. Participants comprised 102 patients who had commenced HD <6 months (incident) or >6 months (prevalent) prior to starting exercise. The intervention comprised a 6-month intradialytic bicycling program. Main outcome measures were hospitalization rate, cause of hospitalization, and LOS. Patients were predominantly male (67.6%) aged 65.6 ± 13.5 years and median HD vintage 1 year (range: 0–12). Comorbidities included diabetes mellitus (50%) and cardiac disease (38.2%). The hospitalization incidence rate ratio (IRR) was 0.48 (0.23–0.98; P = 0.04) in incident and 0.89 (0.56–1.42; P = 0.64) in prevalent patients. The LOS decreased from 7.8 (95% confidence interval (CI): 7.3–8.4) to 3.1 (95% CI: 2.8–3.4) days and LOS IRR was 0.39 (0.35–0.45; P < 0.001). The main predictors of hospitalization were lower albumin levels (P = 0.007) and lack of intradialytic exercise program participation (P < 0.001). In conclusion, 6 months of intradialytic exercise was associated with decreased LOS in both incident and prevalent HD patients.
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Affiliation(s)
- Kristen Parker
- Southern Alberta Renal Program, South Calgary Hemodialysis, 31 Sunpark Plaza SE, Calgary, AB T2X 3W5, Canada
| | - Xin Zhang
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Adriane Lewin
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Jennifer M. MacRae
- Division of Nephrology and Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
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Matsufuji S, Shoji T, Yano Y, Tsujimoto Y, Kishimoto H, Tabata T, Emoto M, Inaba M. Effect of Chair Stand Exercise on Activity of Daily Living: A Randomized Controlled Trial in Hemodialysis Patients. J Ren Nutr 2015; 25:17-24. [DOI: 10.1053/j.jrn.2014.06.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 06/22/2014] [Accepted: 06/24/2014] [Indexed: 11/11/2022] Open
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Esteve Simó V, Junqué A, Fulquet M, Duarte V, Saurina A, Pou M, Moreno F, Carneiro J, Ramírez de Arellano M. Complete Low-Intensity Endurance Training Programme in Haemodialysis Patients: Improving the Care of Renal Patients. ACTA ACUST UNITED AC 2014; 128:387-93. [DOI: 10.1159/000369253] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 10/21/2014] [Indexed: 11/19/2022]
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Tomich GM, Bernardino LS, Ferreira FO. Impact of physical therapy on functional capacity and life quality of patients with chronic kidney disease. FISIOTERAPIA EM MOVIMENTO 2014. [DOI: 10.1590/0103-5150.027.004.ao16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Studies have demonstrated beneficial effects of exercise in patients with chronic kidney disease, however, based on current scientific literature, more research is needed to increase evidence level of potential effects of physical activity for this population. Objective To evaluate effects of physical therapy based on the supervised exercise practice on functional capacity and life quality of patients with chronic kidney disease. Material and methods This quasi-experimental study, with repeated measures design, was conducted in the ambulatory of physical therapy, in a public hospital, located in a city of the state of Pará (north region of Brazil). Functional capacity and life quality were assessed at baseline and after six weeks of aerobic and resistance training performed three times per week on alternate days with hemodialysis. Results Eight patients (3M / 5F) with a mean age of 60.38 years (SD = 14.75) were evaluated. There was significant increase of 24% in distance walked in six minute walk test (p = 0.007), and of 47% in number of repetitions during sit-to-stand test (p = 0.002); there was also significant improvement in emotional role (p = 0.043) of life quality assessed with SF36 questionnaire. Conclusion There was a positive impact of only six weeks of rehabilitation with physical exercise on functional capacity and emotional role of life quality of patients with chronic kidney disease.
