Intradialytic resistance training: an effective and easy-to-execute strategy

Improving dialysis adequacy and quality of life in patients undergoing hemodialysis with twice a week range of motion exercise

The study aimed to determine the effects of giving range of motion (ROM) twice a week as a form intradialytic exercise on patients' dialysis adequacy and quality of life. A total of 48 eligible participants were recruited and completed this study. The intervention group (n = 24) received twice a week ROM exercise over a 4 weeks period. The outcomes were assessed at pretest and at the end of the intervention. The study shows that ROM exercise was effective in improving dialyis adequacy that include ureum retention ratio (p= 0.027) and Kt/V (p= 0.017). Quality of life improved significantly particularly in the domains of symptom and effect of kidney disease. Integrating ROM into dialysis care shows as a potential intervention to improve dialysis adequacy and quality of life for patients undergoing hemodialysis. Future research should evaluate its efficacy using a randomized clinical trial design and larger sample of patients.

Age, diabetes mellitus, and dialysis modality are associated with risk of poor muscle strength and physical function in hemodialysis and peritoneal dialysis patients

Background

Due to the poor outcomes associated with the impairment of physical function and muscle strength in patients on maintenance dialysis, it is important to understand the factors that may influence physical function and muscle strength. The aim of this study was to explore the factors associated with physical function in hemodialysis and peritoneal dialysis patients.

Methods

Patients with chronic kidney disease on dialysis for at least 3 months, aged 18 years old or above, were enrolled. Physical function was assessed by handgrip strength, gait and sit-to-stand tests, and the Short Physical Performance Battery (SPPB). Clinical and laboratory data were collected to verify the association with physical function parameters through binary logistic regression.

Results

One-hundred ninety patients on maintenance dialysis were included; 140 patients (73.7%) on hemodialysis and 50 (26.3%) on peritoneal dialysis. The mean age was 57.3 ± 14.9 years, 109 (57.4%) were male, and 87 (45.8%) were older than 60 years. The median SPPB was 8.0 points (6.0–10.0 points) and the mean ± standard deviation of handgrip strength was 24.7 ± 12.2 kg. Binary logistic regression showed that age, type of renal replacement therapy, diabetes mellitus, and serum creatinine were significantly associated with both higher 4-meter gait test times and lower SPPB scores. Only age and diabetes mellitus were associated with higher sit-to-stand test times, while age and ferritin were associated with lower handgrip strength.

Conclusion

Age, diabetes mellitus, serum creatinine, and hemodialysis modality are factors related to physical function in dialysis patients.

Does regular resistance exercise improve resting and intradialytic pain and haemodynamic measures in sedentary chronic haemodialysis women?

Pain is one of the major problems in haemodialysis patients. Regular resistance exercise (RE), as an effective lifestyle modification, may play a role in reducing pain through changes in blood pressure (BP). Therefore, we aimed to evaluate the effect of RE training on pain, BP, and heart rate. In a randomised controlled trial, eighteen sedentary women completed the study in RE (n=10) or control (n=8) groups. In the exercise group, the patients had a circuit RE program in non-dialysis days, two times a week, for six weeks. The RE protocol consisted of six exercises performing with 10 repetitions at 50-60% of 1-repetition maximum. Resting and intradialytic pain threshold (algometer using a 1 kg pressure load), BP, and heart rate were measured 48 h before and after the intervention. There were no significant differences from pre- to post-intervention, or between the groups regarding pain threshold, systolic and diastolic BP, and heart rate at rest and during the haemodialysis process (P>0.05). Although the 6-week low-intensity RE training in non-dialysis days was safe for chronic haemodialysis women, it could not change resting and intradialytic pain and hemodynamic measures.

Beneficios del ejercicio físico en la sesión de hemodiálisis. Una revisión sistemática

Objetivo: El objetivo principal de esta revisión fue conocer los principales beneficios del ejercicio físico durante la sesión de diálisis, en los pacientes en programa de hemodiálisis periódicas.Material y Método: Se llevó a cabo una revisión sistemática a través de las bases de datos Pubmed, Science Direct y Google Académico. Se incluyeron artículos científicos en inglés y español, y se analizaron los artículos que trataban sobre ejercicio físico en la sesión de hemodiálisis. Se excluyeron aquellos artículos que no presentaran resultados y en los que el ejercicio físico fuese domiciliario.Resultados: Se incluyeron 18 artículos publicados entre 2015 y 2019. Todos los artículos fueron de diseño experimental. Se encontró una mejoría significativa de la fuerza muscular, al igual que de la capacidad física y de de la sintomatología depresiva. En menor medida, se observó una disminución de la presión arterial, disminución del proceso inflamatorio, mejoría de los valores nutricionales y mejora de la calidad de vida de estos pacientes.Conclusiones: El ejercicio físico en la sesión de hemodiálisis tiene beneficios para la salud de los pacientes. El ejercicio físico de baja intensidad, así como la electroestimulación neuromuscular en las sesiones de diálisis, mejora objetivamente la fuerza muscular, aumenta la capacidad física, mejora la sintomatología depresiva con un mejor manejo del estrés y la ansiedad. Además, perece que puede mejorar el proceso inflamatorio, parámetros nutricionales y disminuir la presión arterial, así como mejorar la calidad de vida. La electroestimulación neuromuscular y el ejercicio físico de baja intensidad, son los ejercicios más utilizados.