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Valera S, Diz JC, Rey-Fernández B, González-Devesa D, García-Fresneda A, Ayán C. Efficacy of physical exercise on sleep quality in patients with chronic kidney disease: a systematic review and meta-analysis. Sleep Breath 2024; 28:381-392. [PMID: 37566185 DOI: 10.1007/s11325-023-02891-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND AND OBJECTIVE To revise and critically summarize the available scientific evidence regarding the effect of exercise on sleep quality in patients with chronic kidney disease (CKD). METHODS A systematic review of randomized controlled trials (RCTs) and comparative studies was conducted, searching MEDLINE/PubMed, SPORTDiscus, and Scopus using keywords "Exercise", "Physical Activity", "Chronic Kidney Disease," and "Sleep". The methodological quality of included studies was assessed using the PEDRo and MINORS scales. RESULTS A total of 8 RCTs and 3 comparative studies were included, showing a low (n = 1), fair (n = 7), and good (n = 3) methodological quality. Most of the studies included patients undergoing hemodialysis (HD) (n = 8). Self-reported sleep quality (n = 9), sleepiness (n = 2), and objective sleep status (n = 2) were the main outcomes analyzed. The most frequent exercise interventions included aerobic training (n = 7), resistance training (n = 2), or a combination of both (n = 4). Generally, exercise induced positive effects on the reported outcomes. Data synthesis indicated that participants who exercised obtained significant improvements on their self-reported sleep quality in comparison with those included in the control groups, with a mean difference in the Pittsburgh Sleep Quality Index of - 5.27 points (95% CI - 7.76, - 2.77; p < 0.001). CONCLUSION Preliminary scientific evidence indicates that patients with CKD, especially those undergoing HD, report improvements in self-reported sleep quality after taking part in aerobic exercise programs, while combined training interventions yielded diverse findings. The effects of exercise on sleepiness and objective sleep status were backed by few studies with mixed results.
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Affiliation(s)
- Silvia Valera
- Departamento de Didácticas Especiais, Universidade de Vigo, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Pontevedra, Spain
| | - José Carlos Diz
- Departamento de Didácticas Especiais, Universidade de Vigo, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Pontevedra, Spain
| | - Belén Rey-Fernández
- Facultad de Ciencias de La Educación Y El Deporte, Universidade de Vigo, Pontevedra, Spain
| | - Daniel González-Devesa
- Facultad de Ciencias de La Educación Y El Deporte, Universidade de Vigo, Pontevedra, Spain
| | - Adrián García-Fresneda
- Tecnologia Aplicada a l'Alt Rendiment i la Salut (TAARS), Tecnocampus, Department of Health Sciences, Pompeu Fabra University, Carrer d'Ernest Lluch, 32, 08302, Mataró, Spain.
| | - Carlos Ayán
- Departamento de Didácticas Especiais, Universidade de Vigo, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Pontevedra, Spain
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Andrade FP, Borba CF, Ribeiro HS, Rovedder PME. Cardiorespiratory fitness and mortality risk in patients receiving hemodialysis: a prospective cohort. J Bras Nefrol 2024; 46:39-46. [PMID: 37497828 PMCID: PMC10962417 DOI: 10.1590/2175-8239-jbn-2022-0124en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 05/12/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Kidney failure reduces life expectancy by one-third compared with the general population, and cardiovascular complications and poor cardiorespiratory fitness (CRF) are the main causes. We aimed to evaluate the association between severely low CRF and all-cause mortality risk in HD patients. METHODS This observational prospective cohort study followed-up patients receiving HD from August 2015 until March 2022. Cardiorespiratory fitness was evaluated through the cardiopulmonary exercise test, and the peak oxygen uptake (VO2peak) value was used to determine severely low CRF (< 15 mL∙kg-1∙min-1). Cox regression and univariate Kaplan-Meier analysis were used to evaluate the association of severely low CRF with mortality risk and survival rate. RESULTS Forty-eight patients were followed-up for a median of 33.0 [14.3 - 49.3] months. A total of 26 patients had severely low CRF. During the follow-up period, 11 patients (22.92%) died from all causes. From these, eight (30.8%) had severely low CRF. Even so, severely low CRF was not associated with crude death rates for patients stratified by CRF levels (p = 0.189), neither in unadjusted (HR 2.18; CI 95% 0.58-8.23) nor in adjusted (HR 1.32; CI 95% 0.31-5.59) Cox proportional hazard models. As a continuous variable, VO2peak was not associated with mortality risk (HR 1.01; CI 95% 0.84-1.21). Univariate Kaplan-Meier analysis showed that patients with severely low CRF did not have significantly worse survival rates than those with mild-moderate CRF (p = 0.186). CONCLUSION Our findings indicated that severely low CRF was not associated with all-cause mortality in patients on HD. Despite severely low CRF being prevalent, larger cohort studies are needed to establish strong conclusions on its association with all-cause mortality.
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Affiliation(s)
- Francini Porcher Andrade
- Universidade Federal do Rio Grande do Sul, Ciências Pneumológicas
Post-Graduation Program, Porto Alegre, RS, Brazil
| | - Carolina Ferraro Borba
- Universidade Federal do Rio Grande do Sul, Escola de Fisioterapia,
Porto Alegre, RS, Brazil
| | | | - Paula Maria Eidt Rovedder
- Universidade Federal do Rio Grande do Sul, Ciências Pneumológicas
Post-Graduation Program, Porto Alegre, RS, Brazil
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Battaglia Y, Amicone M, Mantovani A, Combe C, Mitra S, Basile C. Home-based exercise in patients on maintenance dialysis: a systematic review and meta-analysis of randomized clinical trials. Nephrol Dial Transplant 2023; 38:2550-2561. [PMID: 37202219 DOI: 10.1093/ndt/gfad102] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The impact of home-based exercise on physical performance and quality of life (QoL) in patients on maintenance dialysis has not yet been fully established. METHODS We searched four large electronic databases to identify randomized controlled trials (RCTs) reporting the impact of home-based exercise interventions vs. usual care or intradialytic exercise interventions, on physical performance and QoL in patients on dialysis. The meta-analysis was performed using fixed effects modeling. RESULTS We included 12 unique RCTs involving 791 patients of various ages on maintenance dialysis. Home-based exercise interventions were associated with an improvement of walking speed at the 6 Minutes Walking Test [6MWT; nine RCTs; pooled weighted mean differences (WMD): 33.7 m, 95% confidence interval (CI) 22.8-44.5; P < 0.001; I2 = 0%) and in aerobic capacity as assessed by the peak oxygen consumption (VO2 peak; 3 RCTs; pooled WMD: 2.04 ml/kg/min, 95% CI 0.25-3.83; P = 0.03; I2 = 0%). They were also associated with improved QoL, as assessed by the Short Form (36) Health (SF-36) score. Stratifying the RCTs by control groups, no significant difference was found between home-based exercise and intradialytic exercise interventions. Funnel plots did not reveal any significant publication bias. CONCLUSIONS Our systematic review and meta-analysis showed that home-based exercise interventions for 3-6 months were associated with significant improvements in physical performance in patients on maintenance dialysis. However, further RCTs with a longer follow-up should be conducted to assess the safety, adherence, feasibility, and effects on QoL of home-based exercise programs in dialysis patients.
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Affiliation(s)
- Yuri Battaglia
- University of Verona, Department of Medicine, Verona, Italy
- Pederzoli Hospital, Nephrology and Dialysis Unit, Peschiera del Garda, Italy
| | - Maria Amicone
- Department of Public Health, Chair of Nephrology, University of Naples Federico II, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Christian Combe
- Department of Nephrology, CHU de Bordeaux and INSERM U1026, University of Bordeaux, Bordeaux, France
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre (MAHSC), University Hospitals, Oxford Road, Manchester, UK
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
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Zhang H, Wang H, Huang L, Bai Y, Zhang F. Interventions to increase physical activity level in patients with whole spectrum chronic kidney disease: a systematic review and meta-analysis. Ren Fail 2023; 45:2255677. [PMID: 37724555 PMCID: PMC10512821 DOI: 10.1080/0886022x.2023.2255677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
Background: Little is known about effective interventions to increase physical activity levels in this population. This systematic review and meta-analysis evaluated the effectiveness of different interventions for physical activity levels in whole-spectrum CKD patients.Methods: In this systematic review and meta-analysis, PubMed, Embase, and Web of Science were searched from inception to December 2022, with an update in March 2023. Studies of clinical interventions based on assessing physical activity outcomes (e.g., daily steps, time spent doing physical activity) in patients with whole-spectrum CKD were included. The pooled effect size was calculated using a restricted maximum likelihood method and reported as a standardized mean difference (SMD) with 95% confidence interval (95% CI).Results: The systematic review included 2,156 participants (59.9 ± 8.7 years) from 35 studies. Interventions aimed at modifying physical activity were associated with significantly higher physical activity levels in patients with CKD (SMD = 0.22; 95% CI: 0.08 to 0.36; I2 = 55%). Exercise-based interventions and real-time step feedback increased physical activity by 0.26 (95% CI: 0.07 to 0.45; I2 = 59%) and 0.36 (95% CI: 0.12 to 0.60; I2 = 0%) standard deviations, respectively. Effect sizes did not vary by disease stage or study duration; however, there was evidence of small study or publication bias for the primary analysis.Conclusion: In this systematic review and meta-analysis, intervention strategies aimed at modifying physical activity were associated with significantly increased physical activity levels in patients with whole-spectrum CKD.
