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Zang W, Fang M, Xiao N, Zhang X, Lin C, Wang S. Quantifying the dose-response relationship between exercise and health-related quality of life in patients undergoing haemodialysis: A meta-analysis. Prev Med Rep 2024; 42:102737. [PMID: 38707251 PMCID: PMC11066687 DOI: 10.1016/j.pmedr.2024.102737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024] Open
Abstract
Objective This meta-analysis aims to explore the dose-response relationship of aerobic exercise or aerobic combined resistance exercise on cardiopulmonary function in maintenance hemodialysis(MHD), with the goal of aiding in the formulation of precise exercise prescriptions. Methods A literature search up to August 18, 2023, was conducted in databases including Web of Science, among others, focusing on the effects of exercise interventions on cardiopulmonary function in hemodialysis patients.Two researchers independently conducted literature screening, data extraction, and an assessment of study methodology quality. A dose-response meta-analysis was carried out using a one-stage cubic spline mixed-effects model, followed by stratified analyses based on intervention period, intervention method, and exercise environment. Results A nonlinear dose-response relationship was observed between exercise and 6-minute walk test (6WMT) as well as peak oxygen uptake (VO2Peak) in hemodialysis patients. The optimal exercise dose for the 6WMT across the full exposure range was 922 METs-min/week, with VO2Peak increasing with the dose. The effects were influenced by the type of exercise, intervention period, and exercise environment. An exercise dose of 500 METs-min/week and 619 METs-min/week was found sufficient to achieve the minimal clinically important differences (MCID) for 6WMT and VO2Peak, respectively. Conclusion There is a significant association between the dose of exercise and its effects. With appropriate adjustment of variables, even low-dose exercise can lead to clinically significant improvements in cardiopulmonary function.
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Affiliation(s)
- Wanli Zang
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Mingqing Fang
- Xiangya Hospital, Central South University, Changsha, China
| | - Ningkun Xiao
- Department of Immunochemistry, Institution of Chemical Engineering, Ural Federal University, Russia
| | - Xianzuo Zhang
- Department of Orthopedics, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Changchun Lin
- Xiangya Hospital, Central South University, Changsha, China
| | - Su Wang
- Department of Sports Science, University of Harbin Sport, Harbin, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Yu H, Huang M, Tao Y, Li S, Wang J, Li P, Lv H, Ni C. The effects of exercise training interventions on depression in hemodialysis patients. Front Psychiatry 2024; 14:1321413. [PMID: 38260806 PMCID: PMC10800967 DOI: 10.3389/fpsyt.2023.1321413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose Depression considerably influences the clinical outcomes, treatment compliance, quality of life, and mortality of hemodialysis patients. Exercise plays a beneficial role in depressive patients, but its quantitative effects remain elusive. This study aimed to summarize the effects of exercise training on depression in patients with end-stage renal disease undergoing hemodialysis. Methods The PUBMED, EMBASE, and Cochrane Library databases were systematically searched from inception to April 2023 to identify published articles reporting the effect of exercise training on the depression level of patients with End-Stage Renal Disease undergoing hemodialysis. Data were extracted from the included studies using predefined data fields by two independent researchers. The Cochrane Handbook for Systematic Reviews of Interventions and Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies were employed for quality evaluation. Results A total of 22 studies enrolling 1,059 patients who participated in exercise interventions were included. Hemodialysis patients exhibited superior outcomes with intradialytic exercise (SMD = -0.80, 95% CI: -1.10 to -0.49) and lower levels of depression following aerobic exercise (SMD = -0.93, 95%CI: -1.32 to -0.55) compared to combined exercise (c - 0.85, 95% CI: -1.29 to -0.41) and resistance exercise (SMD = -0.40, 95%CI: -0.96 to 0.17). Regarding exercise duration, patients manifested lower depression levels when engaging in exercise activities for a duration exceeding 6 months (SMD = -0.92, 95% CI: -1.67 to -0.17). Concerning the duration of a single exercise session, the most significant improvement was noted when the exercise duration exceeded 60 min (SMD = -1.47, 95% CI: -1.87 to -1.06). Conclusion Our study determined that exercise can alleviate depression symptoms in hemodialysis patients. This study established the varying impacts of different exercise parameters on the reduction of depression levels in hemodialysis patients and is anticipated to lay a theoretical reference for clinicians and nurses to devise tailored exercise strategies for interventions in patients with depression. Systematic review registration https://www.crd.york.ac.uk/prospero/, This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database, with registration number CRD42023434181.
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Affiliation(s)
- Huihui Yu
- School of Nursing, Air Force Medical University, Xi’an, China
- The 1th Department of Gerontology, the 960th Hospital of PLA Joint Logistics Support Force, Jinan, China
| | - Mei Huang
- School of Nursing, Air Force Medical University, Xi’an, China
| | - Yuxiu Tao
- School of Nursing, Air Force Medical University, Xi’an, China
| | - Shanshan Li
- School of Nursing, Air Force Medical University, Xi’an, China
| | - Jing Wang
- School of Nursing, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Ping Li
- School of Nursing, Air Force Medical University, Xi’an, China
| | - Honghong Lv
- Blood Purification Center, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Chunping Ni
- School of Nursing, Air Force Medical University, Xi’an, China
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Ferrari F, Andrade FP, Teixeira MS, Ziegelmann PK, Carvalho G, Bittencourt ESS, Barcellos FC, Stein R. Efficacy of six exercise-based interventions for individuals undergoing hemodialysis: a network meta-analysis of randomized clinical trials. Nephrol Dial Transplant 2023; 38:2389-2406. [PMID: 37118876 DOI: 10.1093/ndt/gfad083] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Evidence comparing different exercise modalities in individuals undergoing hemodialysis remains incipient. Our aim was to conduct a systematic review and network meta-analysis of randomized clinical trials to compare and synthesize the efficacy of five different intradialytic exercise modalities and home-based training in this population. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Studies were searched in PubMed/MEDLINE, Cochrane Library, Embase, Cinahl, and Scopus from their inception to 19 September 2022. We used traditional random-effects models and Bayesian network meta-analysis models. The risk of bias was assessed using the RoB v.2.0 tool, and the assessment of confidence in the results through the Confidence in Network Meta-Analysis (CINeMA) tool. RESULTS Seventy-eight studies involving 3326 participants were included. Our network meta-analysis showed that combined training was the intervention with the best performance to increase VO2 peak [mean difference (MD) = 3.94 ml/kg/min; 95% credible interval (CrI), 2.38 to 5.76] and to reduce diastolic blood pressure (MD = -5.19 mmHg; 95%CrI, -9.35 to -0.96) compared to the usual care group. Inspiratory muscle training was the intervention that most improved the 6-minute walk test distance (MD = 70.97 m; 95%CrI, 18.09 to 129.87). C-reactive protein decreased in resistance training (MD = -2.6 mg/l; 95%CrI, -4.97 to -0.33) and aerobic training (MD = -1.4 mg/l; 95%CrI, -3.15 to -0.06). Kt/V improved in aerobic training (MD = 0.11; 95%CrI, 0.02 to 0.18), and SF-36 physical functioning outcomes improved in resistance training (MD = 10.66 points; 95%Crl, 1.91 to 20.22). No intradialytic exercise modality was superior to others or comparable with home-based training in improving the evaluated outcomes. Subgroup analysis revealed that exercise interventions >12 weeks improved functional capacity more than interventions ≤12 weeks, and that combined training reduces diastolic blood pressure only after 12 weeks of follow-up. Furthermore, our results suggest that moderate or moderate-to-vigorous intensity training leads to more pronounced improvements in functional capacity, whereas mild or mild-to-moderate intensity training does not have the same effect. In this review, most of the included studies were assessed as having some concern, which resulted in a low to very low level of confidence in the overall findings. CONCLUSIONS Both intradialytic training and home-based training can promote benefits for individuals undergoing hemodialysis, with no evidence of the superiority of either training modality over the other.
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Affiliation(s)
- Filipe Ferrari
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Exercise Cardiology Research Group (CardioEx), Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Francini P Andrade
- Graduate Program in Pneumological Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, Maia, Portugal
| | - Marcelo S Teixeira
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Exercise Cardiology Research Group (CardioEx), Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Patrícia K Ziegelmann
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Gabriel Carvalho
- Exercise Cardiology Research Group (CardioEx), Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Eduarda S S Bittencourt
- Exercise Cardiology Research Group (CardioEx), Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Ricardo Stein
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Exercise Cardiology Research Group (CardioEx), Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Li Y, Zhu B, Shen J, Miao L. Depression in maintenance hemodialysis patients: What do we need to know? Heliyon 2023; 9:e19383. [PMID: 37662812 PMCID: PMC10472011 DOI: 10.1016/j.heliyon.2023.e19383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
Chronic kidney disease (CKD) is now recognized as a major public health problem in the world. The global prevalence of CKD is estimated at 13.4% (11.7-15.1%), with an estimated 490.2 to 7.083 million patients with End stage renal disease requiring renal replacement therapy. Hemodialysis is the main treatment for End stage renal disease patients because of its high safety and efficiency. The survival time of these patients was significantly prolonged, but many psychological problems followed. Depression is a type of mood disorder caused by a variety of causes, often manifested as disproportionate depression and loss of interest, sometimes accompanied by anxiety, agitation, even hallucinations, delusions and other psychotic symptoms. Depression has become the most common mental disorder in maintenance hemodialysis (MHD) patients according to the meta-analysis. In recent years, depression has seriously affected the quality of life and prognosis of MHD patients from dietary, sleep, treatment adherence, energy and other dimensions. This article reviews the epidemiology, etiology, diagnosis and treatment of depression in MHD patients.
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Affiliation(s)
- Yulu Li
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Bin Zhu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jianqin Shen
- Blood Purification Centre, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Liying Miao
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Liu Y, Luo X, Deng S, Chen J, Zhang L, Huang Y, Hu H. Combined aerobic and resistance exercise in maintenance hemodialysis patients: A meta-analysis. Semin Dial 2023; 36:278-293. [PMID: 37313761 DOI: 10.1111/sdi.13162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 06/15/2023]
Abstract
Exercise brings many benefits to patients undergoing maintenance hemodialysis (MHD), but the effect of combined aerobic and resistance exercise remains unclear. English and Chinese databases (PubMed, Cochrane Library, Embase, Web of Science, CNKI, VIP, Wan Fang, and CBM) were searched from inception to January 2023 to retrieve qualified randomized controlled trials. The literature selection, data extraction, and risk of bias assessment of included studies were conducted independently by two reviewers. Meta-analysis was performed using RevMan 5.3 software. A total of 23 studies with 1214 participants were included, and 17 of the interventions were conducted during dialysis. Results showed that combined aerobic and resistance exercise (CARE) improved the peak oxygen uptake, six-minute walking test, 60 s sit-to-stand test (STS), 30 s STS, dialysis adequacy, five (out of eight) domains and physical component summary of health-related quality of life (HRQOL) measured by the Medical Outcomes Study Short Form-36, blood pressure, and hemoglobin for MHD patients compared with usual care. No significant changes were found in the mental component summary of HRQOL, C-reactive protein, creatinine, potassium, sodium, calcium, and phosphate. Subgroup analysis showed that intradialytic CARE ameliorated more outcomes, except for handgrip strength and hemoglobin, than non-intradialytic ones. CARE is an effective way to improve physical function, aerobic capacity, dialysis adequacy, and HRQOL for MHD patients. Strategies should be implemented by clinicians and policymakers to motivate patients to do more exercise. Well-designed clinical trials are warranted to explore the effectiveness of non-intradialytic CARE.