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Rossi AP, Burris DD, Lucas FL, Crocker GA, Wasserman JC. Effects of a renal rehabilitation exercise program in patients with CKD: a randomized, controlled trial. Clin J Am Soc Nephrol 2014; 9:2052-8. [PMID: 25414318 DOI: 10.2215/cjn.11791113] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients with CKD have a high prevalence of cardiovascular disease associated with or exacerbated by inactivity. This randomized, controlled study investigated whether a renal rehabilitation exercise program for patients with stages 3 or 4 CKD would improve their physical function and quality of life. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In total, 119 adults with CKD stages 3 and 4 were randomized, and 107 of these patients proceeded to usual care or the renal rehabilitation exercise intervention consisting of usual care plus guided exercise two times per week for 12 weeks (24 sessions). Physical function was determined by three well established performance-based tests: 6-minute walk test, sit-to-stand test, and gait-speed test. Health-related quality of life was assessed by the RAND 36-Item Short Form Health Survey. RESULTS At baseline, no differences in self-reported level of activity, 6-minute walk test, and sit-to-stand test scores were observed between the usual care (n=48) and renal rehabilitation exercise (n=59) groups, although baseline gait-speed test score was higher in the renal rehabilitation exercise group (P<0.001). At follow-up, the renal rehabilitation exercise group but not the usual care group showed significant improvements in the 6-minute walk test (+210.4±266.0 ft [19% improvement] versus -10±219.9 ft; P<0.001), the sit-to-stand test (+26.9±27% of age prediction [29% improvement] versus +0.7±12.1% of age prediction; P<0.001), and the RAND-36 physical measures of role functioning (P<0.01), physical functioning (P<0.01), energy/fatigue levels (P=0.01), and general health (P=0.03) and mental measure of pain scale (P=0.04). The renal rehabilitation exercise regimen was generally well tolerated. CONCLUSIONS A 12-week/24-session renal rehabilitation exercise program improved physical capacity and quality of life in patients with CKD stages 3 and 4. Longer follow-up is needed to determine if these findings will translate into decreased mortality rates.
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Affiliation(s)
- Ana P Rossi
- Department of Nephrology and Transplantation, Maine Medical Center
| | - Debra D Burris
- Clinical Trial Support Services, Maine Medical Center Research Institute
| | - F Leslie Lucas
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, and
| | - Gail A Crocker
- Turning Point Cardiac Rehabilitation & Prevention, Maine Medical Center, Portland, Maine
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Aucella F, Gesuete A, Battaglia Y. A "nephrological" approach to physical activity. Kidney Blood Press Res 2014; 39:189-96. [PMID: 25118037 DOI: 10.1159/000355796] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2014] [Indexed: 11/19/2022] Open
Abstract
Despite consensus among nephrologists that exercise is important and probably beneficial for their patients, assessment of physical function or encouragement of physical activity is not a part of the routine management of patients with CKD. In order to plan an useful strategy for exercise training we need to clearly define some questions. First of all, nephrologists need to be aware of physical exercise benefits; lack of motivation and increased perceived risk by health care professionals have been identified as contributing factors to physical inactivity. Moreover, the main elements necessary for sustaining exercise programs in this population have to take in account, such as the requirement of exercise professionals, equipment and space, individual prescription, adequate commitment from dialysis and medical staff. When PA may not be implemented, a comprehensive, individualized occupational therapy program may improve functional independence and activity of daily living. Finally, physical function has to be careful monitored and assesses by medical staff.
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Affiliation(s)
- Filippo Aucella
- Nephrology and Dialysis Unit, Scientific Institute for Research and Health Care, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy
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Bohm C, Stewart K, Onyskie-Marcus J, Esliger D, Kriellaars D, Rigatto C. Effects of intradialytic cycling compared with pedometry on physical function in chronic outpatient hemodialysis: a prospective randomized trial. Nephrol Dial Transplant 2014; 29:1947-55. [DOI: 10.1093/ndt/gfu248] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bessa B, de Oliveira Leal V, Moraes C, Barboza J, Fouque D, Mafra D. Resistance training in hemodialysis patients: a review. Rehabil Nurs 2014; 40:111-26. [PMID: 24729123 DOI: 10.1002/rnj.146] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE Few studies have examined the role of resistance training (RT) in chronic kidney patients on hemodialysis (HD). This study reviews the literature about resistance exercise for patients on HD and describes protocols and clinical outcomes. METHODS A search of the MEDLINE database found 21 eligible publications, of which 14 studies applied only RT and 7 combined RT and aerobic training. FINDINGS Regarding the period of exercise training, 14 studies applied intradialytic exercise. The main outcome reported was muscle strength, which was assessed through knee strength and handgrip measures. CONCLUSIONS All studies reviewed presented at least one significant result in relation to biochemical parameters, physical capacity, strength, body composition, or quality of life. CLINICAL RELEVANCE This review demonstrates that RT improves muscle strength, some biochemical parameters, and quality of life of the HD patients.