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Affiliation(s)
- Huachun Zhang
- Department of Nursing, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Hui Wang
- Department of Anorectology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Liuyan Huang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Yan Bai
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Fan Zhang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
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Martínez-Majolero V, Urosa B, Hernández-Sánchez S, Arroyo D. The Moderating Role of Health Variables on the Association between Physical Exercise and Quality of Life in Patients with End-Stage Renal Disease. Healthcare (Basel) 2023; 11:2148. [PMID: 37570388 PMCID: PMC10419082 DOI: 10.3390/healthcare11152148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Scientific evidence demonstrates the positive impact that physical exercise has on the quality of life (QOL) of patients with chronic kidney disease (CKD). However, no study has proposed a model investigating the effect physical exercise has on the QOL of end-stage renal disease (ESRD) patients, considering the most frequent associated diseases (diabetes/hypertension). The objectives were (1) to explore the relationship between physical exercise and the QOL of adults with ESRD, and (2) to examine the moderating and/or mediating role of relevant patient variables. This non-interventional study utilized an ex post facto retrospective data analysis design with a sample of 310 patients with ESRD through two validated questionnaires. The dependent variables were the QOL scale (KDQOL-SF), and the physical function dimension (EFFISICA). The independent variables were the regular practice of intense physical activity (DEPINTE) and the daily time (in hours) the patient is in a sedentary attitude (TiParado). The moderating variables were the clinical situation and associated diseases. The mediator variable used was the body mass index. Bivariate and multiple regression analyses were conducted. Findings suggest implementing intense physical activity in transplant recipients and programmes to avoid sedentary lifestyles in dialysis patients have a positive effect in the QOL of ESRD patients.
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Affiliation(s)
| | - Belén Urosa
- Faculty of Human and Social Sciences, Universidad Pontificia Comillas, 28049 Madrid, Spain;
| | | | - David Arroyo
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
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Ribeiro HS, Andrade FP, Leal DV, Oliveira JS, Wilund KR, Viana JL. How is exercise being prescribed for patients on hemodialysis? A scoping review. J Nephrol 2023; 36:1307-1319. [PMID: 36418777 DOI: 10.1007/s40620-022-01513-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/22/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Exercise is important for patients on hemodialysis, but details and descriptions on how it is prescribed are lacking. We reviewed the existing literature and described how exercise is being prescribed for patients on hemodialysis. METHODS A scoping review according to the JBI and PRISMA-ScR guidelines was conducted. MEDLINE, EMBASE and other databases were searched from inception until December 2021. Websites, books, and guidelines were also searched. We included evidence from patients on hemodialysis, describing exercise protocols, in all settings and designs. RESULTS Two hundred and eighty-five studies were included, yielding 327 exercise protocols. Aerobic (38.8%) and strength (21.4%) were the most prescribed exercise types. Exercise was mainly prescribed during dialysis (71.0%) and delivered within the first half of the session (94.6%). Although 33.3% of the exercise protocols did not report whether there was supervision or not, those that did were mostly delivered by physiotherapists (20.5%) and exercise physiologists (17.4%). The most followed exercise training principles were type (99.0%) and frequency (93.2%), whereas progression was adopted in 40.7% protocols. The most prescribed frequency and duration were three times/week (79.9%) and 30-60-min (69.2%) sessions, respectively. Exercise intensity was predominantly prescribed in moderate cut-offs (72.3%), mostly assessed by subjective methods (47.5%). CONCLUSIONS Aerobic and strength were the most prescribed exercise types, mainly during dialysis. Interventions were mostly supervised by physiotherapists and exercise physiologists. Future exercise protocols for patients on hemodialysis should adopt recommended exercise principles, especially with systematic progression.
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Affiliation(s)
- Heitor S Ribeiro
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, Maia, Portugal
- Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - Francini P Andrade
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, Maia, Portugal
- Ciências Pneumológicas Post-Graduation Program, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
| | - Diogo V Leal
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, Maia, Portugal
| | - Juliana S Oliveira
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Kenneth R Wilund
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, USA
| | - João L Viana
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, Maia, Portugal.
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Huang HH, Stubbs B, Chen LJ, Ku PW, Hsu TY, Lin CW, Weng YM, Wu SH. The effect of physical activity on sleep disturbance in various populations: a scoping review of randomized clinical trials. Int J Behav Nutr Phys Act 2023; 20:44. [PMID: 37069626 PMCID: PMC10107572 DOI: 10.1186/s12966-023-01449-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/04/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Promoting physical activity (PA) in different populations experiencing sleep disturbance may increase population PA levels and improve sleep. This scoping review aimed to examine the effect of various PA intervention strategies on sleep across different populations, identify key sleep outcomes, and analyze knowledge gaps by mapping the relevant literature. METHODS For this study, we systematically searched articles published till March 2022 from PubMed, Web of Science, Cochrane Library, and Embase databases for randomized clinical trials (RCTs) regarding the effect of physical activity on sleep. Two authors extracted key data and descriptively analyzed the data. Thematic analysis was used to categorize the results into themes by all authors. Arksey and O'Malley's scoping review framework was used to present the findings. RESULTS Twenty-one randomized controlled trials out of 3052 studies were finally included with 3677 participants (2852 females (78%)). Five trials were conducted in healthy working-age adults with sleep disturbance but without the diagnosis of insomnia, five in healthy older adults, two in perinatal women, four in patients with cancer, three in mental illness related subjects, and another two in other disease-related areas. PA interventions were diverse, including walking, resistance training, aerobic exercise, housework, water exercise, basketball, smartphone/tablet "apps", web, online videos or wearable actigraphy, and self-determined exercise. Three major themes were identified: (1) Sleep environment may be important to address prior to instituting PA interventions, (2) All types of PA were effective for improving sleep in all populations studied, (3) Self-tolerated PA is safe for improving sleep in the elderly and in co-morbid or perinatal populations. CONCLUSIONS PA is effective and safe for improving sleep in both healthy and co-morbid populations with sleep disturbance by increasing daily activity levels using a variety of strategies, even low intensity, such as housekeeping, sit-to-stand repetitions, along with encouraging PA through web pages, videos, and self-goal setting apps. In addition, this scoping review identifies the need for further therapeutic research and future exploration in populations with sleep initiation or sleep maintenance disturbance.
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Affiliation(s)
- Hung-Hsin Huang
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, Box, UK
| | - Li-Jung Chen
- Department of Exercise Health Science, National Taiwan University of Sport, 271, Lixing Road, Taichung City, 404, Taiwan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Po-Wen Ku
- Graduate Institute of Sports and Health Management, National Chung Hsing University, 145 Xingda Rd., South Dist, Taichung City, 402, Taiwan
- Department of Kinesiology, National Tsing Hua University, Hsinchu, 300, Taiwan
| | - Tai-Yi Hsu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Wei Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- Doctoral Degree Program in Artificial Intelligence, Asia University, Taichung, Taiwan
| | - Yi-Ming Weng
- Emergency department of Taoyuan General Hospital, MOHW, Taoyuan, Taiwan
| | - Shih-Hao Wu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan.
- Department of Exercise Health Science, National Taiwan University of Sport, 271, Lixing Road, Taichung City, 404, Taiwan.
- Attending Physician of Emergency Department, China Medical University Hospital, Taichung, 404, Taiwan.
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Tang X, Wang L, Ni S, Wu M, Hu S, Zhang L. Feasibility and effect of emotional freedom therapy on sleep quality in patients with end-stage renal disease receiving maintenance hemodialysis: A pilot study. Geriatr Nurs 2023; 51:112-120. [PMID: 36940505 DOI: 10.1016/j.gerinurse.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/22/2023]
Abstract
OBJECTIVE To explore the feasibility and efficacy of emotional freedom therapy (EFT) in improving sleep quality and managing negative emotions in end-stage renal disease patients on maintenance hemodialysis. METHODS Between May 2021 and February 2022, 66 maintenance hemodialysis patients with sleep problems were recruited and randomized into an intervention and control group. The intervention group underwent a 12-week intervention of EFT. Two groups' hospital anxiety depression scale (HADS) scores, Pittsburgh sleep quality index (PSQI), and interdialysis weight gain (IDWG) before and one week after the formal intervention were collected and compared. Feasibility analysis was performed using a feasibility questionnaire and in-depth interviews with patients. RESULTS Before the intervention, there was no statistical difference in the anxiety, depression, PSQI scores and IDWG between the two groups. After balancing the effects of gender and pre-intervention scores, two-way ANCOVA results showed that there were statistically significant differences between the two groups after the intervention in terms of anxiety, depression, sleep quality, sleep duration, daytime dysfunction and PSQI total score. However, interactions effect for IDWG was statistically significant. Simple effects analysis revealed a difference in post-intervention IDWG between the intervention and control groups for patients over 65 (p < 0.05). Most patients agreed or strongly agreed that the EFT was easy to schedule and they did not experience difficulties during learning the EFT process (respectively 75% and 71.88%). And 75% of the participants were willing to continue practicing EFT. Qualitative content analysis identified five prominent categories related to feasibility and acceptability: affirmation, benefits, communication, support and trust. CONCLUSION EFT can relieve anxiety and depression, enhance sleep quality, and improve the physical condition of patients with end-stage renal disease receiving maintenance hemodialysis. As well, the EFT intervention is practicable, acceptable, and perceived as being beneficial to the patient.