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Affiliation(s)
- Yixiu Liu
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xiju Luo
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Siyan Deng
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Jing Chen
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Lu Zhang
- Xi'an Medical University, Xi'an, Shan'xi, China
| | - Ying Huang
- Hemodialysis Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huagang Hu
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
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Zang W, Fang M, He H, Mu L, Zheng X, Shu H, Ge N, Wang S. Comparative efficacy of exercise modalities for cardiopulmonary function in hemodialysis patients: A systematic review and network meta-analysis. Front Public Health 2022; 10:1040704. [PMID: 36530731 PMCID: PMC9751492 DOI: 10.3389/fpubh.2022.1040704] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Background To provide reliable evidence to exercise rehabilitation therapists and clinicians, we compared and analyzed the effects of different exercise modalities on cardiopulmonary function in hemodialysis patients using Bayesian network meta-analysis. Methods PubMed, OVID, Web of Science, Cochrane Library, Embase, Scopus, CINAHL, SPORT Discus, SinoMed, CNKI, Wanfang, and VIP were searched from inception to July 20, 2022. We included randomized controlled trials comparing 12 exercise modalities to improve cardiorespiratory fitness in hemodialysis patients. All statistical analysis was performed using STATA and R. Result A total of 82 randomized controlled trials involving 4146 maintenance hemodialysis patients were included in this study. The pair-wise meta-analysis showed that all exercise modalities had a positive effect on all indicators of cardiorespiratory capacity. The network meta-analysis demonstrated that Blood flow restriction training (BFRT), Cycle exercise (CE), Inspiratory muscle training (IMT), Combined aerobic and resistance training (CT), and Aerobic training (AT) were significantly better than usual care for 6-min walkability; Medium intensity continuous training (MICT), CT, CE, and AT were considerably better than usual care for VO2Peak; body and mind training (MBT) and CT significantly improved SBP compared to usual care; and only MBT was significantly better than usual care for DBP. Both the two-dimensional plot and the radar plot demonstrated that CT had the best combined-effect on each index of cardiorespiratory fitness. Subgroup and sensitivity analyses demonstrated the robustness of the results. The evidence was mainly "low" to "very low" for this network meta-analysis. Conclusion There is no one exercise that can achieve the best effect on all of the outcomes. The benefits of MBT in decreasing arterial blood pressure are unsurpassed by other exercise methods. The intervention effect of the CT is better and more stable. Electrical muscle stimulation training (MEST) can be employed in individuals who do not wish to exercise actively but may cause an increase in blood pressure. On the basis of the characteristics of different exercise types, guidelines developers, clinicians, and patients may employ them appropriately. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#recordDetails.
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Affiliation(s)
- Wanli Zang
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Mingqing Fang
- Xiangya Hospital, Central South University, Changsha, China
| | - He He
- Winter Olympic Academy, University of Harbin Sport, Harbin, China
| | - Liang Mu
- Winter Olympic Academy, University of Harbin Sport, Harbin, China,Postdoctoral Research Station, University of Harbin Sport, Harbin, China
| | - Xiaoqin Zheng
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Heng Shu
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Nan Ge
- School of Physical Education, South China Normal University, Guangzhou, China
| | - Su Wang
- Department of Sports Science, University of Harbin Sport, Harbin, China,*Correspondence: Su Wang
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Moeinzadeh F, Shahidi S, Shahzeidi S. Evaluating the effect of intradialytic cycling exercise on quality of life and recovery time in hemodialysis patients: A randomized clinical trial. J Res Med Sci 2022; 27:84. [PMID: 36685021 PMCID: PMC9854908 DOI: 10.4103/jrms.jrms_866_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/24/2022] [Accepted: 05/10/2022] [Indexed: 11/26/2022]
Abstract
Background The aim of this study was to assess the effect of intradialytic cycling exercise on quality of life (QOL) and recovery time in patients who underwent hemodialysis. Materials and Methods Hemodialysis patients were recruited from the referral dialysis centers affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. Patients were randomly assigned into the intervention and the control groups. Patients in the intervention group exercised on a stationary bike for 12 weeks (3 times per week for 30 min); however, patients in the control group received usual hemodialysis. The kidney disease QOL (KDQOL)-short-form version 1.3 was used to assess QOL. Patients were asked to answer the question "How long does it take to recover from a dialysis session?" to assess recovery time. Results A total of 110 hemodialysis patients, including 60 in the intervention group and 50 in the control group were analyzed. A significant increase was observed in the generic (mean difference ± SE: 1.50 ± 0.44, P = 0.001), kidney disease (mean difference ± SE: 0.84 ± 0.28, P = 0.004), and overall QOL (mean difference ± SE: 1.18 ± 0.33, P = 0.001) scores after 12 weeks of intradialytic cycling exercise in the intervention group. Furthermore, a significant difference was noted between the intervention and the control group regarding the mean difference of all QOL scores after the intervention (P < 0.05). We also found a significant difference in the mean difference of recovery time between the intervention and the control group after the intervention (P < 0.001). Conclusion KDQOL and recovery time could improve in hemodialysis patients after 12-week intradialytic exercise.
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Affiliation(s)
- Firouzeh Moeinzadeh
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahrzad Shahidi
- Isfahan Kidney Diseases Research Center, Khorshid Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Safoora Shahzeidi
- Department of Internal Medicine, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Safoora Shahzeidi, Department of Internal Medicine, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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Pella E, Boutou A, Boulmpou A, Papadopoulos CE, Papagianni A, Sarafidis P. Cardiopulmonary exercise testing in patients with end-stage kidney disease: principles, methodology and clinical applications of the optimal tool for exercise tolerance evaluation. Nephrol Dial Transplant 2022; 37:2335-2350. [PMID: 33823012 DOI: 10.1093/ndt/gfab150] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Indexed: 12/31/2022] Open
Abstract
Chronic kidney disease (CKD), especially end-stage kidney disease (ESKD), is associated with an increased risk for cardiovascular events and all-cause mortality. Exercise intolerance as well as reduced cardiovascular reserve is extremely common in patients with CKD. Cardiopulmonary exercise testing (CPET) is a non-invasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, neuropsychological and metabolic function during maximal or submaximal exercise, allowing the evaluation of functional reserves of these systems. This assessment is based on the principle that system failure typically occurs when the system is under stress and thus CPET is currently considered to be the gold standard for identifying exercise limitation and differentiating its causes. It has been widely used in several medical fields for risk stratification, clinical evaluation and other applications, but its use in everyday practice for CKD patients is scarce. This article describes the basic principles and methodology of CPET and provides an overview of important studies that utilized CPET in patients with ESKD, in an effort to increase awareness of CPET capabilities among practicing nephrologists.
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Affiliation(s)
- Eva Pella
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Aristi Boulmpou
- Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abdelwahab MMA, Sabri Y, Elkalla IHR, Nassar MK, Abdel-Gawad SM, Gomaa ZAE. Cognitive impairment in different hemodialysis techniques. Middle East Curr Psychiatry 2022. [DOI: 10.1186/s43045-022-00258-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Cognitive impairment is one of the most common, often untreated, comorbidities affecting patients with chronic kidney disease treated with hemodialysis. Increased mortality, poor compliance, depression, and poor quality of life were all linked to cognitive impairment in the hemodialysis population. The intradialytic exercise proved to be beneficial in improving patients’ quality of life, among other positive effects. Cooling dialysate has various positive effects, including improved patients’ mood and decreased hypotensive episodes during hemodialysis. The study aims to assess the effect of intradialytic exercise and cool hemodialysis on cognitive function in patients on hemodialysis.
Results
The study showed no significant effect of both interventions on the patient’s cognitive functions. However, cooling dialysate showed an improvement in the severity of depressive symptoms by Beck’s Depression Inventory II (p = 0.02). On the other hand, Mini-International Neuropsychiatric Interview showed an increase of patients diagnosed with depression in the intradialytic exercise group.
Conclusions
Both interventions had no significant effect on the mean scores of the Montreal Cognitive Assessment, which are lower in our sample than in the general population (23.9–25). Potential implications include the importance of managing psychiatric comorbidities in patients on hemodialysis. Cooling dialysate can be adopted to alleviate depressive symptoms in patients on hemodialysis.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mitsiou M, Dimitros E, Roumeliotis S, Liakopoulos V, Kouidi E, Deligiannis A. Effects of a Combined Intradialytic Exercise Training Program and Music on Cardiac Autonomic Nervous System Activity in Hemodialysis Patients. Life (Basel) 2022; 12:life12081276. [PMID: 36013455 PMCID: PMC9410492 DOI: 10.3390/life12081276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to examine the effect of an intradialytic exercise program in combination with music on heart rate variability (HRV) indices and functional capacity in patients on maintenance hemodialysis (HD). Methods: Forty HD patients were randomized to four training groups for six months: the combined music and exercise group (Group A), the exercise group (Group B), the music group (Group C), and the control group (Group D). At baseline and after 6 months, all participants underwent both short- (for 30 min) and long- (for 24 h) term measurements of HRV and functional capacity assessment with a 6 min walking test (6MWT). Patients of groups A and C listened to preferred music. Results: Long-term HRV analysis showed that standard deviation of all normal-to-normal RR intervals (SDNN) and the square root of the mean squared differences of successive RR intervals (rMSSD) were significantly higher at the end of the study in groups A (by 13.2% and 47.3%), B (by 15.1% and 50%), and C (by 9.0% and 30.1%), compared to group D (p < 0.05). Values of rMSSD and percentage of RR intervals differing by more than 50 ms from the preceding RR interval (pNN50) were elevated in groups A (by 35.6% and 142.9%), B (by 36.1% and 75%), and C (by 15.2% and 28.6%), compared to baseline measurements (p < 0.05). Also, pNN50 was increased in group A compared to groups B (by 21.4%), C (by 88.9%), and D (by 142.9%) (p < 0.05). Similar results were noted by short-term HRV analysis. Functional capacity was improved at the end of the 6-month study in groups A (by 20.3% and 25.7%) and B (by 15.8% and 21.1%) compared to groups C and D (p < 0.05). Conclusions: Intradialytic exercise combined with music-listening can improve the functional capacity and cardiac autonomic nervous system activity in hemodialysis patients.
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Affiliation(s)
- Maria Mitsiou
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Eleftherios Dimitros
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Correspondence: ; Tel.: +30-231-099-4694
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Asterios Deligiannis
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
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Abstract
BACKGROUND Dialysis treatments weigh heavily on patients' physical and psychosocial health. Multiple studies have assessed the potential for exercise training to improve outcomes in adults undergoing dialysis. However, uncertainties exist in its relevance and sustainable benefits for patient-important outcomes. This is an update of a review first published in 2011. OBJECTIVES To assess the benefits and safety of regular structured exercise training in adults undergoing dialysis on patient-important outcomes including death, cardiovascular events, fatigue, functional capacity, pain, and depression. We also aimed to define the optimal prescription of exercise in adults undergoing dialysis. SEARCH METHODS In this update, we conducted a systematic search of the Cochrane Kidney and Transplant Register of Studies up to 23 December 2020. The Register includes studies identified from CENTRAL, MEDLINE, EMBASE, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov as well as kidney-related journals and the proceedings of major kidney conferences. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs of any structured exercise programs of eight weeks or more in adults undergoing maintenance dialysis compared to no exercise or sham exercise. DATA COLLECTION AND ANALYSIS Two authors independently assessed the search results for eligibility, extracted the data and assessed the risk of bias using the Cochrane risk of bias tool. Whenever appropriate, we performed random-effects meta-analyses of the mean difference in outcomes. The primary outcomes were death (any cause), cardiovascular events and fatigue. Secondary outcomes were health-related quality of life (HRQoL), depression, pain, functional capacity, blood pressure, adherence to the exercise program, and intervention-related adverse events. MAIN RESULTS We identified 89 studies involving 4291 randomised participants, of which 77 studies (3846 participants) contributed to the meta-analyses. Seven studies included adults undergoing peritoneal dialysis. Fifty-six studies reported aerobic exercise interventions, 21 resistance exercise interventions and 19 combined aerobic and resistance training within the same study arm. The interventions lasted from eight weeks to two years and most often took place thrice weekly during dialysis treatments. A single study reported death and no study reported long-term cardiovascular events. Five studies directly assessed fatigue, 46 reported HRQoL and 16 reported fatigue or pain through their assessment of HRQoL. Thirty-five studies assessed functional capacity, and 21 reported resting peripheral blood pressure. Twelve studies reported adherence to exercise sessions, and nine reported exercise-related adverse events. Overall, the quality of the included studies was low and blinding of the participants was generally not feasible due to the nature of the intervention. Exercise had uncertain effects on death, cardiovascular events, and the mental component of HRQoL due to the very low certainty of evidence. Compared with sham or no exercise, exercise training for two to 12 months may improve fatigue in adults undergoing dialysis, however, a meta-analysis could not be conducted. Any exercise training for two to 12 months may improve the physical component of HRQoL (17 studies, 656 participants: MD 4.12, 95% CI 1.88 to 6.37 points on 100 points-scale; I² = 49%; low certainty evidence). Any exercise training for two to 12 months probably improves depressive symptoms (10 studies, 441 participants: SMD -0.65, 95% CI -1.07 to -0.22; I² = 77%; moderate certainty evidence) and the magnitude of the effect may be greater when maintaining the exercise beyond four months (6 studies, 311 participants: SMD -0.30, 95% CI 0.14 to -0.74; I² = 71%). Any exercise training for three to 12 months may improve pain (15 studies, 872 participants: MD 5.28 95% CI -0.12 to 10.69 points on 100 points-scale; I² = 63%: low certainty evidence) however, the 95% CI indicates that exercise training may make little or no difference in the level of pain. Any exercise training for two to six months probably improves functional capacity as it increased the distance reached during six minutes of walking (19 studies, 827 participants: MD 49.91 metres, 95% CI 37.22 to 62.59; I² = 34%; moderate certainty evidence) and the number of sit-to-stand cycles performed in 30 seconds (MD 2.33 cycles, 95% CI 1.71 to 2.96; moderate certainty evidence). There was insufficient evidence to assess the safety of exercise training for adults undergoing maintenance dialysis. The results were similar for aerobic exercise, resistance exercise, and a combination of both aerobic and resistance exercise. AUTHORS' CONCLUSIONS It is uncertain whether exercise training improves death, cardiovascular events, or the mental component of HRQoL in adults undergoing maintenance dialysis. Exercise training probably improves depressive symptoms, particularly when the intervention is maintained beyond four months. Exercise training is also likely to improve functional capacity. Low certainty evidence suggested that exercise training may improve fatigue, the physical component of quality of life, and pain. The safety of exercise training for adults undergoing dialysis remains uncertain.