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Affiliation(s)
- Bruno Bessa
- Medical Sciences Postgraduate Program, Fluminense Federal University (UFF), Niterói-RJ, Brazil
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Estimation of physical functional disabilities and long-term care needs for patients under maintenance hemodialysis. Med Care 2014; 52:63-70. [PMID: 24300025 PMCID: PMC3868019 DOI: 10.1097/mlr.0000000000000010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Objectives: Physical functional disabilities in hemodialysis (HD) patients may increase their mortality and long-term care needs. The aim of this study was to estimate the changes of proportion for different physical functional disabilities along time after beginning HD and the lifelong care needs. Methods: We used a population-based cohort consisting of 84,657 incident HD patients in Taiwan between 1998 and 2009 to estimate the survival function and extrapolate to lifetime through a semiparametric method. The Barthel Index (BI) was used to measure the functional disability levels cross-sectionally in 1334 HD patients recruited from 9 HD centers. A BI score <50 was considered as severe disability. Lifetime care needs were obtained by extrapolating the age-stratified survival functions to lifetime and then multiplying them with proportions of different kinds of functional disabilities over time. Results: On average, HD patients had at least 6.4, 2.0, and 1.3 years without disability, with moderate disability, and severe disability, respectively. The most common care needs were stair-climbing and bathing, which were 3.0 and 1.7 years, respectively. HD patients were expected to have about 3 years living with disabilities for those beginning HD at an age above 35 years; however, the older the patient, the higher the proportion of functional disabilities and care needs. Conclusions: HD patients are in need of long-term care and require early intervention and resource planning. The method developed in this study can also be applied to other chronic illnesses with various functional disabilities.
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Lægreid IK, Aasarød K, Bye A, Leivestad T, Jordhøy M. The impact of nutritional status, physical function, comorbidity and early versus late start in dialysis on quality of life in older dialysis patients. Ren Fail 2013; 36:9-16. [PMID: 24028283 DOI: 10.3109/0886022x.2013.830206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For the majority of the older patients in dialysis, the treatment will be lifelong. Thus, quality of life (QoL) is a crucial outcome. Our aim was to assess the QoL of older Norwegian dialysis patients and to investigate the impact of early (estimated glomerular filtration rate, eGFR ≥10 mL/min) versus late (eGFR <10 mL/min) start in dialysis, comorbidity, nutritional status and physical capacity. METHODS A self-report questionnaire including SF-36 (QoL) and the Subjective Global Assessment (SGA; nutritional status) was mailed to all patients (n = 320) ≥75 years registered in the Norwegian Renal Registry (NRR) as being in dialysis by September 2009. Reply was received from 233 patients (73%). Medical data including comorbidities and eGFR at dialysis start (obtained for 194 patients) were retrieved from the NRR. Functional capacity was determined from the SGA. RESULTS Compared to reports from younger dialysis patients, our patients scored poorer on all SF-36 subscales. Early start in dialysis was registered for 52 patients, 142 patients started late, 51.4% were well nourished (SGA A), 32.3% moderately malnourished (SGA B) and 16.4% were severely malnourished (SGA C). No significant association between any SF-36 scores and early versus late start, nutritional status or comorbidity was found. Better physical function was significantly associated with better scores on all SF-36 scales. CONCLUSIONS Our results indicate that physical function is important to all QoL aspects. Increased focus on physical rehabilitation seems pertinent. Early start of dialysis treatment was not associated with better long term QoL scores.