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Affiliation(s)
- Xin Tang
- Department of Nursing, Medical College of Hunan Normal University, Changsha 410013, PR China; Hemodialysis Center, Lukou District Hospital of Traditional Chinese Medicine, Zhuzhou, Hunan 412000, PR China
| | - Li Wang
- Department of Nursing, Medical College of Hunan Normal University, Changsha 410013, PR China
| | - Siyao Ni
- Department of Nursing, Medical College of Hunan Normal University, Changsha 410013, PR China
| | - Mengyu Wu
- Department of Nursing, Medical College of Hunan Normal University, Changsha 410013, PR China
| | - Shengnan Hu
- Department of Nursing, Medical College of Hunan Normal University, Changsha 410013, PR China
| | - Liuyi Zhang
- Department of Nursing, Medical College of Hunan Normal University, Changsha 410013, PR China.
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Zhou L, Shi D, Zhang L, Wang Q, Chen L, Chen H. Does Intradialytic Group Exercise Programme Influence Patient-Reported Outcomes, Laboratory Parameters, and Anthropometric Parameters in Maintenance Hemodialysis Patients? A Single-Group Repeated-Measures Trial. Patient Prefer Adherence 2023; 17:491-501. [PMID: 36852381 PMCID: PMC9962523 DOI: 10.2147/ppa.s400005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/10/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Maintenance hemodialysis(MHD) patients often suffer from fatigue and are recommended to undertake physical activities. The optimal format of exercise rehabilitation for MHD patients remains uncertain despite demonstrated health benefits. This study aimed to evaluate the effectiveness of an intradialytic group exercise programme for MHD patients. METHODS This was a single-centre, single-group repeated-measures design study. The 12-week, three times per-week intradialytic group exercise programme was conducted for around 30 min during the first 2 hours of each dialysis session. Patient-reported outcomes including fatigue, anxiety, depression and health-related quality of life, laboratory parameters including haemoglobin, albumin, pre-albumin and hypersensitive C-reactive protein, and anthropometric parameters including triceps skinfold thickness, mid-upper arm circumference, mid-arm muscle circumference and handgrip strength, were measured at baseline, immediately post-intervention and 12-weeks post-intervention. The repeated-measures analysis of variance and Friedman test were used to compare the parametric and non-parametric data across time points, respectively. RESULTS Ninety patients were enrolled and 75 completed. Participants reported significant improvements across time points in fatigue (F = 10.19, p < 0.01), depression (F = 19.20, p < 0.001), health-related quality of life (F = 5.36, p = 0.006), haemoglobin (F = 3.43, p = 0.047), albumin (F = 4.42, p = 0.032), hypersensitive C-reactive protein (χ 2 = 50.39, p < 0.001), pre-albumin (χ 2 = 11.85, p = 0.003), triceps skinfold thickness (F = 25.03, p < 0.001), mid-upper arm circumference (F = 6.32, p = 0.005), mid-arm muscle circumference (F = 4.89, p = 0.02), and handgrip strength (F = 13.59, p < 0.001). Although the mean anxiety score tended to reduce, the difference across time points was nonsignificant (F = 1.33, p = 0.27). CONCLUSION The findings suggested that the intradialytic group exercise programme could improve MHD patients' fatigue, depression, health-related quality of life, nutritional status, and inflammation. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000034394 (04/07/2020).
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Affiliation(s)
- Lijuan Zhou
- Medical School, Nantong University, Nantong, People’s Republic of China
- Nursing Department, Taizhou People’s Hospital, Taizhou, People’s Republic of China
| | - Dan Shi
- Nursing Department, Taizhou People’s Hospital, Taizhou, People’s Republic of China
| | - Liyuan Zhang
- Nursing Department, Taizhou People’s Hospital, Taizhou, People’s Republic of China
| | - Qian Wang
- Nursing Department, Taizhou People’s Hospital, Taizhou, People’s Republic of China
| | - Li Chen
- Nursing Department, Taizhou People’s Hospital, Taizhou, People’s Republic of China
| | - Honglin Chen
- School of Public Health, Nantong University, Nantong, People’s Republic of China
- Correspondence: Honglin Chen, Email
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Zhang F, Wang H, Huang L, Bai Y, Wang W, Zhang H. Effect of exercise interventions for sleep quality in patients with chronic kidney disease: a systematic review and meta-analysis. Int Urol Nephrol 2022; 55:1193-1204. [PMID: 36401765 DOI: 10.1007/s11255-022-03413-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Sleep disorder is a common and unpleasant symptom in patients with chronic kidney disease (CKD), bringing a heavy burden on the patients and families. As a non-pharmacological therapy, exercise interventions are widely recommended for CKD patients. However, whether exercise can improve overall sleep quality in such a population remains ambiguous. The systematic review and meta-analysis aimed to evaluate the effect of exercise interventions on sleep quality in CKD patients. METHODS PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched from inception to April 22, 2022. A randomized controlled trial (RCT) added an exercise intervention to conventional treatment/usual care to assess the effect on sleep quality in CKD patients. Two authors independently selected literature, extracted data, assessed the risk of bias using the Cochrane risk of bias tool 2, and assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation. The outcome was analyzed using a random-effect model using the Hartung-Knapp-Sidik-Jonkman method as a standardized mean difference (SMD). Additional statistical analysis includes the Egger regression test, subgroup analysis, sensitivity analysis, and meta-regression. RESULTS Nineteen articles (20 RCTs) enrolling 989 patients with CKD were included. The pooled SMD suggested favorably associated exercise interventions (SMD - 0.16; 95% CI - 0.62 to 0.31; very low evidence) with substantial heterogeneity (I2 = 87%). Subgroup analyses demonstrated that SMD for sleep quality favored moderate intensity and aerobic exercise, no matter the time, but not statistically significant. Meta-regression showed that the effect size of exercise interventions on sleep quality was not associated with the total sample size, the proportion of males, duration of intervention, mean age, and exercise volume but was associated with baseline sleep scores. In addition, there may be an exercise threshold for the effect of exercise on sleep in CKD patients (i.e., 80 min/week). CONCLUSION This systematic review and meta-analysis suggest that exercise interventions may be associated with improved sleep quality in patients with CKD. However, high heterogeneity and a small effect size limit this result. More studies and standardized reporting of exercise intervention characteristics should be conducted in the future to strengthen the most convincing evidence in this field.
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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 CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00258-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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12
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Seng AWP, Tham SL. Palliative rehabilitation in end-stage renal failure. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00442-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
In end-stage chronic kidney disease (CKD), patients experience disabilities stemming from organ failure. These can be worsened by symptoms and complications of underlying cause(s), and the conditions associated with the CKD. There is a dearth of literature regarding palliative rehabilitation in end-stage CKD. Our case highlights the complex medical and rehabilitative issues that such patients face.
Case presentation
A 64-year-old male had end-stage CKD and declined dialysis. After sustaining a myocardial infarction, he suffered a posterior circulation stroke the following month. Whilst undergoing stroke rehabilitation, his progress was further hampered by symptoms of kidney failure. The patient underwent interdisciplinary rehabilitation for 29 days. Goal-setting was performed with the patient and family to allow contextualization to the patient’s stage of disease, beliefs and environment. Care-giver training was provided to facilitate discharge back home. He demonstrated improvements in physical endurance and function. His Functional Independence Measure score improved from 51 to 82. He outlived his prognosis of 3–6 months and demised 15 months after discharge.
Conclusions
In end-stage CKD without renal replacement therapy, rehabilitation and palliative care efforts align to enhance quality of life, in the face of unlikely cure. While palliative care provides symptom management and supportive care, rehabilitation safeguards physical endurance and ability. It is in the hope of doing so, independence and thence, self-esteem, can be maintained. Future research should explore the benefits of palliative rehabilitation in renal failure.
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Hotta K, Muller-Delp J. Microvascular Adaptations to Muscle Stretch: Findings From Animals and the Elderly. Front Physiol 2022; 13:939459. [PMID: 35860661 PMCID: PMC9289226 DOI: 10.3389/fphys.2022.939459] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Microcirculation in skeletal muscle is disturbed with advancing aging, causing limited capillary blood flow and exercise incapacity. Muscle stretch has been widely performed in physical therapy, sports medicine, and health promotion. However, the effect of stretch on microvascular reactivity and muscle blood flow remains unknown. This review focuses on stretch-induced microvascular adaptations based on evidence from cultured cells, small animals, and human studies. Vascular endothelium senses and responds to mechanical stimuli including stretch. This endothelial mechanotransduction potentially plays a vital role in the stretch-induced microvascular adaptation alongside hypoxia. Aging impairs microvascular endothelial function, but muscle stretch has the potential to restore it. Muscle stretch may be an alternative to improve vascular function and enhance exercising blood flow, especially for those who have difficulties in participating in exercise due to medical, functional, or psychological reasons.