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Affiliation(s)
- Amelie Bernier-Jean
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Nadim A Beruni
- Resident Support Unit, Western Sydney Local Health District, Westmead, Australia
| | - Nicola P Bondonno
- School of Biomedical Sciences, The University of Western Australia, Royal Perth Hospital, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Gabrielle Williams
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | | | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
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Abstract
Depression disproportionately affects patients with kidney disease, including those with nondialysis chronic kidney disease, end-stage kidney disease requiring dialysis, and kidney transplant recipients. Patients across the spectrum of kidney disease should be screened for depression every 6 to 12 months using self-report questionnaires, followed by an interview with a clinician to confirm the presence of sadness or anhedonia when depressive symptoms are identified. Pharmacologic treatment with selective serotonin reuptake inhibitors has not consistently shown benefit compared with placebo and may be associated with serious adverse outcomes including cardiovascular events, bleeding, and fractures. However, based on the availability of alternative therapies, a watchful trial with close monitoring for therapeutic and adverse effects is reasonable. Several clinical trials have suggested that cognitive behavioral therapy and physical activity improve depressive symptoms when compared with a control group. Given the low risk associated with these therapies, they should be recommended to patients who have access and are amenable to such interventions. Future trials are needed to study therapeutic options for depression in nondialysis chronic kidney disease, peritoneal dialysis, or kidney transplant recipients, as well as alternative pharmacologic therapy and combination therapies. Given improvement in depressive symptoms with placebo in existing trials, inclusion of a control group is paramount.
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Affiliation(s)
- L Parker Gregg
- Selzman Institute for Kidney Health, Department of Medicine, Baylor College of Medicine, Houston, TX; Division of Nephrology, Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
| | - Joseph M Trombello
- Center for Depression Research and Clinical Care, Department of Psychiatry, Division of Psychology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Meredith McAdams
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - S Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
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Agustin WR, Safitri W, Kurniasari D, Setiyawan S, Murharyati A, Fitriana RN. Intradialytic Exercise on Changes in Blood Pressure in Chronic Kidney Failure Patients during Hemodialysis Therapy. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
BACKGROUND: Chronic renal failure (CRF) is a reduction in chronic renal function that leads to non-reversible and progressive kidney tissue damage. Blood pressure is a major risk factor that can increase the mortality rate by up to 20 times in patients with chronic renal failure who are undergoing hemodialysis therapy. Intradialytic exercise is an intervention that can be used to control systolic blood pressure.
AIM: This study was to analyze the effect of intradialytic exercise on changes in blood pressure in chronic renal failure patients undergoing hemodialysis therapy at Indriati Solo Baru Hospital.
METHODS: The research method is quasi-experimental design pre-post with control group design. The study population was 97 dialysis patients. The sampling technique used a purposive sampling of 30 people. Data analysis using Paired t-Test.
RESULTS: The research results showed that the sex characteristics of most respondents were male as many as 17 people (56.7%), the average age of the respondents was 51.03 years, the pre-intervention in the control group obtained an average systolic blood pressure of 168.93 mmHg and 106 diastole, 120 mmHg, while the blood pressure in the control group post was 173.13 mmHg systole and 107 mmHg diastoles. In the treatment group, the average blood pressure in the pre-intradialytic exercise showed 162.20 mmHg systole and 104.27 mmHg diastole, while the post-intradialytic exercise system blood pressure was 153.13 mmHg and diastole 94.33 mmHg.
CONCLUSION: There is an effect of intradialytic exercise on changes in blood pressure in chronic renal failure patients undergoing hemodialysis therapy at Indriati Solo Baru Hospital with a p-value of 0.025. Intradialytic exercise can be recommended as structured physical exercise therapy for hemodialysis therapy patients.
KEYWORDS: intradialytic exercise, chronic renal failure, patients, changes in blood pressure, hemodialysis
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16
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Hu H, Liu X, Chau PH, Choi EPH. Effects of intradialytic exercise on health-related quality of life in patients undergoing maintenance haemodialysis: a systematic review and meta-analysis. Qual Life Res 2021; 31:1915-1932. [PMID: 34731388 DOI: 10.1007/s11136-021-03025-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To summarize the current evidence regarding the effectiveness of intradialytic exercise (IDE) on the health-related quality of life (HRQOL) of patients undergoing maintenance haemodialysis. METHODS Five English databases (PubMed, EMBASE, Cochrane Library, Web of Science, and ScienceDirect) and four Chinese databases (VIP, WAN FANG, CNKI, CBM) were comprehensively searched from their inception to 18 March 2021. This study was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two independent reviewers selected the papers and extracted the details of each study therein. Only randomized controlled trials were included. The risk of bias tool version 2.0 was used to evaluate the risk of bias of the included studies. A random-effects meta-analysis was conducted to pool the effect size. RESULTS Thirty-three eligible studies with 1481 participants were included. For the generic HRQOL, assessed by the Medical Outcomes Study Short-Form survey, IDE significantly improved most domains and the physical component summary compared with the control group. Furthermore, aerobic exercise alone significantly improved more domains compared to resistance exercise, combined aerobic and resistance exercise, and other types of exercise. Regarding the kidney-specific HRQOL, IDE improved three of eleven domains, including the symptom/problem list, the effect of kidney disease, and the quality of social interaction. No significant effect was found on other domains of kidney-specific HRQOL. CONCLUSION Intradialytic exercise could benefit patients undergoing haemodialysis in improving most domains of generic HRQOL, but the effect on most domains of kidney-specific HRQOL is insufficient.
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Affiliation(s)
- Huagang Hu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, SAR, China.,School of Nursing, Medical College, Soochow University, Box 203, 1 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Xu Liu
- Department of Infectious Disease; Guangdong Provincial Engineering Research Center of Molecular Imaging; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52, Meihua East Rd, Xiangzhou District, Zhuhai, 519000, Guangdong Province, China
| | - Pui Hing Chau
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, SAR, China
| | - Edmond Pui Hang Choi
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, SAR, China.
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17
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Andrade FP, Borba GC, da Silva KC, Ferreira TDS, de Oliveira SG, Antunes VVH, Veronese FV, Rovedder PME. Intradialytic periodized exercise improves cardiopulmonary fitness and respiratory function: A randomized controlled trial. Semin Dial 2021; 35:181-189. [PMID: 34536050 DOI: 10.1111/sdi.13020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/06/2021] [Accepted: 08/14/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a factor that predisposes to gradual physical deconditioning from its early stages leading to cardiorespiratory fitness and musculoskeletal system impairment. We evaluated the effects of combined and periodized intradialytic exercise training on cardiopulmonary fitness and respiratory function in HD subjects. METHODS A randomized controlled trial with HD subjects was allocated into two groups: exercise group (EXG) and usual care group (UCG). EXG performed a 12-week combined and periodized intradialytic training. UCG maintained the HD routine. RESULTS Thirty-nine HD subjects were analyzed (EXG = 20; UCG = 19). The EXG in comparison with the UCG showed improvements in peak oxygen consumption (Δ3.1[0.4-5.5] vs. -0.2[-2.0-1.5] ml/kg/min; p = 0.003), forced expiratory volume in the first second (Δ0.1[-0.0-0.1] vs. -0.0[-0.1-0.0] L; p = 0.022), forced vital capacity (Δ0.1[0.0-0.2] vs. -0.1[-0.2-0.0] L; p = 0.005), peak expiratory flow (Δ0.4[-0.7-1.2] vs. -0.1[-0.5-0.2] L; p = 0.046), and maximal inspiratory pressure (Δ7.35[-8.5-17.5] vs. -4.0[-18.0-12.0] cmH2 O; p = 0.028). The EXG, different from the UCG, did not worsen the maximal expiratory pressure (Δ0.1[-8.8-7.5] vs. -2.5[-15.0-9.0] cmH2 O; p = 0.036). Besides, EXG showed a significant improvement in quadriceps strength (32.05 ± 10.61 vs. 33.35 ± 11.62 kg; p = 0.042). CONCLUSIONS The combined and periodized intradialytic exercise training improved cardiopulmonary fitness, respiratory function, inspiratory muscle strength, and quadriceps strength, beyond maintaining the expiratory muscle strength in HD subjects.
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Affiliation(s)
- Francini Porcher Andrade
- Ciências Pneumológicas Post-Graduation Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Gabrielle Costa Borba
- Ciências Pneumológicas Post-Graduation Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Kacylen Costa da Silva
- Ciências Pneumológicas Post-Graduation Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Tatiane de Souza Ferreira
- Ciências Pneumológicas Post-Graduation Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | | | | | - Paula Maria Eidt Rovedder
- Ciências Pneumológicas Post-Graduation Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Physiotherapy School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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18
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Lin CH, Hsu YJ, Hsu PH, Lee YL, Lin CH, Lee MS, Chiang SL. Effects of Intradialytic Exercise on Dialytic Parameters, Health-Related Quality of Life, and Depression Status in Hemodialysis Patients: A Randomized Controlled Trial. Int J Environ Res Public Health 2021; 18:9205. [PMID: 34501792 DOI: 10.3390/ijerph18179205] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/18/2021] [Accepted: 08/27/2021] [Indexed: 01/18/2023]
Abstract
Exercise is fundamentally important in managing chronic diseases and improving health-related quality of life (HRQL). However, whether intradialytic exercise is safe through assessment of changes in dialytic parameters and has a positive impact on HRQL and depression status of hemodialysis patients requires further research with diverse racial and cultural populations to identify. This study aimed to evaluate the effects of intradialytic exercise on dialytic parameters, HRQL, and depression status in hemodialysis patients. A randomized controlled trial was conducted at a medical center in Northern Taiwan. Sixty-four hemodialysis patients were recruited using stratified random sampling. Participants were randomized into an experimental group (EG, n = 32) or a control group (CG, n = 32). The EG received a 12-week intradialytic exercise program while the CG maintained their usual lifestyles. Dialytic parameters, HRQL, and depression status were collected at baseline and at 12 weeks. The results indicated no differences in the dialytic parameters from the baseline between both groups. However, the EG had increased HRQL (ß = 22.6, p < 0.001) and reduced depression status (ß = −7.5, p = 0.02) at 12 weeks compared to the CG. Therefore, a 12-week intradialytic exercise regime is safe and effective in improving HRQL and reducing depression status for hemodialysis patients.