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Affiliation(s)
- Inger Karin Lægreid
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, NTNU , Trondheim , Norway
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Use of Complementary and Alternative Medicine among Patients with End-Stage Renal Disease. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:654109. [PMID: 23710227 PMCID: PMC3655568 DOI: 10.1155/2013/654109] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/31/2013] [Indexed: 11/30/2022]
Abstract
Among patients with end-stage renal disease (ESRD), few studies have examined the use of complementary and alternative medicine (CAM) and patients' interest in learning mind-body interventions to address health issues. We surveyed 89 adult patients (response rate 84%) at an outpatient hemodialysis center in Brookline, MA, USA regarding the utilization of CAM, including mind-body practices, and willingness to learn mind-body practices. Of respondents, 47% were female, 63% were black, and mean age was 62 years. 61% reported using CAM for health in their lifetime, and 36% reported using CAM within a month of the survey. The most frequent CAM modalities reported in ones' lifetime and in the last month were mind-body practices (42% and 27%, resp.). Overall lifetime CAM use did not differ significantly by sex, race, dialysis vintage, diagnosis of ESRD, employment status, or education level. Subjects reported that mind-body interactions were very important to health with a median score of 9 on a 10-point Likert scale (ranging from 0 for not important to 10 for extremely important). Most patients (74%) reported interest in learning mind-body practices during maintenance hemodialysis. In summary, CAM use, particularly mind-body practice, is frequent among patients with ESRD providing opportunities for future clinical research.
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Kim JC, Kalantar-Zadeh K, Kopple JD. Frailty and protein-energy wasting in elderly patients with end stage kidney disease. J Am Soc Nephrol 2012; 24:337-51. [PMID: 23264684 DOI: 10.1681/asn.2012010047] [Citation(s) in RCA: 194] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Older people constitute an increasingly greater proportion of patients with advanced CKD, including those patients undergoing maintenance dialysis treatment. Frailty is a biologic syndrome of decreased reserve and resistance to stressors that results from cumulative declines across multiple physiologic systems and causes vulnerability to adverse outcomes. Frailty is common in elderly CKD patients, and it may be associated with protein-energy wasting (PEW), sarcopenia, dynapenia, and other complications of CKD. Causes of frailty with or without PEW in the elderly with CKD can be classified into three categories: causes primarily caused by aging per se, advanced CKD per se, or a combination of both conditions. Frailty and PEW in elderly CKD patients are associated with impaired physical performance, disability, poorer quality of life, and reduced survival. Prevention and treatment of these conditions in the elderly CKD patients often require a multifaceted approach. Here, we examine the causes and consequences of these conditions and examine the interplay between frailty and PEW in elderly CKD patients.
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Affiliation(s)
- Jun Chul Kim
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
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50
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Walking and talking in maintenance hemodialysis patients. Arch Phys Med Rehabil 2012; 94:127-31. [PMID: 22858796 DOI: 10.1016/j.apmr.2012.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 07/11/2012] [Accepted: 07/16/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To investigate whether there is a reduction in walking with the simultaneous performance of a cognitive task (ie, dual-task cost [DTC]) in persons undergoing hemodialysis (HD), and whether it is greater in persons undergoing HD compared with age-matched controls. DESIGN Cohort. SETTING University research laboratory. PARTICIPANTS Persons undergoing HD (n=14; 5 women, 9 men; mean age ± SD, 50.0±11.8y) and age-matched controls (n=14; 4 women, 10 men; mean age ± SD, 48.5±10.1y) participated in the investigation. INTERVENTIONS Not applicable. MAIN OUTCOMES MEASURES Participants walked at a self-selected pace on an electronic pathway, which recorded spatiotemporal parameters of gait, in 4 separate trials and completed a cognitive task in the last 2 trials. The DTC was quantified as the change in spatiotemporal parameters of gait from baseline to the cognitive trials. RESULTS The HD group had a greater decrease in walking function during the cognitive task, with DTC ranging from 6% to 14%. On average, walking velocity decreased to less than 1m/s in HD patients during the cognitive condition. Baseline walking velocity was found to be moderately correlated with the magnitude of DTC of cadence and step time (ρ=-.44 and .46; P values <.05). CONCLUSIONS Persons undergoing HD have greater interference between walking and talking compared with controls. Difficulty walking while thinking has implications for everyday life and may be related to the risk of falls. Further work is necessary to determine other contributing factors to elevated DTC in HD patients, and whether DTC can be reduced with targeted interventions.
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