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Affiliation(s)
- Kazuki Hotta
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
- *Correspondence: Kazuki Hotta,
| | - Judy Muller-Delp
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL, United States
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Using the Intelligent System to Improve the Delivered Adequacy of Dialysis by Preventing Intradialytic Complications. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8160269. [PMID: 35783584 PMCID: PMC9246598 DOI: 10.1155/2022/8160269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/30/2022] [Accepted: 05/26/2022] [Indexed: 01/26/2023]
Abstract
Acute kidney failure patients while detoxificated by hemodialysis (HD) mostly or continuously faced regular problems such as low blood pressure (hypotension), muscle cramps, nausea, or vomiting. Higher intradialytic symptom leads to low-quality HD treatment. Although more known therapeutic interventions are used to relieve the HD side effects, this study was designed to investigate how intelligent systems can make highly beneficial alterations in dialysis facilities and equipment to ease intradialytic complications and help the staff deliver high-quality treatment. A search was performed among relevant research articles based on nonpharmacological intervention methods considered to prevent adverse effects of renal replacement therapy until 2020 in the PubMed databases using the terms “intradialytic complications,” “intradialytic complication interventions,” “nonpharmacological interventions,” “intradialytic exercises,” and “adequacy calculation methods.” Studies included the prevalence of intradialytic complications, different strategies with the aim of preventing complications, the outcome of intradialytic exercises on dialysis symptoms, and dialysis dose calculation methods. The results showed the incidence of hypotension varying between 5% and 30%, fatigue, muscular cramps, and vomiting as the most common complications during dialysis, which greatly affect the outcome of HD sessions. To prevent hypotension, ultrafiltration profiling, sodium modeling, low dialysate temperature, and changing the position to Trendelenburg are some strategies. Urea reduction ratio (URR), formal urea kinetic modeling (FUKM), formal single-pool urea kinetics, and online clearance monitoring (OCM) are methods for calculating the delivered dose of dialysis in which OCM is a low-cost and accessible way to monitor regularly the quality of dialysis delivered. Integration of the chair and HD machine which is in direct contact with the patient provides an intelligent system that improves the management of the dialysis session to enhance the quality of healthcare service.
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Ribeiro HS, Cunha VA, Dourado GÍ, Duarte MP, Almeida LS, Baião VM, Inda-Filho AJ, Viana JL, Nóbrega OT, Ferreira AP. Implementing a resistance training programme for patients on short daily haemodialysis: A feasibility study. J Ren Care 2022; 49:125-133. [PMID: 35526118 DOI: 10.1111/jorc.12423] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 03/20/2022] [Accepted: 04/02/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Kidney failure patients receiving haemodialysis experience protein-energy wasting, muscle mass loss and physical function impairment. Intradialytic exercise interventions seem to modify these features, but they are often not implemented as a clinical routine. OBJECTIVE To investigate the feasibility of implementing a supervised intradialytic resistance training programme as a clinical routine for patients receiving short daily haemodialysis. DESIGN A prospective longitudinal study. PARTICIPANTS Eighteen patients in a supervised intradialytic resistance training programme for 8 months. MEASUREMENTS It consisted of a warm-up, lower- and upper-limb resistance exercises and a cool-down. Patients performed the resistance training during the first half of haemodialysis, twice a week, supervised by exercise physiologists and physiotherapists. The feasibility was assessed by the total and partial adherences, the reasons for refusing or for not exercising and the intradialytic complications. RESULTS From a total of 953 potential exercise sessions, 759 were performed, with a 79.6% adherence rate. In the first 9 weeks, the adherence rate was 86.6% and the lowest rate was in the 19-27 weeks (73.5%). The main intradialytic complication during exercise sessions was hypotension (n = 31; 4.1%). The highest number of complications was reported during the first 9 weeks (n = 27; 9.1%). The main reasons for refusing or for not performing the intradialytic exercise sessions were clinical complications previous to exercise time (n = 63; 32.5%) and self-reported indisposition (n = 62; 32.0%). CONCLUSIONS The intradialytic resistance training programme, supervised by exercise physiologists and physiotherapists, had very low complications, achieved a high long-term adherence rate and showed to be feasible as a clinical routine for patients receiving short daily haemodialysis.
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Affiliation(s)
- Heitor S Ribeiro
- Faculty of Physical Education, University of Brasília, Brasília, Brazil.,Interdisciplinary Research Department, University Centre ICESP, Brasília, Brazil.,Research Centre in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, Maia, Portugal
| | - Vinícius A Cunha
- Faculty of Health Science, University of Brasília, Brasília, Brazil
| | | | - Marvery P Duarte
- Faculty of Physical Education, University of Brasília, Brasília, Brazil.,Faculty of Health Science, University of Brasília, Brasília, Brazil
| | - Lucas S Almeida
- Faculty of Physical Education, University of Brasília, Brasília, Brazil
| | - Victor M Baião
- Faculty of Health Science, University of Brasília, Brasília, Brazil
| | - Antônio J Inda-Filho
- Interdisciplinary Research Department, University Centre ICESP, Brasília, Brazil
| | - João L Viana
- Research Centre in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, Maia, Portugal
| | - Otávio T Nóbrega
- Faculty of Health Science, University of Brasília, Brasília, Brazil
| | - Aparecido P Ferreira
- Interdisciplinary Research Department, University Centre ICESP, Brasília, Brazil.,Post-graduation Program, Santa Úrsula University, Rio de Janeiro, Brazil
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Arazi H, Mohabbat M, Saidie P, Falahati A, Suzuki K. Effects of Different Types of Exercise on Kidney Diseases. Sports (Basel) 2022; 10:sports10030042. [PMID: 35324651 PMCID: PMC8952011 DOI: 10.3390/sports10030042] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/26/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
The effects of exercise on kidney function have been studied for more than three decades. One of the most common health issues among patients with chronic kidney disease (CKD) is a lack of physical activity, which leads to a low exercise capacity in these patients. The majority of maintenance hemodialysis (MHD) patients do not exercise at all. At each stage of dialysis, patients lose 10–12 g of their amino acids through blood sampling. Dialysis also leads to increased cortisol and circadian rhythm sleep disorders in hemodialysis (HD) patients. Studies have also reported higher C-reactive protein levels in HD patients, which causes arterial stiffness. Exercise has a variety of health benefits in these patients, including improved blood pressure control, better sleep, higher physical function, and reduced anxiety and depression. On the other hand, it should be noted that intense exercise has the potential to progress KD, especially when conducted in hot weather with dehydration. This review aimed to investigate the effects of different types of exercise on kidney disease and provide exercise guidelines. In conclusion, moderate-intensity and long-term exercise (for at least a 6-month period), with consideration of the principles of exercise (individualization, intensity, time, etc.), can be used as an adjunctive treatment strategy in patients undergoing dialysis or kidney transplantation.
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Affiliation(s)
- Hamid Arazi
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran; (M.M.); (P.S.); (A.F.)
- Correspondence: (H.A.); (K.S.); Tel.: +98-911-139-9207 (H.A.)
| | - Majid Mohabbat
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran; (M.M.); (P.S.); (A.F.)
| | - Payam Saidie
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran; (M.M.); (P.S.); (A.F.)
| | - Akram Falahati
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran; (M.M.); (P.S.); (A.F.)
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan
- Correspondence: (H.A.); (K.S.); Tel.: +98-911-139-9207 (H.A.)
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Zhang F, Wang H, Wang W, Zhang H. The Role of Physical Activity and Mortality in Hemodialysis Patients: A Review. Front Public Health 2022; 10:818921. [PMID: 35252096 PMCID: PMC8891147 DOI: 10.3389/fpubh.2022.818921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/26/2022] [Indexed: 12/20/2022] Open
Abstract
Available data indicated that physical activity was related to improved outcomes in hemodialysis patients. Multiple observational studies involving different cohorts have reported that increased physical activity level was associated with decreased mortality among hemodialysis patients. Therefore, promoting physical activity has become an increasingly critical and promising approach to improving cardiovascular health and clinical outcomes in hemodialysis patients. This review summarizes the published articles regarding physical activity and hemodialysis patients, focusing on mortality and strategy to promote physical activity.
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Affiliation(s)
- Fan Zhang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Wang
- Department of Anorectal, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weiqiong Wang
- Blood Purification Centre, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huachun Zhang
- Department of Nursing, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
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18
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Bernier-Jean A, Beruni NA, Bondonno NP, Williams G, Teixeira-Pinto A, Craig JC, Wong G. Exercise training for adults undergoing maintenance dialysis. Cochrane Database Syst Rev 2022; 1:CD014653. [PMID: 35018639 PMCID: PMC8752366 DOI: 10.1002/14651858.cd014653] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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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Hornik B, Duława J, Durmała J. Metabolic Syndrome and Psychological Effects of Exercise in Hemodialysis Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11952. [PMID: 34831708 PMCID: PMC8622865 DOI: 10.3390/ijerph182211952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022]
Abstract
Metabolic syndrome (MS) and anxiety disorders are common problems among hemodialysis patients (HD). However, there have been no studies defining the role of physical activity in reducing anxiety in HD patients with MS. This study was aimed to determine the effects on the severity of anxiety of a four-week rehabilitation program for HD patients, with or without metabolic syndrome (MS), planned and adapted to their abilities. The study was single-center, interventional, non-randomized, and prospective. Fifty-eight individuals completed the project (28 HD patients and 30 controls (C) with normal kidney function). Each group was divided into two subgroups with respect to MS. The mean age of the subjects in the HD and C groups was 56.9 ± 13.3 years (x¯ ± SD) and 61.5 ± 8.3 years (x¯ ± SD), respectively. Planned and adapted to the patient's abilities, the rehabilitation program based on physiotherapy was provided to each subject for 4 weeks. Baseline and post-intervention determined anxiety levels using the State-Trait Anxiety Inventory (STAI). The X1 scale tests state anxiety, and the X2 scale tests trait anxiety. Post-intervention, there was no significant difference in the intensity of state anxiety observed in HD patients compared to C with normal renal function, as observed before the program. After four weeks of regular physical activity planned and adapted to the patient's abilities in an inpatient ward, the level of state anxiety (X1) and trait anxiety (X2) lowered considerably in all HD patients (respectively: 35.1 ± 8.0 vs. 29.2 ± 5.0, p = 0.001 for X1 and 41.8 ± 9.1 vs. 38.1 ± 5.9, p = 0.008 for X2). The rehabilitation program significantly reduced the intensity of state anxiety (X1) in HD patients with MS (35.8 ± 7.9 vs. 29.2 ± 5.1; p = 0.01). The rehabilitation program helped to significantly reduce the intensity of trait anxiety (X2) in HD patients without MS (41.9 ± 10.7 vs. 36.9 ± 5.9; p = 0.04). Four-week physical activity planned and adapted to the patient's abilities reduces the intensity of anxiety in HD patients and controls with normal renal function. HD patients with MS benefit more in terms of reducing perceived state anxiety, and HD patients without MS in terms of reducing trait anxiety.