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de Souza Rezende P, Porcher Andrade F, Ferraro Dos Santos Borba C, Eidt Rovedder PM. Pulmonary function, muscle strength, and quality of life have differed between chronic kidney disease patients and healthy individuals. Ther Apher Dial 2021; 26:337-344. [PMID: 34328280 DOI: 10.1111/1744-9987.13714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022]
Abstract
Chronic kidney disease (CKD) patients have lower pulmonary function, respiratory and peripheral muscle strength values when compared to the general population, which reflects negatively in the quality of life (QoL). The aim of this study was to compare the pulmonary function, respiratory and peripheral muscle strength, and QoL between CKD patients and healthy individuals. Cross-sectional study with a consecutive sample of 39 individuals separated into three groups: nondialysis-dependent CKD in stage 5 (CKD-5), HD group (CKD-HD), and healthy individuals. The tests performed were spirometry, manovacuometry, handgrip strength (HGS), and Medical Outcomes Short-Form Health Survey (SF-36). A significant difference between groups was observed in forced expiratory volume in 1 second (FEV1 ) and its predicted value (p = 0.004 and p < 0.001, respectively), forced vital capacity (FVC), and its predicted value (p = 0.008 and p < 0.001, respectively), peak expiratory flow (PEF) and its predicted value (p = 0.004 and p < 0.001, respectively), maximal inspiratory pressure (MIP) and its predicted value (p = 0.022), maximal expiratory pressure (MEP) and its predicted value (p = 0.030 and p = 0.009, respectively) in which CKD-5 presented the worst values, followed by CKD-HD and healthy group. The CKD-5 had worse pulmonary function, respiratory muscle strength, and QoL. Moreover, CKD-HD also showed some impairment in pulmonary function and QoL when compared with healthy individuals. Even with the peripheral muscle strength preserved, its decrease is proportional to the pulmonary impairment in the evaluated CKD patients.
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Affiliation(s)
- Patrícia de Souza Rezende
- Physiotherapy School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Francini Porcher Andrade
- Ciências Pneumológicas Post Graduation Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Paula Maria Eidt Rovedder
- Physiotherapy School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Ciências Pneumológicas Post Graduation Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
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20
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Ibrahim AA, Althomali OW, Atyia MR, Hussein HM, Abdelbasset WK, Eldesoky MTM, Gamal M. A systematic review of trials investigating the efficacy of exercise training for functional capacity and quality of life in chronic kidney disease patients. Int Urol Nephrol 2021; 54:289-298. [PMID: 34146218 DOI: 10.1007/s11255-021-02917-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 06/06/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the efficacy of exercise training on functional capacity and quality of life in chronic kidney disease. DATA SOURCES SCOPUS, CINAHL, Science Direct, Web of Science, MEDLINE, ProQuest, Physiotherapy Evidence Database (PEDRO), and Google Scholar databases were searched between 2010 and December 2020. METHODS Randomized controlled trials were included if they involved any types of exercise training (aerobic, resisted and respiratory ex.) conducted with chronic kidney disease patients. Three authors independently screened articles, extracted data, and assessed the methodological quality using PEDro scale, and two authors released any confliction. Modified Sackett Scale was used to determine the level of evidence for each outcome. RESULTS Out of 130 papers screened, 13 studies with 619 participants met the inclusion criteria. The frequency of the treatment ranged from three to four sessions per week for a period ranging from 8 to 24 weeks. According to the Pedro scale, the quality of studies ranged from good (three studies) to fair (ten studies). All included studies showed positive effects on the measured outcomes (functional capacity and quality of life in chronic kidney disease). CONCLUSION Exercise programs for chronic kidney disease patients provide beneficial clinical outcomes and optimize functional capacity and quality of life in those patients. Future studies still need to focus on high-quality evidence and studies evaluating the adverse effects of exercise.
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Affiliation(s)
- Ahmed Abdelmoniem Ibrahim
- College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia.,Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
| | | | | | - Hisham Mohamed Hussein
- College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia.,College of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
| | - Walid Kamal Abdelbasset
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia. .,Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt.
| | - Mohamed Taher Mahmoud Eldesoky
- College of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia.,Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Mervat Gamal
- College of Art, University of Ha'il, Ha'il, Saudi Arabia.,Working with Communities and Organizations Department, Faculty of Social Work, Helwan University, Cairo, Egypt
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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Greenwood SA, Koufaki P, Macdonald JH, Bhandari S, Burton JO, Dasgupta I, Farrington K, Ford I, Kalra PA, Kean S, Kumwenda M, Macdougall IC, Messow CM, Mitra S, Reid C, Smith AC, Taal MW, Thomson PC, Wheeler DC, White C, Yaqoob M, Mercer TH. Randomized Trial-PrEscription of intraDialytic exercise to improve quAlity of Life in Patients Receiving Hemodialysis. Kidney Int Rep 2021; 6:2159-2170. [PMID: 34386665 PMCID: PMC8343798 DOI: 10.1016/j.ekir.2021.05.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/24/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction Whether clinically implementable exercise interventions in people receiving hemodialysis (HD) therapy improve health-related quality of life (HRQoL) remains unknown. The PrEscription of intraDialytic exercise to improve quAlity of Life (PEDAL) study evaluated the clinical benefit and cost-effectiveness of a 6-month intradialytic exercise program. Methods In a multicenter, single-blinded, randomized, controlled trial, people receiving HD were randomly assigned to (i) intradialytic exercise training (exercise intervention group [EX]) and (ii) usual care (control group [CON]). Primary outcome was change in Kidney Disease Quality of Life Short-Form Physical Component Summary (KDQOL-SF 1.3 PCS) from baseline to 6 months. Cost-effectiveness was determined using health economic analysis; physiological impairment was evaluated by peak oxygen uptake; and harms were recorded. Results We randomized 379 participants; 335 and 243 patients (EX n = 127; CON n = 116) completed baseline and 6-month assessments, respectively. Mean difference in change PCS from baseline to 6 months between EX and CON was 2.4 (95% confidence interval [CI]: -0.1 to 4.8) arbitrary units (P = 0.055); no improvements were observed in peak oxygen uptake or secondary outcome measures. Participants in the intervention group had poor compliance (47%) and poor adherence (18%) to the exercise prescription. Cost of delivering intervention ranged from US$598 to US$1092 per participant per year. The number of participants with harms was similar between EX (n = 69) and CON (n = 56). A primary limitation was the lack of an attention CON. Many patients also withdrew from the study or were too unwell to complete all physiological outcome assessments. Conclusions A 6-month intradialytic aerobic exercise program was not clinically beneficial in improving HRQoL as delivered to this cohort of deconditioned patients on HD.
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Affiliation(s)
- Sharlene A Greenwood
- Renal Medicine, King's College Hospital NHS 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, Wales, UK
| | - Sunil Bhandari
- Renal Medicine, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Indranil Dasgupta
- Renal Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | - Sharon Kean
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | - Iain C Macdougall
- Renal Medicine, King's College Hospital NHS Trust, London, UK.,School of Renal Medicine, King's College London, London, UK
| | | | - Sandip Mitra
- Renal Medicine, Manchester University Hospitals, Manchester, UK
| | - Chante Reid
- Renal Medicine, King's College Hospital NHS Trust, London, UK
| | - Alice C Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Maarten W Taal
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - Peter C Thomson
- Renal Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - David C Wheeler
- Renal Medicine, University College London, London, UK.,The George Institute for Global Health, New South Wales, Australia
| | - Claire White
- Renal Medicine, King's College Hospital NHS Trust, London, UK
| | - Magdi Yaqoob
- Renal Medicine, The Royal London Hospital, London, UK
| | - Thomas H Mercer
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
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23
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Hargrove N, El Tobgy N, Zhou O, Pinder M, Plant B, Askin N, Bieber L, Collister D, Whitlock R, Tangri N, Bohm C. Effect of Aerobic Exercise on Dialysis-Related Symptoms in Individuals Undergoing Maintenance Hemodialysis: A Systematic Review and Meta-Analysis of Clinical Trials. Clin J Am Soc Nephrol 2021; 16:560-574. [PMID: 33766925 PMCID: PMC8092056 DOI: 10.2215/cjn.15080920] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hemodialysis is associated with a high symptom burden that impairs health-related quality of life and functional status. Effective symptom management is a priority for individuals receiving hemodialysis. Aerobic exercise may be an effective, nonpharmacologic treatment for specific hemodialysis-related symptoms. This systematic review investigated the effect of aerobic exercise on hemodialysis-related symptoms in adults with kidney failure undergoing maintenance hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We searched MEDLINE, PubMed, Cochrane CENTRAL, CINAHL, PsycINFO, SPORTDiscus, EMBASE, PEDro, and Scopus databases from 1960 or inception until April 15, 2020 for randomized controlled trials investigating the effect of aerobic exercise on hemodialysis-related symptoms, identified as prespecified primary or secondary outcomes, as compared with controls in adults on maintenance hemodialysis. We identified restless legs syndrome as the primary outcome. RESULTS Of 3048 studies identified, 15 randomized controlled trials met the eligibility criteria. These studies investigated the effect of aerobic exercise on restless legs syndrome (two studies), sleep disturbance (four studies), anxiety (four studies), depression (nine studies), muscle cramping (one study), and fatigue (one study). Exercise interventions were intradialytic in ten studies and outside of hemodialysis in five studies. Heterogenous interventions and outcomes and moderate to high risk of bias precluded meta-analysis for most symptoms. Aerobic exercise demonstrated improvement in symptoms of restless legs syndrome, muscle cramping, and fatigue, as compared with nonexercise controls. Meta-analysis of depressive symptoms in studies using the Beck Depression Inventory demonstrated a greater reduction in Beck Depression Inventory score with exercise as compared with control (mean difference -7.57; 95% confidence interval, -8.25 to -6.89). CONCLUSIONS Our review suggests that in adults on maintenance hemodialysis, aerobic exercise improves several hemodialysis-related symptoms, including restless legs syndrome, symptoms of depression, muscle cramping, and fatigue. However, the use of validated outcome measures with demonstrated reliability and responsiveness in more diverse hemodialysis populations is required to fully characterize the effect of this intervention. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER PROSPERO #CRD42017056658.
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Affiliation(s)
- Nicholas Hargrove
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nada El Tobgy
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Olivia Zhou
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark Pinder
- Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada
| | - Brittany Plant
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Askin
- University of Manitoba Libraries, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura Bieber
- University of Manitoba Libraries, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Collister
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada
| | - Reid Whitlock
- Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada
| | - Navdeep Tangri
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada,Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Clara Bohm
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada,Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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24
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Perez-Dominguez B, Casaña-Granell J, Garcia-Maset R, Garcia-Testal A, Melendez-Oliva E, Segura-Orti E. Effects of exercise programs on physical function and activity levels in patients undergoing hemodialysis. A randomized controlled trial. Eur J Phys Rehabil Med 2021; 57:994-1001. [PMID: 33826277 DOI: 10.23736/s1973-9087.21.06694-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There are still many barriers when implementing exercise routines within daily dialysis care, even though benefits are well-known. Developing cost-effective strategies is necessary to overcome these barriers and include exercise as a complementary therapy in dialysis. AIM To compare several exercise programs on hemodialysis patient's functional capacity and health-related quality of life. DESIGN This study was a 16-week follow-up, two-parallel group trial with balanced randomization. SETTING Participants in this study belonged to a private hospitalized care center. POPULATION Referred sample of 71 patients that suffered end-stage chronic kidney disease who underwent hemodialysis for at least 3 months and had a medical stable condition. METHODS 36 participants performed during 16 weeks an intradialytic exercise program lead by the nursing staff of the hemodialysis unit and 35 a home-based program supervised by physical therapists of the hospital. RESULTS The main researcher and the data analyst were both blinded to participant allocation. There was a significant effect in time for both groups. Participants improved significantly in the Short Performance Physical Battery (SPPB), One-Leg Heel-Rise (OLHR) and 6 Minute-Walk Test (6MWT), and in the Physical Activity Scale for the Elderly (PASE) and Short Survey Form 36 (SF-36) questionnaires. CONCLUSIONS Nurse-led and home-based exercise interventions produce beneficial effects involving physical function, activity levels and health-related quality of life in patients undergoing hemodialysis. CLINICAL REHABILITATION IMPACT The study emphasizes the importance of exercise rehabilitation routines in fragile populations such as dialysis patients, and the potential to overcome barriers for its daily implementation.