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Affiliation(s)
- Beata Hornik
- Department of Internal Nursing, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Jan Duława
- Department of Internal Medicine and Metabolic Diseases, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
- Diaverum, 40-635 Katowice, Poland
| | - Jacek Durmała
- Department of Rehabilitation, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
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Li T, Lv A, Xu N, Huang M, Su Y, Zhang B, Li X. Barriers and facilitators to exercise in haemodialysis patients: A systematic review of qualitative studies. J Adv Nurs 2021; 77:4679-4692. [PMID: 34258784 DOI: 10.1111/jan.14960] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/08/2021] [Accepted: 06/15/2021] [Indexed: 01/24/2023]
Abstract
AIMS The purpose of this systematic review is to synthesize the results of qualitative research and to identify the barriers and facilitators to exercise in haemodialysis patients from the perspectives of haemodialysis patients, caregivers and dialysis staff members. DESIGN Systematic review of qualitative studies. DATA SOURCES Qualitative studies were extracted from MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, PubMed, CBM, CNKI and WanFang Database from inception of each database until July 2020. Qualitative research and mixed method research including barriers and/or facilitators to exercise in haemodialysis patients were included. REVIEW METHODS The systematic search method SPIDER (sample, phenomenon of interest, design, evaluation, research type) was used. Thematic synthesis of qualitative data was used. RESULTS 284 studies were screened and 10 studies published between 2007 and 2020 were finally included in this review. The review included 180 patients, 70 dialysis staff members and seven caregivers. Five analytical themes were identified: disease distress, perception of exercise, environmental restrictions, spirit strength and hospital management. Barriers include disease distress, perception of exercise (security issue), environmental restrictions and hospital management. Facilitators include perception of exercise (exercise being considered beneficial, preference for exercise) and spirit strength (from religious beliefs). It is the spiritual strength (from family and friends, from dialysis staff members) that is both the barrier and the facilitator. CONCLUSION There are many barriers in popularizing exercise among haemodialysis patients. Future intervention measures and health policies should strengthen the facilitators and reduce the barriers, so as to promote the clinical practice of exercise for haemodialysis patients. IMPACT This review summarizes the barriers and facilitators to exercise in haemodialysis patients. The results of this study have an impact on research, practice and health policy setting. The exercise level of haemodialysis patients can be improved by using the facilitators and solving the barriers.
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Affiliation(s)
- Tianzi Li
- Health Science Center, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Aili Lv
- Health Science Center, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Na Xu
- Health Science Center, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Mei Huang
- The Fourth Military Medical University, Xi'an, Shaan Xi, China
| | - Yan Su
- Health Science Center, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Bin Zhang
- Health Science Center, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - XiaoMei Li
- Health Science Center, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
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Li H, Zuo L, Long S, Li B. Effects of nonpharmacological intervention on sleep quality in hemodialysis patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26401. [PMID: 34232172 PMCID: PMC8270589 DOI: 10.1097/md.0000000000026401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nonpharmacological intervention can improve the sleep quality of hemodialysis patients. However, there are many types of nonpharmacological interventions, which makes it difficult to determine the best one. Therefore, this study carried out network meta-analysis to evaluate the effects of nonpharmacological intervention on sleep quality of hemodialysis patients, so as to provide evidence for the selection of the optimal nonpharmacological intervention for the improvement of sleep quality of hemodialysis patients clinically. METHODS Randomized controlled trials on the effects of nonpharmaceutical interventions on sleep quality in hemodialysis patients were conducted by searching English databases (PubMed, Cochrane Library, EMBASE, and Web of Science) and Chinese databases (Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, Wanfang, and China Biomedical Literature Database) on computer. The retrieval time was from the establishment of the database to May 2021. Literature screening, data extraction, and evaluation of the risk of bias in the included studies were conducted independently by two researchers. Data analysis was performed with STATA14.0 and GEMTC 0.14.3 software. RESULTS We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals. CONCLUSIONS This study will provide the best evidence-based evidence to support the effects of non-pharmacological interventions on sleep quality in hemodialysis patients. ETHICS AND DISSEMINATION Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms. This review would be disseminated in a peer-reviewed journal or conference presentations. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/4BPKT.
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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: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [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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23
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Parker K, Bennett PN, Tayler C, Lee C, MacRae J. Reasons for Nonparticipation in a Sustained Hemodialysis Intradialytic Exercise Program. J Ren Nutr 2021; 31:421-426. [PMID: 33642193 DOI: 10.1053/j.jrn.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/30/2020] [Accepted: 11/22/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE(S) Patients with end-stage kidney disease requiring hemodialysis suffer frailty and poor physical function. Exercise can improve physical function; however, barriers exist to intradialytic exercise programs. The objective of this study was to explore patients' reasons for not exercising in an extant intradialytic exercise program. DESIGN AND METHODS We conducted a retrospective analysis reporting the reasons for not exercising in an intradialytic exercise program in two hemodialysis centers over a 4-week period. We explored whether patient characteristics and the presence of an exercise professional were associated with missed exercise sessions. RESULTS Seventy-five patients participating in the intradialytic exercise program completed 57% of prescribed intradialytic exercise sessions. The three most frequently reported reasons from patients not exercising were refusal (24%), followed by fatigue (19%) and symptoms (14%). Patients were more than twice as likely to exercise if a kinesiologist was present (odds ratio [OR]: 2.26, confidence interval [CI]: 1.5, 3.4 P = .03). They were less likely to exercise if they were women (OR: 0.66, CI: 0.45, 0.95 P = .002), had been on dialysis greater than 60 months (OR: 0.55, CI: 0.37, 0.80 P < .002), or had more than two comorbid conditions (OR: 0.63, CI: 0.43, 0.90, P = .01). CONCLUSION Patient adherence to intradialytic exercise programs is strongly associated with the presence of exercise professionals.
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Affiliation(s)
| | - Paul N Bennett
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia; Satellite Healthcare, San Jose, California.
| | - Cassandra Tayler
- School of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Chel Lee
- Department of Mathematics, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer MacRae
- Division of Nephrology and Department of Cardiac Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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24
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Bündchen DC, Sousa H, Afreixo V, Frontini R, Ribeiro O, Figueiredo D, Costa E. Intradialytic exercise in end-stage renal disease: An umbrella review of systematic reviews and/or meta-analytical studies. Clin Rehabil 2021; 35:812-828. [PMID: 33530715 DOI: 10.1177/0269215520986784] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This umbrella review aimed to understand the clinical benefits and adverse events associated with different modalities of intradialytic exercise in patients with end-stage renal disease undergoing hemodialysis. DATA SOURCES The search was performed until September 10th, 2020 on Scopus, Web of Science, the Cochrane Database, CINAHL, and PubMed. METHODS This umbrella review was conducted following the PRISMA guideline statement. The methodological quality of the reviews was assessed with the AMSTAR-2. Standardized mean differences with 95% confidence intervals were estimated. The I-squared statistic was used to assess heterogeneity and the Eggers' test was performed to test asymmetry/small-study effects. RESULTS Eleven reviews were included and 48 unique meta-analyses were examined. Nine were supported by suggestive evidence (P < 0.05, small heterogeneity, absence of small-study effects, and excess significance bias). Clinical benefits were found for functional capacity associated with aerobic exercise (d = 0.81; k = 6), resistance training (d = 0.58; k = 6), neuromuscular electrical stimulation (d = 0.70; k = 5), and inspiratory muscle training (d = 1.13; k = 2), measured by the distance covered in the 6-minutes walking test. This outcome was also associated with aerobic exercise (d = 0.28; k = 7) and combined exercise, measured by VO2peak (d = 1.01; k = 5) and by the duration of the cardiopulmonary test (d = 1.07; k = 4). Isometric quadriceps muscle strength improved with neuromuscular electrical stimulation (d = 1.19; k = 7) while patients' perception of vitality improved with combined exercise (d = 0.60; k = 3). CONCLUSIONS Suggestive evidence was found for the associations between various modalities of intradialytic exercise and functional capacity. Combined exercise was associated with improvements in physical and psychosocial variables. Few or no adverse events were reported.