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Affiliation(s)
| | | | | | | | | | - Eva Segura-Orti
- Department of Physiotherapy, University CEU Cardenal Herrera, Moncada, Spain
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25
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Segura-Orti E, Koufaki P, Kouidi E. Bridging the gap from research to practice for enhanced health-related quality of life in people with chronic kidney disease. Clin Kidney J 2021; 14:ii34-ii42. [PMID: 33981418 PMCID: PMC8101625 DOI: 10.1093/ckj/sfaa268] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/09/2020] [Indexed: 12/11/2022] Open
Abstract
Improving the health status of people with chronic kidney disease (CKD) through physical activity (PA) or exercise interventions is challenging. One of the gaps in the process of translating the general public PA activity guidelines as well as the CKD-specific guidelines into routine clinical practice is the lack of systematic recording and monitoring of PA and physical function attributes, which can also be used to develop individualized and measurable plans of action to promote PA for health. We aim to present an overview of key considerations for PA, physical function and health-related quality of life (HRQoL) evaluation in people with CKD, with the aim of encouraging health professionals to integrate assessment of these outcomes in routine practices. Physical inactivity and impaired physical function, sometimes to the extent of physical and social disability levels, and subsequently lower perceived HRQoL, are highly prevalent in this population. Enhanced PA is associated with better physical function that also translates into multiple health benefits. Breaking the vicious circle of inactivity and physical dysfunction as early as possible in the disease trajectory may confer huge benefits and enhanced life satisfaction in the longer term. With this in mind, the importance of PA/exercise interventions in CKD to improve HRQoL is also summarized.
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Affiliation(s)
- Eva Segura-Orti
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Pelagia Koufaki
- Centre for Health, Physical Activity and Rehabilitation Research, School of Health Sciences, Queen Margaret University, Edinburgh, Scotland
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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26
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Nataatmadja M, Evangelidis N, Manera KE, Cho Y, Johnson DW, Craig JC, Baumgart A, Hanson CS, Shen J, Guha C, Scholes-Robertson N, Tong A. Perspectives on mental health among patients receiving dialysis. Nephrol Dial Transplant 2020; 36:gfaa346. [PMID: 33374004 DOI: 10.1093/ndt/gfaa346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diminished mental health is associated with increased morbidity and mortality and may contribute to loss of independence and motivation in patients receiving dialysis and their caregivers. Increased understanding of the patient perspective on triggers, impacts and strategies for managing mental health may inform ways to address mental health conditions in this population. METHODS A secondary thematic analysis was undertaken using data from the Standardized Outcomes in Nephrology (SONG)-Hemodialysis and SONG-Peritoneal Dialysis projects. We extracted and analysed data on the perceived causes, meaning, impact and management of mental health in patients receiving dialysis from 26 focus groups (in six countries), multinational Delphi surveys and consensus workshops. RESULTS A total of 644 patients and caregivers participated. We identified five themes: bound to dialysis (forced into isolation, enslaved to a machine, stress of relentless planning and grieving the loss of a normal life), underrecognized and ignored (missed by health practitioners, need for mental health support), an uncertain future (dreading complications, coming to terms with mortality), developing self-reliance (vulnerability in being solely responsible for dialysis, sustaining motivation for dialysis, necessity for self-vigilance and taking charge to regulate emotions) and responding to a lifestyle overhaul (guilt of burdening family, controlling symptoms for overall mental wellness, protecting independence and trying to feel grateful). CONCLUSIONS Patients receiving dialysis and their caregivers endure mental and emotional distress attributed to the burden of dialysis, lifestyle restrictions, the constant threat of death and symptom burden, which can impair motivation for self-management. Increased attention to monitoring and management of mental health in this population is needed.
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Affiliation(s)
- Melissa Nataatmadja
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, QLD, Australia
- Sunshine Coast Health Institute, Birtinya, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Karine E Manera
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Amanda Baumgart
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Jenny Shen
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Chandana Guha
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
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27
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Nakayama T, Uchiyama K, Washida N, Morimoto K, Muraoka K, Adachi K, Kasai T, Miyashita K, Wakino S, Itoh H. Exercise Parameters Predict Technique Survival in Patients on Peritoneal Dialysis. Blood Purif 2020; 50:380-389. [PMID: 33091919 DOI: 10.1159/000511293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/16/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The incremental shuttle walking test (ISWT) is an important marker of aerobic capacity in patients on peritoneal dialysis (PD). This study aimed to evaluate its predictive value for PD-related outcomes. METHODS This single-center cohort study recruited outpatients on maintenance PD from our hospital between March 2017 and March 2018. Exercise capacity was assessed using measurement of ISWT and handgrip and quadriceps strength. Patients were divided into 2 groups according to the median of exercise capacity and prospectively followed up until cessation of PD, death, or the study end (October 2019). The primary end point of this study was technique survival rate, and secondary outcomes were rates of peritonitis-free survival and PD-related hospitalization-free survival. RESULTS Among the 50 participants, age and PD vintage were [median (IQR)] 62.5 (58.3-70) and 3.5 (1.3-6.5) years, respectively. At the end of the study, 3 of the 28 participants (11%) in the long-ISWT group and 13 of the 22 participants (59%) in the short-ISWT group were transferred to hemodialysis. The short-ISWT group showed lower technique survival rate (p < 0.001), peritonitis-free survival rate (p = 0.01), and PD-related hospitalization-free survival rate (p < 0.01) than the long-ISWT group, whereas those survival rates did not differ when participants were divided by handgrip or quadriceps strength. Multivariate analysis revealed lower ISWT to be independently associated with technique failure (p = 0.002). CONCLUSION The ISWT is an important predictor of technique survival for patients on PD. Monitoring and enhancing ISWT as a marker of aerobic capacity might improve PD-related outcomes.
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Affiliation(s)
- Takashin Nakayama
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Hanamachi, Shinjuku-ku, Japan
| | - Kiyotaka Uchiyama
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Hanamachi, Shinjuku-ku, Japan,
| | - Naoki Washida
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Hanamachi, Shinjuku-ku, Japan.,Department of Nephrology, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Kohkichi Morimoto
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Hanamachi, Shinjuku-ku, Japan
| | - Kaori Muraoka
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Keika Adachi
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Hanamachi, Shinjuku-ku, Japan
| | - Takahiro Kasai
- Department of Nephrology, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Kazutoshi Miyashita
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Hanamachi, Shinjuku-ku, Japan
| | - Shu Wakino
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Hanamachi, Shinjuku-ku, Japan
| | - Hiroshi Itoh
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Hanamachi, Shinjuku-ku, Japan
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28
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Sovatzidis A, Chatzinikolaou A, Fatouros IG, Panagoutsos S, Draganidis D, Nikolaidou E, Avloniti A, Michailidis Y, Mantzouridis I, Batrakoulis A, Pasadakis P, Vargemezis V. Intradialytic Cardiovascular Exercise Training Alters Redox Status, Reduces Inflammation and Improves Physical Performance in Patients with Chronic Kidney Disease. Antioxidants (Basel) 2020; 9:E868. [PMID: 32942555 DOI: 10.3390/antiox9090868] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023] Open
Abstract
Redox status (RS) perturbations and inflammation are fundamental features of chronic kidney disease (CKD) that are substantially exacerbated in end-stage renal disease (ESRD). This study aimed at investigating the efficacy of a 6-month intradialytic exercise training program on RS, inflammation and physical performance in patients with ESRD. Twenty hemodialysis (HD) patients (17 males, three females) were randomly assigned to either an intradialytic training (bedside cycling) group (TR; n = 10) or a control group (CON; n = 10) for 6 months. Anthropometrics [body mass and height, body mass index (BMI), body composition], physical performance (VO2peak), functional capacity [North Staffordshire Royal Infirmary (NSRI) walk test, sit-to-stand test (STS-60)], quality of life (short form-36 (SF-36) as well as RS [thiobarbituric acid reactive substances (TBARS), protein carbonyls (PC), reduced (GSH) and oxidized (GSSG) glutathione, GSH/GSSG, total antioxidant capacity (TAC), catalase activity (CAT)] and high-sensitivity C-reactive protein (hs-CRP) were assessed at baseline and after the 6-month intervention. Peak oxygen consumption (VO2peak) increased by 15% only in TR (p < 0.01). Performance in NSRI, STS-60 and SF-36 improved by 4–13% only in TR (p < 0.01). Exercise training reduced TBARS (by 28%), PC (by 31%) and hs-CRP (by 15%), and elevated GSH (by 52%), GSH/GSSG (by 51%), TAC (by 59%) and CAT (by 15%) (p < 0.01). These findings suggest that engagement in chronic intradialytic cardiovascular exercise alters RS, reduces inflammation and improves performance in patients with ESRD.
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Ferreira TL, Ribeiro HS, Ribeiro ALA, Bonini-Rocha AC, Lucena JMS, de Oliveira PA, Amorim FRS, Ferreira AP, Magno LAV, Martins WR. Exercise interventions improve depression and anxiety in chronic kidney disease patients: a systematic review and meta-analysis. Int Urol Nephrol 2020; 53:925-933. [PMID: 32869171 DOI: 10.1007/s11255-020-02612-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/12/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE This systematic review examined the effects of exercise interventions on depression and anxiety in chronic kidney disease patients. METHODS Electronic searches were conducted between August 2019 and February 2020 at PubMed, MEDLINE, Web of Science, EBSCO, Scopus, LILACS, EMBASE, Physiotherapy Evidence Database, and Cochrane Library databases. Original clinical trial studies that examined the effects of exercise on depression and anxiety in chronic kidney disease patients, stages 3-5, were included. A total of eight studies were included in the systematic review after applying the eligibility criteria, and six studies used for the meta-analysis procedures. RESULTS The meta-analysis demonstrated statistical difference on depression in favour to exercise when compared to active control (SMD = - 0.66 [- 1.00, - 0.33], p < 0.0001) and passive control (MD = - 6.95 [- 8.76, - 5.14], p < 0.00001). Same results on anxiety demonstrated statistical difference between exercise and active control (SMD = - 0.78 [- 1.21, - 0.34], p = 0.0004). CONCLUSION From the current limited number and quality of published studies, exercise seems to be more effective than sedentary control and other active control groups for improving depression and anxiety symptoms in chronic kidney disease patients.
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Affiliation(s)
| | - Heitor Siqueira Ribeiro
- University Center ICESP, QS 05 Rua 300 Lote 01, Águas Claras, Brasília, DF, 71961-540, Brazil.,Faculty of Physical Education, University of Brasília, Brasília, Brazil
| | | | | | | | | | | | | | | | - Wagner Rodrigues Martins
- Faculty of Physical Education, University of Brasília, Brasília, Brazil.,Department of Physiotherapy, University of Brasília, Brasília, Brazil
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Nishi H, Takemura K, Higashihara T, Inagi R. Uremic Sarcopenia: Clinical Evidence and Basic Experimental Approach. Nutrients 2020; 12:E1814. [PMID: 32570738 DOI: 10.3390/nu12061814] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/27/2020] [Accepted: 06/16/2020] [Indexed: 12/17/2022] Open
Abstract
Sustained physical activity extends healthy life years while a lower activity due to sarcopenia can reduce them. Sarcopenia is defined as a decrease in skeletal muscle mass and strength due not only to aging, but also from a variety of debilitating chronic illnesses such as cancer and heart failure. Patients with chronic kidney disease (CKD), who tend to be cachexic and in frail health, may develop uremic sarcopenia or uremic myopathy due to an imbalance between muscle protein synthesis and catabolism. Here, we review clinical evidence indicating reduced physical activity as renal function deteriorates and explore evidence-supported therapeutic options focusing on nutrition and physical training. In addition, although sarcopenia is a clinical concept and difficult to recapitulate in basic research, several in vivo approaches have been attempted, such as rodent subtotal nephrectomy representing both renal dysfunction and muscle weakness. This review highlights molecular mechanisms and promising interventions for uremic sarcopenia that were revealed through basic research. Extensive study is still needed to cast light on the many aspects of locomotive organ impairments in CKD and explore the ways that diet and exercise therapies can improve both outcomes and quality of life at every level.