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Affiliation(s)
- Daiana Cristine Bündchen
- Department for Health Sciences, Federal University of Santa Catarina, Araranguá, Brazil.,Research Unit on Applied Molecular Biosciences, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing, University of Porto, Porto, Portugal
| | - Helena Sousa
- Center for Health Technology and Services Research, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Vera Afreixo
- Institute for Biomedicine, Department of Mathematics, University of Aveiro, Aveiro, Portugal
| | - Roberta Frontini
- Center for Health Technology and Services Research, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Oscar Ribeiro
- Center for Health Technology and Services Research, Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Daniela Figueiredo
- Center for Health Technology and Services Research, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Elísio Costa
- Research Unit on Applied Molecular Biosciences, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing, University of Porto, Porto, Portugal
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25
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Comments on "Supervised Exercise Intervention and Overall Activity in CKD" by Pike et al.. Kidney Int Rep 2020; 5:2404-2405. [PMID: 33305143 PMCID: PMC7710818 DOI: 10.1016/j.ekir.2020.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
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26
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Pike MM, Alsouqi A, Headley SA, Tuttle K, Evans EE, Milch CM, Moody KA, Germain M, Stewart TG, Lipworth L, Himmelfarb J, Ikizler TA, Robinson-Cohen C. The Authors Reply. Kidney Int Rep 2020; 5:2405-2406. [PMID: 33305144 PMCID: PMC7710819 DOI: 10.1016/j.ekir.2020.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 12/05/2022] Open
Affiliation(s)
- Mindy M. Pike
- Vanderbilt O’Brien Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aseel Alsouqi
- Vanderbilt O’Brien Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Samuel A.E. Headley
- Department of Exercise Science and Athletic Training, Springfield College, Springfield, Massachusetts, USA
| | - Katherine Tuttle
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
| | - Elizabeth Elspeth Evans
- Department of Exercise Science and Athletic Training, Springfield College, Springfield, Massachusetts, USA
| | - Charles M. Milch
- Department of Exercise Science and Athletic Training, Springfield College, Springfield, Massachusetts, USA
| | - Kelsey Anne Moody
- Department of Exercise Science and Athletic Training, Springfield College, Springfield, Massachusetts, USA
| | - Michael Germain
- Department of Nephrology, Bay State Medical Center, Springfield, Massachusetts, USA
| | - Thomas G. Stewart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Loren Lipworth
- Vanderbilt O’Brien Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan Himmelfarb
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - T. Alp Ikizler
- Vanderbilt O’Brien Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cassianne Robinson-Cohen
- Vanderbilt O’Brien Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Assawasaksakul N, Sirichana W, Joosri W, Kulaputana O, Eksakulkla S, Ketanun C, Kittiskulnam P, Chantadisai M, Takkavatakarn K, Susantitaphong P, Praditpornsilpa K, Eiam-Ong S, Tiranathanagul K. Effects of intradialytic cycling exercise on daily physical activity, physical fitness, body composition, and clinical parameters in high-volume online hemodiafiltration patients: a pilot randomized-controlled trial. Int Urol Nephrol 2020; 53:359-371. [PMID: 33128722 DOI: 10.1007/s11255-020-02677-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The mortality of dialysis patients treated with high-volume online hemodiafiltration (OL-HDF) is better than hemodialysis, but is still higher than healthy population. Low daily physical activity increases cardiovascular mortality. Addition of intradialytic exercise (IDX) program might improve physical activity and health status in OL-HDF patients. This pilot open-labeled randomized-controlled trial was conducted to evaluate the effects of IDX on physical activity and other clinical parameters in OL-HDF patients. METHODS Twelve OL-HDF patients were randomized into control (n = 6) or IDX (n = 6) groups. The subjects in IDX group were trained to exercise using a cycle ergometer for 60 min during each OL-HDF session. Physical activity measured as daily step count using a wrist-worn triaxial accelerometer, physical fitness, or cardiorespiratory fitness assessed by VO2max and other physical performance tests, lean body mass determined by the Dual-energy X-ray absorptiometry (DXA), quality of life (QOL), and various parameters were compared between baseline and 6 months. RESULTS The baseline physical activity status was comparable. Following 6-month IDX, the physical activity was significantly improved in IDX group [+ 1048.79 (+ 741.50, + 2792.54) vs. - 362.06 (- 1626.82, - 167.47) steps/day, p = 0.01], while physical fitness and QOL were unchanged. The lean body mass parameters were preserved in the IDX group while seemed to decrease in the control group. Serum albumin was significantly increased in the IDX group (p = 0.01). The hemoglobin changes were significantly better (p = 0.01) and the erythropoietin resistance index was significantly lower in the IDX group (p = 0.03). Phosphate reduction was significantly greater in the IDX group (p = 0.04). CONCLUSIONS IDX could improve physical activity and other metabolic parameters in OL-HDF patients and these might contribute to further improvement in clinical and survival outcomes. TRIAL REGISTRATION ClinicalTrials.gov Registration: NCT03353844.
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Affiliation(s)
- Nawaporn Assawasaksakul
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Worawan Sirichana
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Waraporn Joosri
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Department of Nursing, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Onanong Kulaputana
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Sukanya Eksakulkla
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chutima Ketanun
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Department of Nursing, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Piyawan Kittiskulnam
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Maythinee Chantadisai
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Khajohn Tiranathanagul
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
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Kang SH, Do JY, Kim JC. The relationship between disability and clinical outcomes in maintenance dialysis patients. Yeungnam Univ J Med 2020; 38:127-135. [PMID: 33053615 PMCID: PMC8016623 DOI: 10.12701/yujm.2020.00346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/11/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGRUOUND Dialysis patients are prone to having disabilities. We aimed to evaluate the association between disability and various clinical outcomes in Korean dialysis patients. METHODS This study consisted of 1,615 dialysis patients from 27 centers. We evaluated disability by using four questions on the activities of daily living (ADLs) concerning whether help was needed for feeding, dressing/undressing, getting in/out of bed, or taking a bath/shower. We divided the patients into three groups: no disability (Non-D, none of the four ADL domains required help; n=1,312), mild disability (Mild-D, one ADL domain required some/full help; n=163), or moderate to severe disability (MS-D, two or more ADL domains required some/full help; n=140). We evaluated falls, frailty, health-related quality of life (HRQoL), mortality, and hospitalization. RESULTS The numbers of participants with a fall during the last 1 year were 199 (15.2%), 42 (25.8%), and 44 (31.4%) in the Non-D, Mild-D, and MS-D groups, respectively (p<0.001). The numbers of participants with frailty in the Non-D, Mild-D, and MS-D groups were 381 (29.0%), 84 (51.5%), and 93 (66.4%), respectively (p<0.001). In both univariate and multivariate analyses, the physical component scale and mental component scale scores decreased as the grade of disability increased (p<0.001 for both scores). Hospitalization-free survival rate at 500 days was 64.2%, 56.7%, and 51.1% in the Non-D, Mild-D, and MS-D, respectively (p=0.001 for trend). Patient survival rate at 500 days was 95.3%, 89.5%, and 92.3% in the Non-D, Mild-D, and MS-D, respectively (p=0.005 for trend). CONCLUSION Disability was associated with falls, frailty, HRQoL scales, and survival trends in Korean dialysis patients.
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Affiliation(s)
- Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Jun Young Do
- Division of Nephrology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Jun Chul Kim
- Division of Nephrology, Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi, Korea
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29
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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] [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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Corrêa HL, Moura SRG, Neves RVP, Tzanno-Martins C, Souza MK, Haro AS, Costa F, Silva JAB, Stone W, Honorato FS, Deus LA, Prestes J, Simões HG, Vieira EC, de Melo GF, Moraes MR, Rosa TS. Resistance training improves sleep quality, redox balance and inflammatory profile in maintenance hemodialysis patients: a randomized controlled trial. Sci Rep 2020; 10:11708. [PMID: 32678132 PMCID: PMC7367305 DOI: 10.1038/s41598-020-68602-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/11/2020] [Indexed: 11/09/2022] Open
Abstract
Patients in maintenance hemodialisys (HD) present sleep disorders, increased inflammation, unbalanced redox profiles, and elevated biomarkers representing endothelial dysfunction. Resistance training (RT) has shown to mitigate the loss of muscle mass, strength, improve inflammatory profiles, and endothelial function while decreasing oxidative stress for those in HD. However, the relation between those factors and sleep quality are inadequately described. The aim of this study was to verify the effects of 3 months of RT on sleep quality, redox balance, nitric oxide (NO) bioavailability, inflammation profile, and asymmetric dimethylarginine (ADMA) in patients undergoing HD. Our primary goal was to describe the role of RT on sleep quality. Our secondary goal was to evaluate the effect of RT on NO, metabolism markers, and inflammatory and redox profiles as potential mechanisms to explain RT-induced sleep quality changes. Fifty-five men undergoing maintenance hemodialysis were randomized into either a control (CTL, n = 25) and RT group (RTG; n = 30). Participants in the RT group demonstrated an improvement in sleep pattern, redox, inflammatory profiles, and biomarkers of endothelial function (NO2- and ADMA). This group also increased muscle strength (total workload in RT exercises of upper and lower limbs). These findings support that RT may improve the clinical status of HD patients by improving their sleep quality, oxidative and inflammatory parameters.
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Affiliation(s)
- Hugo Luca Corrêa
- Graduate Program of Physical Education, Catholic University of Brasilia (USB), EPTC, QS07, LT1 s/n. Bloco G Sala 117, Águas Claras, Taguatinga, Brasília, DF, 71966-700, Brazil.
| | - Sting Ray Gouveia Moura
- Graduate Program of Physical Education, Catholic University of Brasilia (USB), EPTC, QS07, LT1 s/n. Bloco G Sala 117, Águas Claras, Taguatinga, Brasília, DF, 71966-700, Brazil
| | - Rodrigo Vanerson Passos Neves
- Graduate Program of Physical Education, Catholic University of Brasilia (USB), EPTC, QS07, LT1 s/n. Bloco G Sala 117, Águas Claras, Taguatinga, Brasília, DF, 71966-700, Brazil
| | | | - Michel Kendy Souza
- Department of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | - Anderson Sola Haro
- Department of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | - Fernando Costa
- Department of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Whitley Stone
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, KY, USA
| | - Fernando Sousa Honorato
- Graduate Program of Physical Education, Catholic University of Brasilia (USB), EPTC, QS07, LT1 s/n. Bloco G Sala 117, Águas Claras, Taguatinga, Brasília, DF, 71966-700, Brazil
| | - Lysleine Alves Deus
- Graduate Program of Physical Education, Catholic University of Brasilia (USB), EPTC, QS07, LT1 s/n. Bloco G Sala 117, Águas Claras, Taguatinga, Brasília, DF, 71966-700, Brazil
| | - Jonato Prestes
- Graduate Program of Physical Education, Catholic University of Brasilia (USB), EPTC, QS07, LT1 s/n. Bloco G Sala 117, Águas Claras, Taguatinga, Brasília, DF, 71966-700, Brazil
| | - Herbert Gustavo Simões
- Graduate Program of Physical Education, Catholic University of Brasilia (USB), EPTC, QS07, LT1 s/n. Bloco G Sala 117, Águas Claras, Taguatinga, Brasília, DF, 71966-700, Brazil
| | - Elaine Cristina Vieira
- Graduate Program of Physical Education, Catholic University of Brasilia (USB), EPTC, QS07, LT1 s/n. Bloco G Sala 117, Águas Claras, Taguatinga, Brasília, DF, 71966-700, Brazil
| | - Gislane Ferreira de Melo
- Graduate Program of Physical Education, Catholic University of Brasilia (USB), EPTC, QS07, LT1 s/n. Bloco G Sala 117, Águas Claras, Taguatinga, Brasília, DF, 71966-700, Brazil
| | - Milton Rocha Moraes
- Graduate Program of Physical Education, Catholic University of Brasilia (USB), EPTC, QS07, LT1 s/n. Bloco G Sala 117, Águas Claras, Taguatinga, Brasília, DF, 71966-700, Brazil
| | - Thiago Santos Rosa
- Graduate Program of Physical Education, Catholic University of Brasilia (USB), EPTC, QS07, LT1 s/n. Bloco G Sala 117, Águas Claras, Taguatinga, Brasília, DF, 71966-700, Brazil
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Edley R. Can non-pharmacological interventions improve sleep quality for haemodialysis patients? ACTA ACUST UNITED AC 2020. [DOI: 10.12968/jokc.2020.5.1.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Poor sleep quality is a major issue for haemodialysis (HD) patients, with as many as 80% reporting problems with sleep. Poor sleep has a negative impact on HD patients' mental health, quality of life and day-to-day functioning, along with increasing morbidity and mortality risks. Non-pharmacological interventions have fewer side-effects compared to hypnotic medications and have been shown to be effective in research studies. Ruth Edley examines acupressure, massage, aerobic and non-aerobic exercise and cognitive behavioural therapy. All have been shown in small-scale studies to improve sleep quality in HD patients, although no intervention has been found to improve sleep quality to normal levels. It is recommended that further research using larger, randomised controlled trials is undertaken to increase confidence in the benefits of these interventions.
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Affiliation(s)
- Ruth Edley
- Clinical Nurse, Fresenius Kidney Care, Perth, Western Australia, Australia
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Young HML, Orme MW, Song Y, Dungey M, Burton JO, Smith AC, Singh SJ. Standardising the measurement of physical activity in people receiving haemodialysis: considerations for research and practice. BMC Nephrol 2019; 20:450. [PMID: 31801480 PMCID: PMC6894215 DOI: 10.1186/s12882-019-1634-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/20/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Physical activity (PA) is exceptionally low amongst the haemodialysis (HD) population, and physical inactivity is a powerful predictor of mortality, making it a prime focus for intervention. Objective measurement of PA using accelerometers is increasing, but standard reporting guidelines essential to effectively evaluate, compare and synthesise the effects of PA interventions are lacking. This study aims to (i) determine the measurement and processing guidance required to ensure representative PA data amongst a diverse HD population, and; (ii) to assess adherence to PA monitor wear amongst HD patients. METHODS Clinically stable HD patients from the UK and China wore a SenseWear Armband accelerometer for 7 days. Step count between days (HD, Weekday, Weekend) were compared using repeated measures ANCOVA. Intraclass correlation coefficients (ICCs) determined reliability (≥0.80 acceptable). Spearman-Brown prophecy formula, in conjunction with a priori ≥ 80% sample size retention, identified the minimum number of days required for representative PA data. RESULTS Seventy-seven patients (64% men, mean ± SD age 56 ± 14 years, median (interquartile range) time on HD 40 (19-72) months, 40% Chinese, 60% British) participated. Participants took fewer steps on HD days compared with non-HD weekdays and weekend days (3402 [95% CI 2665-4140], 4914 [95% CI 3940-5887], 4633 [95% CI 3558-5707] steps/day, respectively, p < 0.001). PA on HD days were less variable than non-HD days, (ICC 0.723-0.839 versus 0.559-0.611) with ≥ 1 HD day and ≥ 3 non-HD days required to provide representative data. Using these criteria, the most stringent wear-time retaining ≥ 80% of the sample was ≥7 h. CONCLUSIONS At group level, a wear-time of ≥7 h on ≥1HD day and ≥ 3 non-HD days is required to provide reliable PA data whilst retaining an acceptable sample size. PA is low across both HD and non- HD days and future research should focus on interventions designed to increase physical activity in both the intra and interdialytic period.
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Affiliation(s)
- Hannah M L Young
- Department of Respiratory Science, University of Leicester, Leicester Kidney Lifestyle Team, Academic Unit, Leicester General Hospital, Gwendolen Road, Leicester, LE4 5PW, UK.
| | - Mark W Orme
- Department of Respiratory Science, University of Leicester, Leicester Kidney Lifestyle Team, Academic Unit, Leicester General Hospital, Gwendolen Road, Leicester, LE4 5PW, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Yan Song
- Department of Health Sciences, University of Leicester, Leicester, UK
- Nantong University, Nantong, China
| | - Maurice Dungey
- Department of Cardiovascular Science, University of Leicester, Leicester, UK
| | - James O Burton
- Department of Cardiovascular Science, University of Leicester, Leicester, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Alice C Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, Leicester Kidney Lifestyle Team, Academic Unit, Leicester General Hospital, Gwendolen Road, Leicester, LE4 5PW, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
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Garcia RSA, Pinheiro BV, Lucinda LMF, Pimentel AL, Júnior JMP, Paula RB, Reboredo MM. Association between exercise training in haemodialysis patients and burden of their family caregivers: A cross-sectional study. Nephrology (Carlton) 2019; 25:332-338. [PMID: 31124254 DOI: 10.1111/nep.13620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2019] [Indexed: 01/19/2023]
Abstract
AIM Considering that exercise programmes are related with a range of benefits for end-stage renal disease patients, we evaluated the association between haemodialysis (HD) patients' involvement in intradialytic exercise training with the burden of their family caregivers. METHODS In this cross-sectional study, 60 caregivers of HD patients were recruited, 30 of them who cared for patients that regularly participated in an exercise programme during dialysis sessions and 30 caregivers who looked after patients undergoing usual HD treatment without intradialytic exercise. The caregivers were submitted to the Caregiver Burden Scale (CBS) and their quality of life (short-form-36 (SF-36)), anxiety and depression levels were assessed. Data were expressed as mean ± SD or median (interquartile range). RESULTS Multiple linear regression showed that the global CBS score was significantly associated with the exercise training after adjusting for age, educational level and anxiety level of caregivers, and dependency level of patients measured by the Lawton scale (coefficient of determination = 0.53; adjusted coefficient of determination = 0.48). Additionally, the caregivers of HD patients submitted to intradialytic exercise (42.0 ± 12.9 years, 33.3% male) compared to caregivers of patients undergoing usual treatment (50.7 ± 17.5 years, 26.7% male) exhibited less caregiver burden (global CBS score = 1.2 (0.2) vs 1.9 (0.7), P < 0.001), better quality of life (physical component score = 53.7 (9.6) vs 49.7 (16.2) and mental component score = 50.6 (17.5) vs 28.2 (32.5), P < 0.05) and lower anxiety (7.2 ± 4.2 vs 10.8 ± 4.1, P = 0.001) and depression levels (3.0 (3.3) vs 6.0 (5.3), P = 0.034), respectively. CONCLUSIONS Intradialytic exercise training in HD patients was associated with lower burden of their family caregivers.