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Borzou SR, Babaei N, Gholyaf M, Molavi Vardanjani M, Tapak L. The Effect of Telephone Follow-Up on Quality of Life in Hemodialysis Patients. Nephrourol Mon 2020; 12. [DOI: 10.5812/numonthly.104178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Maynard LG, de Menezes DL, Lião NS, de Jesus EM, Andrade NLS, Santos JCD, da Silva Júnior WM, Bastos KDA, Barreto Filho JAS. Effects of Exercise Training Combined with Virtual Reality in Functionality and Health-Related Quality of Life of Patients on Hemodialysis. Games Health J 2020; 8:339-348. [PMID: 31539293 DOI: 10.1089/g4h.2018.0066] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: The progression of chronic kidney disease can directly affect patient's health-related quality of life (HRQoL). Exercise training is a good option to reverse the impacts caused by the disease. To escape from the monotonous routine and stimulate further practice, the therapist should consider making physical activity more playful. Using videogames during exercise training is possible to rehabilitate the patient aiming for fun beyond the organic condition. The present study aimed to evaluate the effects of exercise training combined with Virtual Reality (VR) in functionality and HRQoL of patients on hemodialysis. Materials and Methods: A randomized controlled study in which control group (n = 20) maintained only hemodialysis without any physical effort or intervention from the researchers and intervention group (n = 20) who performed endurance and strength physical exercises in combination with VR during hemodialysis for 12 weeks. All eligible patients underwent a familiarization of games and were evaluated by an investigator-blind for functional capacity, quality of life, and depressive symptoms. Functional capacity tests included walking speed, timed up and go (TUG), and Duke Activity Status Index (DASI). To evaluate a HRQoL, Kidney Disease and Quality-of-Life Short-Form (KDQOL-SF™, v. 1.3) was used and to investigate depressive symptoms, the Center for Epidemiological Scale-Depression. Paired sample t-tests were conducted to determine differences within each group. Repeated-measures analysis of variance (group vs. time) was used to assess group differences in our major outcomes. The level of significance was 5%. Results: The exercise improved functional capacity (TUG: P = 0.002, DASI: P < 0.001) and HRQoL in physical and specific domains: physical functioning (P = 0.047), role physical (P = 0.021), as well as in physical composite summary (P < 0.001) and effects of kidney disease (P = 0.013). There was no influence on depressive symptoms (P = 0.154). Conclusion: Physical training combined with VR improved functional capacity and some quality-of-life domains of hemodialysis patients.
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Affiliation(s)
- Luana Godinho Maynard
- Tiradentes University (UNIT), Aracaju, Brazil.,Health Sciences, Federal University of Sergipe, São Cristóvão, Brazil
| | | | - Noelma Santos Lião
- Department of Physiotherapy, Federal University of Sergipe, São Cristóvão, Brazil
| | | | | | | | | | - Kleyton de Andrade Bastos
- Clinic of Nephrology of Sergipe (Clinese), Division of Nephrology, Federal University of Sergipe, Aracaju, Brazil
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Sharma S, Green T, Alexander KE, Bonner A. Educational or behavioural interventions for symptoms and health-related quality of life in adults receiving haemodialysis: A systematic review. J Ren Care 2020; 46:233-249. [PMID: 32319190 DOI: 10.1111/jorc.12329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/13/2020] [Accepted: 03/05/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND People with end-stage kidney disease (ESKD) suffer from multiple symptoms, which have a negative impact on their health-related quality of life (HRQoL). Educational and behavioural interventions are being developed for this population; however, the effect of these interventions is unclear. AIM To evaluate the effectiveness of educational or behavioural interventions compared with standard care or alternative strategies on reducing symptoms and improving HRQoL in adults with ESKD receiving haemodialysis (HD). METHODS An effectiveness systematic review using Joanna Briggs Institute (JBI) procedures was conducted on experimental studies [randomised controlled trials (RCTs), pseudo-RCTs and quasi-experimental designs] published in English between January 2009 and July 2019. Studies were retrieved from CINAHL, PubMed, MEDLINE, Embase, PsycINFO, Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trial) and JBI databases. Effect size at 95% confidence interval was calculated where possible. RESULTS Eighteen studies involving 791 participants were included in this review. All studies involved behavioural interventions with the majority of studies (n = 11) targeting psychological symptoms. Interventions were categorised as either active or passive. Active interventions seemed to improve some physical symptoms, although there was very little evidence of improvements to HRQoL. Passive interventions tended to have a large effect on psychological symptoms and the mental health components of HRQoL. CONCLUSION Due to great heterogeneity between studies, meta-analyses could not be conducted further limiting the evidence to inform practice. In addition, further research on educational interventions to teach self-management strategies for symptom management and to improve HRQoL in people with ESKD receiving HD are needed.
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Affiliation(s)
- Sita Sharma
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Theresa Green
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,Surgical Treatment & Rehabilitation Service, Metro North Hospital and Health Service, Brisbane, Australia
| | | | - Ann Bonner
- School of Nursing, Queensland University of Technology, Brisbane, Australia.,Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Huang M, Lv A, Wang J, Zhang B, Xu N, Zhai Z, Gao J, Wang Y, Li T, Ni C. The effect of intradialytic combined exercise on hemodialysis efficiency in end-stage renal disease patients: a randomized-controlled trial. Int Urol Nephrol 2020; 52:969-76. [DOI: 10.1007/s11255-020-02459-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
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Ju H, Chen H, Mi C, Chen Y, Zuang C. The Impact of Home-Based Exercise Program on Physical Function of Chronic Kidney Disease Patients: A Meta-Analysis of Randomized Controlled Trials. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2020. [DOI: 10.1055/a-1079-3714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Background Home-based exercise program showed the potential in improving physical function of chronic kidney disease patients, and it might need low associated costs. We conducted a systematic review and meta-analysis to explore the impact of home-based exercise program on physical function of chronic kidney disease patients.
Methods PubMed, EMBASE, Web of science, EBSCO, and Cochrane library databases were systematically searched. This meta-analysis included randomized controlled trials (RCTs) assessing the effect of home-based exercise program on physical function of chronic kidney disease patients. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were 6-min walk test and grip strength change.
Results Seven RCTs were included in the meta-analysis. Overall, compared with control intervention in chronic kidney disease patients, home-based exercise program could significantly improve 6-min walk test (MD=79.01; 95% CI=22.39–135.62; P=0.006) and grip strength (SMD=0.52; 95% CI=0.14–0.89; P=0.007), but showed no impact on pain scores (SMD=−1.43; 95% CI=−3.75 to 0.88; P=0.22), Kidney Disease Quality of life including symptom/problem list (SMD=1.92; 95% CI=−1.06 to 4.90; P=0.21), effects of kidney disease (SMD=−3.69; 95% CI=−8.56 to 1.19; P=0.14), or burden of kidney disease (SMD=1.04; 95% CI=−0.75 to 2.82; P=0.26).
Conclusions Home-based exercise program might improve physical function for chronic kidney disease, and more RCTs should be conducted to confirm this issue.
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Affiliation(s)
- Hongbo Ju
- Nephrology Department, Fenghua People's Hospital, Ningbo, Zhejiang, China
| | - Haojun Chen
- Nephrology Department, Fenghua People's Hospital, Ningbo, Zhejiang, China
| | - Caixia Mi
- Nephrology Department, Fenghua People's Hospital, Ningbo, Zhejiang, China
| | - Yifei Chen
- Nephrology Department, Fenghua People's Hospital, Ningbo, Zhejiang, China
| | - Caijiao Zuang
- Nephrology Department, Fenghua People's Hospital, Ningbo, Zhejiang, China
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Affiliation(s)
- Yu Zhao
- Department of Nephrology, Ningbo Urology and Nephrology Hospital, Ningbo, Zhejiang Province, China
| | - Ya-ping Chen
- Department of Psychiatry, Ningbo Psychiatric Hospital, The Demobilized Veterans Psychiatric Sanatorium of Zhejiang Province, Ningbo, Zhejiang Province, China
| | - Yue-qing Wu
- Department of Psychiatry, Ningbo Psychiatric Hospital, The Demobilized Veterans Psychiatric Sanatorium of Zhejiang Province, Ningbo, Zhejiang Province, China
| | - Bei-yan Bao
- Department of Nephrology, Ningbo Urology and Nephrology Hospital, Ningbo, Zhejiang Province, China
- Bei-yan Bao, Department of Nephrology, Ningbo Urology and Nephrology Hospital, No.1 Qianhe Road, Ningbo, Zhejiang Province, People’s Republic of China.
| | - Heng Fan
- Department of Intensive Care Unit, Ningbo First Hospital, Ningbo, Zhejiang Province, China
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Sowtali S, Harith S, Mohd. Shah A, Ishak N, Yusoff D, Draman C, Mohd Rasani A, Ghazali N. Educational needs of chronic kidney disease patients who presented to tengku ampuan afzan hospital: Preliminary findings. Saudi J Kidney Dis Transpl 2020; 31:118-128. [DOI: 10.4103/1319-2442.279931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bogataj Š, Pajek M, Pajek J, Buturović Ponikvar J, Paravlic A. Exercise-Based Interventions in Hemodialysis Patients: A Systematic Review with a Meta-Analysis of Randomized Controlled Trials. J Clin Med 2019; 9:E43. [PMID: 31878176 DOI: 10.3390/jcm9010043] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 01/22/2023] Open
Abstract
There is a lack of agreement on the efficacy of different exercise interventions in hemodialysis patients. We analyzed which exercise type is the most beneficial in terms of functional fitness and inflammation. A literature search of seven databases yielded 33 studies that met the inclusion criteria. Compared with an inactive control, the intervention group showed moderate effects (ES = 0.74; 95% CI 0.35 to 1.14; p < 0.001; and ES = 0.70; 95% CI 0.39 to 1.01; p < 0.001; respectively) on functional capacity (six-minute walk test) and oxygen consumption. Small nonsignificant effects were observed for aerobic (ES = -0.36; 95% CI -0.85 to 0.13; p = 0.154) and resistance (ES = -0.44; 95% CI -1.07 to 0.19; p = 0.169) training types, whereas moderate effects were found for combined (ES = -0.69; 95% CI -1.47 to 0.10; p = 0.088) training type based on a 10-repetition sit-to-stand test. Further, large and small effects were observed for aerobic (ES = -1.21; 95% CI -1.94 to -0.49; p = 0.001) and resistance training (ES = -0.54; 95% CI -0.90 to -0.17; p = 0.004) types on C-reactive protein. Overall, the results showed the numerically largest effect sizes for combined types compared to solely aerobic or resistance training types, with the differences between training types not reaching statistical significance. There was a significant modifying impact of age, training frequency, and session duration on performance and inflammatory outcomes.
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Ferrari F, Helal L, Dipp T, Soares D, Soldatelli Â, Mills AL, Paz C, Tenório MCC, Motta MT, Barcellos FC, Stein R. Intradialytic training in patients with end-stage renal disease: a systematic review and meta-analysis of randomized clinical trials assessing the effects of five different training interventions. J Nephrol 2019; 33:251-266. [PMID: 31865607 DOI: 10.1007/s40620-019-00687-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/15/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Patients with end-stage renal disease (ESRD) undergoing hemodialysis may have reduced dialysis adequacy (Kt/V), low cardiorespiratory fitness, and worse prognosis. Different types of intradialytic training (IDT) may serve as an adjunct therapy for the management of the ESRD. This systematic review and meta-analysis aimed to assess the impact of different types of IDT on clinical outcomes and functional parameters in ESRD. METHODS PubMed, Embase, CINAHL, Cochrane CENTRAL, Scopus, SPORTDiscus, and Google Scholar were searched for randomized clinical trials in adult patients with ESRD which compared IDT with usual care (UC), without language restrictions and published up to July 2019; a handsearch of references was also performed. Certainty of evidence was assessed using GRADE, and risk of bias in primary studies with the RoB 1.0 tool. RESULTS Fifty studies were included (n = 1757). Compared to UC, aerobic IDT improved Kt/V (WMD = 0.08), VO2peak (WMD = 2.07 mL/kg/min), 6-minute walk test (6MWT) distance (64.98 m), reduced systolic blood pressure (- 10.07 mmHg) and C-reactive protein (- 3.28 mg/L). Resistance training increased 6MWT distance (68.50 m). Combined training increased VO2peak (5.41 mL/kg/min) and reduced diastolic blood pressure (- 5.76 mmHg). Functional electrostimulation (FES) and inspiratory muscle training (IMT) improved 6MWT distance (54.14 m and 117.62 m, respectively). There was no impact on total cholesterol, interleukin-6, or hemoglobin levels. There was no difference in incidence of adverse events between the IDT and control groups. The certainty of evidence was variable according to the GRADE scale, with most outcomes rated very low certainty. The risk of bias assessment of primary studies showed unclear risk in most. CONCLUSIONS Aerobic, resistance, and combined training during hemodialysis, as well as FES and IMT, demonstrated to be effective for the treatment of the patient with ESRD. Our data should be interpreted in light of the unclear risk of bias of most evaluated articles and the low to very low certainty of evidence for evaluated outcomes. PROSPERO REGISTRATION ID CRD42017081338. DATA SHARING REPOSITORY: https://osf.io/fpj54/.
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Affiliation(s)
- Filipe Ferrari
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350-Santa Cecília, Porto Alegre, RS, 90035-003, Brazil.,Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Helal
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350-Santa Cecília, Porto Alegre, RS, 90035-003, Brazil.,Exercise Pathophysiology Laboratory (LaFiEx), Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Thiago Dipp
- School of Physical Therapy, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil
| | - Douglas Soares
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350-Santa Cecília, Porto Alegre, RS, 90035-003, Brazil.,Experimental and Molecular Cardiovascular Laboratory and Heart Failure Unit, Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ângela Soldatelli
- Exact Sciences and Engineering, Universidade de Caxias do Sul, Caxias do Sul, Brazil
| | - Andrew Lee Mills
- Center for Workplace Health, American Heart Association, Houston, TX, USA
| | | | | | - Marcelo Trotte Motta
- Department of Biotechnology, Universidade Estadual de Feira de Santana, Feira de Santana, Brazil
| | | | - Ricardo Stein
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350-Santa Cecília, Porto Alegre, RS, 90035-003, Brazil. .,Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Vitta Centro de Bem-Estar Físico, Porto Alegre, Brazil. .,Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Natale P, Palmer SC, Ruospo M, Saglimbene VM, Rabindranath KS, Strippoli GFM. Psychosocial interventions for preventing and treating depression in dialysis patients. Cochrane Database Syst Rev 2019; 12:CD004542. [PMID: 31789430 PMCID: PMC6886341 DOI: 10.1002/14651858.cd004542.pub3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND People with end-stage kidney disease (ESKD) treated with dialysis are frequently affected by major depression. Dialysis patients have prioritised depression as a critically important clinical outcome in nephrology trials. Psychological and social support are potential treatments for depression, although a Cochrane review in 2005 identified zero eligible studies. This is an update of the Cochrane review first published in 2005. OBJECTIVES To assess the effect of using psychosocial interventions versus usual care or a second psychosocial intervention for preventing and treating depression in patients with ESKD treated with dialysis. SEARCH METHODS We searched Cochrane Kidney and Transplant's Register of Studies up to 21 June 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs of psychosocial interventions for prevention and treatment of depression among adults treated with long-term dialysis. We assessed effects of interventions on changes in mental state (depression, anxiety, cognition), suicide, health-related quality of life (HRQoL), withdrawal from dialysis treatment, withdrawal from intervention, death (any cause), hospitalisation and adverse events. DATA COLLECTION AND ANALYSIS Two authors independently selected studies for inclusion and extracted study data. We applied the Cochrane 'Risk of Bias' tool and used the GRADE process to assess evidence certainty. We estimated treatment effects using random-effects meta-analysis. Results for continuous outcomes were expressed as a mean difference (MD) or as a standardised mean difference (SMD) when investigators used different scales. Dichotomous outcomes were expressed as risk ratios. All estimates were reported together with 95% confidence intervals (CI). MAIN RESULTS We included 33 studies enrolling 2056 participants. Twenty-six new studies were added to this 2019 update. Seven studies originally excluded from the 2005 review were included as they met the updated review eligibility criteria, which have been expanded to include RCTs in which participants did not meet criteria for depression as an inclusion criterion. Psychosocial interventions included acupressure, cognitive-behavioural therapy, counselling, education, exercise, meditation, motivational interviewing, relaxation techniques, social activity, spiritual practices, support groups, telephone support, visualisation, and voice-recording of a psychological intervention. The duration of study follow-up ranged between three weeks and one year. Studies included between nine and 235 participants. The mean study age ranged between 36.1 and 73.9 years. Random sequence generation and allocation concealment were at low risk of bias in eight and one studies respectively. One study reported low risk methods for blinding of participants and investigators, and outcome assessment was blinded in seven studies. Twelve studies were at low risk of attrition bias, eight studies were at low risk of selective reporting bias, and 21 studies were at low risk of other potential sources of bias. Cognitive behavioural therapy probably improves depressive symptoms measured using the Beck Depression Inventory (4 studies, 230 participants: MD -6.10, 95% CI -8.63 to -3.57), based on moderate certainty evidence. Cognitive behavioural therapy compared to usual care probably improves HRQoL measured either with the Kidney Disease Quality of Life Instrument Short Form or the Quality of Life Scale, with a 0.5 standardised mean difference representing a moderate effect size (4 studies, 230 participants: SMD 0.51, 95% CI 0.19 to 0.83) , based on moderate certainty evidence. Cognitive behavioural therapy may reduce major depression symptoms (one study) and anxiety, and increase self-efficacy (one study). Cognitive behavioural therapy studies did not report hospitalisation. We found low-certainty evidence that counselling may slightly reduce depressive symptoms measured with the Beck Depression Inventory (3 studies, 99 participants: MD -3.84, 95% CI -6.14 to -1.53) compared to usual care. Counselling reported no difference in HRQoL (one study). Counselling studies did not measure risk of major depression, suicide, or hospitalisation. Exercise may reduce or prevent major depression (3 studies, 108 participants: RR 0.47, 95% CI 0.27 to 0.81), depression of any severity (3 studies, 108 participants: RR 0.69, 95% CI 0.54 to 0.87) and improve HRQoL measured with Quality of Life Index score (2 studies, 64 participants: MD 3.06, 95% CI 2.29 to 3.83) compared to usual care with low certainty. With moderate certainty, exercise probably improves depression symptoms measured with the Beck Depression Inventory (3 studies, 108 participants: MD -7.61, 95% CI -9.59 to -5.63). Exercise may reduce anxiety (one study). No exercise studies measured suicide risk or withdrawal from dialysis. We found moderate-certainty evidence that relaxation techniques probably reduce depressive symptoms measured with the Beck Depression Inventory (2 studies, 122 participants: MD -5.77, 95% CI -8.76 to -2.78). Relaxation techniques reported no difference in HRQoL (one study). Relaxation studies did not measure risk of major depression or suicide. Spiritual practices have uncertain effects on depressive symptoms measured either with the Beck Depression Inventory or the Brief Symptom Inventory (2 studies, 116 participants: SMD -1.00, 95% CI -3.52 to 1.53; very low certainty evidence). No differences between spiritual practices and usual care were reported on anxiety (one study), and HRQoL (one study). No study of spiritual practices evaluated effects on suicide risk, withdrawal from dialysis or hospitalisation. There were few or no data on acupressure, telephone support, meditation and adverse events related to psychosocial interventions. AUTHORS' CONCLUSIONS Cognitive behavioural therapy, exercise or relaxation techniques probably reduce depressive symptoms (moderate-certainty evidence) for adults with ESKD treated with dialysis. Cognitive behavioural therapy probably increases health-related quality of life. Evidence for spiritual practices, acupressure, telephone support, and meditation is of low certainty . Similarly, evidence for effects of psychosocial interventions on suicide risk, major depression, hospitalisation, withdrawal from dialysis, and adverse events is of low or very low certainty.
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Affiliation(s)
- Patrizia Natale
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The University of SydneySydney School of Public HealthSydneyAustralia
| | - Suetonia C Palmer
- University of Otago ChristchurchDepartment of Medicine2 Riccarton AvePO Box 4345ChristchurchNew Zealand8140
| | - Marinella Ruospo
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The University of SydneySydney School of Public HealthSydneyAustralia
| | - Valeria M Saglimbene
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The University of SydneySydney School of Public HealthSydneyAustralia
| | | | - Giovanni FM Strippoli
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The University of SydneySydney School of Public HealthSydneyAustralia
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
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Nilsson BB, Bunæs-Næss H, Edvardsen E, Stenehjem AE. High-intensity interval training in haemodialysis patients: a pilot randomised controlled trial. BMJ Open Sport Exerc Med 2019; 5:e000617. [PMID: 31798950 PMCID: PMC6863672 DOI: 10.1136/bmjsem-2019-000617] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2019] [Indexed: 01/01/2023] Open
Abstract
Objectives Patients with end-stage renal disease (ESRD) undergoing haemodialysis (HD) have significantly reduced cardiorespiratory fitness and health-related quality of life (HRQoL). Our hypothesis was that high-intensity interval training (HIIT) is a feasible and safe form of exercise during HD and that HIIT would elicit greater change in cardiorespiratory fitness and HRQoL compared with moderate-intensity continuous training (MICT). Methods Twenty patients were randomised to either HIIT (n=6), MICT (n=8) (two times a week within 22 weeks) or usual care (n=6). Feasibility was assessed by session attendance and adherence to exercise intensity. Safety was assessed by adverse event reporting. Efficacy was determined from change in peak oxygen uptake (VO2peak), 6 min walk distance and a HRQoL questionnaire (the COOP-WONCA chart). Results Eleven patients (55%) completed premeasurements and postmeasurements. The main reason for drop-out was due to kidney transplant during follow-up. The patients completed the same number of sessions in each group and adhered to the target heart rates after habituation. There were no adverse events. In the HIIT group, two of the three patients increased VO2peak by 46% and 53%, respectively. Three of the five patients in the MICT group increased their VO2peak by 6%, 18% and 36%, respectively. Conclusions This pilot study demonstrated that HIIT is a feasible and safe exercise model for intradialytic exercise in patients undergoing HD. There might be a considerable potential of intradialytic HIIT in patients undergoing HD. Further studies with larger sample sizes are needed to determine if HIIT is an optimal approach in patients with ESRD undergoing HD. Trial registration number NCT01728415.
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Affiliation(s)
- Birgitta Blakstad Nilsson
- Department of Clinical Services, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Heidi Bunæs-Næss
- Department of Clinical Services, Oslo University Hospital, Oslo, Norway
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42
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Hart A, Johansen KL. Cardiovascular protection and mounting evidence for the benefits of intradialytic exercise. Nephrol Dial Transplant 2019; 34:1816-1818. [PMID: 30830221 PMCID: PMC6826164 DOI: 10.1093/ndt/gfz038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
- Allyson Hart
- Division of Nephrology, Hennepin Healthcare System, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Kirsten L Johansen
- Division of Nephrology, Hennepin Healthcare System, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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43
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Abstract
Neuropsychiatric conditions including depression, anxiety disorders, and cognitive impairment are prevalent in patients with chronic kidney disease (CKD). These conditions often make worse the quality of life and also lead to longer hospitalizations and higher mortality. Over the past decades, some hypotheses have tried to explain the connection between CKD and neuropsychiatric disorders. The most common hypothesis is based on the occurrence of cerebrovascular disease and accumulated uremic toxins in adult patients with CKD. However, the lack of a direct association between known vascular risk factors (e.g., diabetes and hypertension) with CKD-related cognitive deficits suggests that other mechanisms may also play a role in the pathophysiology shared by renal and neuropsychiatric diseases. This hypothesis is corroborated by the occurrence of neuropsychiatric comorbidities in pediatric patients with CKD preceding vascular damage, and the inconsistent findings on neuroprotective effects of antihypertensives. The aim of this narrative review was to summarize clinical evidence and potential mechanisms that links CKD and brain disorders, specifically in regard to cognitive impairment, anxiety, and depression.
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Affiliation(s)
| | - Aline Silva Miranda
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, UFMG, Belo Horizonte, Brazil.,Laboratory of Neurobiology, Department of Morphology, Institute of Biological Sciences, UFMG, Houston, Brazil
| | - Natalia Pessoa Rocha
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, UFMG, Belo Horizonte, Brazil.,Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Antônio Lúcio Teixeira
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, UFMG, Belo Horizonte, Brazil.,Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
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Cops J, Haesen S, De Moor B, Mullens W, Hansen D. Exercise intervention in hospitalized heart failure patients, with emphasis on congestion-related complications: a review. Heart Fail Rev 2019; 25:257-268. [DOI: 10.1007/s10741-019-09833-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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45
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Wen X, Wang Y, Zhao Q, Zhang H, Shi H, Wang M, Lu P. Nonpharmacological Interventions for Depressive Symptoms in End-Stage Renal Disease: A Systematic Review. West J Nurs Res 2019; 42:462-473. [PMID: 31248356 DOI: 10.1177/0193945919857540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Depressive symptoms are common in patients with end-stage renal disease, which can affect treatment and prognosis. We aimed to evaluate the effects of nonpharmacological interventions for depressive symptoms in end-stage renal disease. Eligible studies were identified using PubMed, Web of Science, the Cochrane Library, Embase, and PsycNET (up to March 2019). We identified 24 studies including 1,376 patients. We found that psychological intervention (-0.60, 95% confidence interval [CI] = [-0.87, -0.33]), exercise (-1.13, 95% CI = [-1.56, -0.69]), and manual acupressure (-0.26, 95% CI = [-0.50, 0.03]) were associated with a significant effect on depressive symptoms. However, few studies reported adverse events, and conclusions about safety should be drawn cautiously. While the available data show that nonpharmacological interventions are potential strategies to alleviate depressive symptoms of patients with end-stage renal disease, recommendation of the most efficacious interventions for this population will require future randomized controlled trials with large-scale, long-term intervention.
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Affiliation(s)
- Xin Wen
- Jilin University, Changchun, China
| | - Yu Wang
- Jilin University, Changchun, China
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46
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Yamagata K, Hoshino J, Sugiyama H, Hanafusa N, Shibagaki Y, Komatsu Y, Konta T, Fujii N, Kanda E, Sofue T, Ishizuka K, Kitagawa M, Kono K, Hinamoto N, Miyai T, Koike K, Toda S, Hasegawa J, Yamanouchi M, Yoshimura R, Ishii R, Goto S, Kawarazaki H, Takase K, Taki F, Matsumura M, Raita Y, Sakurai S, Shimizu T, Yamanoto S, Kawaguchi T, Oguchi H, Tsujita M, Yazawa M, Uchida A, Ando Y, Kaneko S, Matsunaga A, Harada T, Ito O, Kohzuki M. Clinical practice guideline for renal rehabilitation: systematic reviews and recommendations of exercise therapies in patients with kidney diseases. Ren Replace Ther 2019. [DOI: 10.1186/s41100-019-0209-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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47
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Khan A, Khan AH, Adnan AS, Sulaiman SAS, Mushtaq S. Prevalence and predictors of depression among hemodialysis patients: a prospective follow-up study. BMC Public Health 2019; 19:531. [PMID: 31072378 PMCID: PMC6507067 DOI: 10.1186/s12889-019-6796-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 04/10/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Even though depression is one of the most common psychiatric disorders, it is under-recognized in hemodialysis (HD) patients. Existing literature does not provide enough information on evaluation of predictors of depression among HD patients. The objective of the current study was to determine the prevalence and predictors of depression among HD patients. METHODS A multicenter prospective follow-up study. All eligible confirmed hypertensive HD patients who were consecutively enrolled for treatment at the study sites were included in the current study. HADS questionnaire was used to assess the depression level among study participants. Patients with physical and/or cognitive limitations that prevent them from being able to answer questions were excluded. RESULTS Two hundred twenty patients were judged eligible and completed questionnaire at the baseline visit. Subsequently, 216 and 213 patients completed questionnaire on second and final follow up respectively. The prevalence of depression among patients at baseline, 2nd visit and final visit was 71.3, 78.2 and 84.9% respectively. The results of regression analysis showed that treatment given to patients at non-governmental organizations (NGO's) running HD centers (OR = 0.347, p-value = 0.039) had statistically significant association with prevalence of depression at final visit. CONCLUSIONS Depression was prevalent in the current study participants. Negative association observed between depression and hemodialysis therapy at NGO's running centers signifies patients' satisfaction and better depression management practices at these centers.
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Affiliation(s)
- Amjad Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
- Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Malaysia
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45320 Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
- Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Malaysia
| | - Azreen Syazril Adnan
- Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Malaysia
- Management Science University, University Drive, Off Persiaran Olahraga, Section 13, 40100 Shah Alam, Selangor Malaysia
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - Saima Mushtaq
- Health Care Biotechnology Department, Atta ur Rahman School of Applied Biosciences, National University of Science & Technology, Islamabad, 44000 Pakistan
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48
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Bohm C, Schick-Makaroff K, MacRae JM, Tan M, Thompson S. The role of exercise in improving patient-reported outcomes in individuals on dialysis: A scoping review. Semin Dial 2019; 32:336-350. [PMID: 31006928 DOI: 10.1111/sdi.12806] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Exercise improves objective measures of physical function in individuals on hemodialysis, but its effect on patient-reported outcomes (PROs) is largely unknown. We performed a scoping review to characterize the existing knowledge base on exercise and PROs in dialysis patients to make recommendations for future research. We searched Medline, Embase, Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials, CINAHL, and SPORT Discus from inception to November 28, 2018 and then screened results for randomized controlled trials comparing aerobic/resistance exercise, or both, with no exercise in individuals on dialysis that reported results of any PRO. Of 1374 eligible studies, 25 studies met inclusion criteria. Study interventions included aerobic exercise (11 intradialytic and 3 home-based trials); intradialytic resistance exercise (seven studies) and combined aerobic and resistance exercise (six intradialytic and one facility-based trial). The PROs measured included health-related quality of life (n = 19), depression (n = 6), anxiety (n = 3), symptom burden (n = 4), sleep quality (n = 2), restless legs syndrome (n = 2), disability (n = 2), and self-reported physical activity level (n = 4). Only five studies included a PRO as a primary outcome. Studies primarily used broad/generic measures of health-related quality of life and the effect of exercise on symptoms remains relatively unexplored, particularly in peritoneal dialysis populations. Although limited, the role of exercise in improving restless legs was consistent and is a promising outcome for future study. A critical step to improving the quality of the research on this topic includes the use of validated and consistent PRO measures.
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Affiliation(s)
- Clara Bohm
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Jennifer M MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maria Tan
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
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49
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Sy J, McCulloch CE, Johansen KL. Depressive symptoms, frailty, and mortality among dialysis patients. Hemodial Int 2019; 23:239-246. [PMID: 30821900 DOI: 10.1111/hdi.12747] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/02/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Frailty and depression are highly prevalent in the dialysis population, but the association between them, the risk factors for their development, and their independent associations with mortality have not been studied. METHODS We examined 771 patients enrolled in the ACTIVE/ADIPOSE prevalent dialysis cohort study. Fried's frailty phenotype and the Center for Epidemiologic Studies Depression score were used to determine frailty and presence of depressive symptoms, respectively. We assessed the baseline association between frailty and depressive symptoms, whether one entity is a risk factor for development of the other, and associations between frailty and depressive symptoms with mortality. FINDINGS At baseline, 13.1% of our population screened positive for depressive symptoms, 21.8% met criteria for frailty, and 10.0% met criteria for both. During follow-up, 26.6% of our population developed frailty and 12.7% developed depressive symptoms. Using multivariable logistic regression, baseline depressive symptoms were associated with 2.14-fold higher odds of being frail at baseline (95% confidence interval [CI] 1.45-3.17) and with a 2.16-fold higher odds of incident frailty during follow-up (95% CI 1.22-3.82). However, baseline frailty was not associated with incident depressive symptoms. Frailty and depressive symptoms were independent predictors of mortality in time-varying survival analysis (meeting frailty criteria: hazard ratio [HR] 1.53, 95% CI 1.05-2.23; depressive symptoms: HR 2.21, 95% CI 1.50-3.25). DISCUSSION Frailty and depressive symptoms remained highly prevalent over time and were strongly associated with one another and independently associated with mortality among dialysis patients. Future studies should investigate whether interventions for depression could potentially mitigate the appearance of frailty and its associated poor outcomes.
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Affiliation(s)
- John Sy
- Division of Nephrology, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Kirsten L Johansen
- Division of Nephrology, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA.,Division of Nephrology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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50
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Cardoso RK, Araujo AM, Orcy RB, Bohlke M, Oses JP, Del Vecchio FB, Barcellos FC, Gonzalez MC, Rombaldi AJ. Effects of continuous moderate exercise with partial blood flow restriction during hemodialysis: A protocol for a randomized clinical trial. MethodsX 2019; 6:190-198. [PMID: 30740314 PMCID: PMC6357543 DOI: 10.1016/j.mex.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/20/2019] [Indexed: 12/31/2022] Open
Abstract
Chronic kidney disease (CKD) is associated with physical weakness and increased oxidative stress and inflammation levels. Rehabilitation programs are associated with an improvement in the functional capacity, inflammatory and oxidative stress profile. Exercise associated with blood flow restriction (BFR) has been demonstrating positive effects in training programs, but there is lack information about exercise with BFR in CKD. Therefore, the aim of the present study is to describe a protocol using continuous moderate exercise with blood flow restriction (BFR) applied during hemodialysis (HD) to measures health indicators and immune system and oxidative stress parameters in CKD patients. Methods: A RTC will be conducted with 42 patients in HD. Baseline measures will be compared with final measures (anthropometric, cardiorespiratory, biochemical, muscle fitness, nutritional and behavioral questions). Participants will be randomly allocated to: 1) Continuous moderate exercise group with BFR; 2) Continuous moderate exercise group without BFR; 3) Control group without exercise. The intervention will be 12 weeks long during HD session. Patients will perform 20 min of continuous moderate exercise on a stationary bicycle three times a week. The present study is expected to generate significant information about the role of exercise with BFR in patients with CKD during HD.
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Affiliation(s)
- Rodrigo Kohn Cardoso
- Post-Graduate Program of Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Aline Machado Araujo
- Post-Graduate Program of Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Rafael Bueno Orcy
- Department of Physiology and Pharmacology, Federal University of Pelotas, Pelotas, RS, Brazil
- Corresponding author.
| | - Maristela Bohlke
- Dialysis and Renal Transplantation Unit, São Francisco de Paula University Hospital, Catholic University of Pelotas, Pelotas, RS, Brazil
- Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Jean Pierre Oses
- Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | | | - Franklin Correa Barcellos
- Dialysis and Renal Transplantation Unit, São Francisco de Paula University Hospital, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Maria Cristina Gonzalez
- Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Airton José Rombaldi
- Post-Graduate Program of Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil
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