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Affiliation(s)
- Rodrigo S A Garcia
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Bruno V Pinheiro
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil.,School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Leda M F Lucinda
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil.,School of Medicine of Barbacena, Barbacena, Brazil
| | | | | | - Rogério B Paula
- School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Maycon M Reboredo
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil.,School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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Natale P, Ruospo M, Saglimbene VM, Palmer SC, Strippoli GFM. Interventions for improving sleep quality in people with chronic kidney disease. Cochrane Database Syst Rev 2019; 5:CD012625. [PMID: 31129916 PMCID: PMC6535156 DOI: 10.1002/14651858.cd012625.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Sleep disorders are commonly experienced by people with chronic kidney disease (CKD). Several approaches for improving sleep quality are used in clinical practice including relaxation techniques, exercise, acupressure, and medication. OBJECTIVES To assess the effectiveness and associated adverse events of interventions designed to improve sleep quality among adults and children with CKD including people with end-stage kidney disease (ESKD) treated with dialysis or kidney transplantation. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 8 October 2018 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) or quasi-randomised RCTs of any intervention in which investigators reported effects on sleep quality. Two authors independently screened titles and abstracts of identified records. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias for included studies. The primary outcomes were sleep quality, sleep onset latency, sleep duration, sleep interruption, and sleep efficiency. Risks of bias were assessed using the Cochrane tool. Evidence certainty was assessed using the GRADE approach. We calculated treatment estimates as risk ratios (RR) for dichotomous outcomes or mean difference (MD) or standardised MD (SMD) for continuous outcomes to account for heterogeneity in measures of sleep quality. MAIN RESULTS Sixty-seven studies involving 3427 participants met the eligibility criteria. Thirty-six studies involving 2239 participants were included in meta-analyses. Follow-up for clinical outcomes ranged between 0.3 and 52.8 weeks (median 5 weeks). Interventions included relaxation techniques, exercise, acupressure, cognitive-behavioural therapy (CBT), educational interventions, benzodiazepine treatment, dopaminergic agonists, telephone support, melatonin, reflexology, light therapy, different forms of peritoneal dialysis, music, aromatherapy, and massage. Incomplete reporting of key methodological details resulted in uncertain risk of bias in many studies.In very low certainty evidence relaxation techniques had uncertain effects on sleep quality and duration, health-related quality of life (HRQoL), depression, anxiety, and fatigue. Studies were not designed to evaluate the effects of relaxation on sleep latency or hospitalisation. Exercise had uncertain effects on sleep quality (SMD -1.10, 95% CI -2.26 to 0.05; I2 = 90%; 5 studies, 165 participants; very low certainty evidence). Exercise probably decreased depression (MD -9.05, 95% CI -13.72 to -4.39; I2 = 0%; 2 studies, 46 participants; moderate certainty evidence) and fatigue (SMD -0.68, 95% CI -1.07 to -0.29; I2 = 0%; 2 studies, 107 participants; moderate certainty evidence). Compared with no acupressure, acupressure had uncertain effects on sleep quality (Pittsburgh Sleep Quality Index (PSQI) scale 0 - 21) (MD -1.27, 95% CI -2.13 to -0.40; I2 = 89%; 6 studies, 367 participants: very low certainty evidence). Acupressure probably slightly improved sleep latency (scale 0 - 3) (MD -0.59, 95% CI -0.92 to -0.27; I2 = 0%; 3 studies, 173 participants; moderate certainty evidence) and sleep time (scale 0 - 3) (MD -0.60, 95% CI -1.12 to -0.09; I2 = 68%; 3 studies, 173 participants; moderate certainty evidence), although effects on sleep disturbance were uncertain as the evidence certainty was very low (scale 0 - 3) (MD -0.49, 95% CI -1.16 to 0.19; I2 = 97%). In moderate certainty evidence, acupressure probably decrease fatigue (MD -1.07, 95% CI -1.67 to -0.48; I2 = 0%; 2 studies, 137 participants). Acupressure had uncertain effects on depression (MD -3.65, 95% CI -7.63 to 0.33; I2 = 27%; 2 studies, 137 participants; very low certainty evidence) while studies were not designed to evaluate the effect of acupressure on HRQoL, anxiety, or hospitalisation. It was uncertain whether acupressure compared with sham acupressure improved sleep quality (PSQI scale 0 to 21) because the certainty of the evidence was very low (MD -2.25, 95% CI -6.33 to 1.82; I2 = 96%; 2 studies, 129 participants), but total sleep time may have been improved (SMD -0.34, 95% CI -0.73 to 0.04; I2 = 0%; 2 studies, 107 participants; low certainty evidence). 2 =2 =There were no studies designed to directly examine and/or correlate efficacy of any interventions aimed at improving sleep that may have been attempted for the spectrum of sleep disordered breathing. No studies reported treatment effects for children. Adverse effects of therapies were very uncertain. AUTHORS' CONCLUSIONS The evidence base for improving sleep quality and related outcomes for adults and children with CKD is sparse. Relaxation techniques and exercise had uncertain effects on sleep outcomes. Acupressure may improve sleep latency and duration, although these findings are based on few studies. The effects of acupressure were not confirmed in studies in which sham acupressure was used as the control. Given the very low certainly evidence, future research will very likely change the evidence base. Based on the importance of symptom management to patients, caregivers and clinicians, future studies of sleep interventions among people with CKD should be a priority.
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Affiliation(s)
- Patrizia Natale
- DiaverumMedical Scientific OfficeLundSweden
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
| | | | - Valeria M Saglimbene
- DiaverumMedical Scientific OfficeLundSweden
- The University of SydneySydney School of Public HealthSydneyAustralia
| | - Suetonia C Palmer
- University of Otago ChristchurchDepartment of Medicine2 Riccarton AvePO Box 4345ChristchurchNew Zealand8140
| | - Giovanni FM Strippoli
- DiaverumMedical Scientific OfficeLundSweden
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The University of SydneySydney School of Public HealthSydneyAustralia
- Diaverum AcademyBariItaly
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
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Moriyama Y, Hara M, Aratani S, Ishikawa H, Kono K, Tamaki M. The association between six month intra-dialytic resistance training and muscle strength or physical performance in patients with maintenance hemodialysis: a multicenter retrospective observational study. BMC Nephrol 2019; 20:172. [PMID: 31096932 PMCID: PMC6524282 DOI: 10.1186/s12882-019-1375-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/07/2019] [Indexed: 11/18/2022] Open
Abstract
Background Reduced muscle strength and physical performance are prevalent in patients of maintenance hemodialysis (MHD), and deleterious changes in these parameters are associated with increased mortality. Methods This retrospective observational study included 306 patients, who received a 6-month resistance exercise program during hemodialysis, three times per week on an outpatient basis. The training protocol consisted of two sets of 10 repetitions of knee extension, hip abduction, and hip flexion, using an elastic band in a sitting or supine position. Primary outcome measures included muscle strength, measured by percent knee extension muscle power to dry body weight (pKEMP-dBW), and physical performance, measured by short physical performance battery (SPPB). The adjusted mean differences in these variables during the 6 months were estimated using a multivariate linear regression model. Results The mean age with standard deviation was 70 ± 11 years. One hundred and sixty patients (52.3%) were men and the dry weight was 55.6 ± 11.3 kg. Sarcopenia, defined as SPPB ≤8, was present in 21.4% patients. Their hemodialysis adequacy was acceptable, with a Kt/V of 1.65 ± 0.29, and their nutritional status was good, with a normalized protein catabolism rate of 0.89 ± 0.18 g/kg/day. During the 6 months, both pKEMP-dBW and SPPB showed a slight but significant increase with an adjusted mean difference of 2.8 (95% confidence interval 1.3–4.3, p < 0.001) and 0.6 (0.4–0.9, p < 0.001), respectively. Conclusions Six-month resistance training was associated with improved muscle strength and physical performance in patients with MHD.
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Affiliation(s)
- Yoshifumi Moriyama
- Department of Health Fitness Program, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Masahiko Hara
- Department of Clinical Investigation, Japan Society of Clinical Research, Kita-ku Umeda 1-11-1000, Osaka Ekimae 4th Bldg 10F, Osaka, 530-0001, Japan. .,Center for Community-based Healthcare Research and Education, Shimane University, Izumo, Japan.
| | - Sae Aratani
- Department of Nephrology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Hideaki Ishikawa
- Department of Nephrology, Nagoya First Red Cross Hospital, Aichi, Japan
| | - Kenichi Kono
- Department of Physical Therapy, International University of Health and Welfare School of Health Science at Narita, Narita, Japan
| | - Masatake Tamaki
- Department of Clinical Investigation, Japan Society of Clinical Research, Kita-ku Umeda 1-11-1000, Osaka Ekimae 4th Bldg 10F, Osaka, 530-0001, Japan.,Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
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36
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Martins do Valle F, Valle Pinheiro B, Almeida Barros AA, Ferreira Mendonça W, de Oliveira AC, de Oliveira Werneck G, de Paula RB, Moura Reboredo M. Effects of intradialytic resistance training on physical activity in daily life, muscle strength, physical capacity and quality of life in hemodialysis patients: a randomized clinical trial. Disabil Rehabil 2019; 42:3638-3644. [PMID: 31034264 DOI: 10.1080/09638288.2019.1606857] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: We evaluated the effects of supervised intradialytic resistance training on physical activity in daily life (PADL), muscle strength, physical capacity and quality of life (QoL) in hemodialysis patients.Methods: Twenty-four hemodialysis patients were randomly assigned to either a 12-weeks moderate-intensity resistance training or a control period. An accelerometer evaluated PADL for seven consecutive days, measuring the time spent in different activities and positions of daily routine and the number of steps taken. Muscle strength, physical capacity and QoL were evaluated.Results: After 12 weeks of training, we did not find significant difference (post-pre values) in walking time (-1.2 ± 18.3 vs. -9.2 ± 13.1 min/day); standing time (-10.2 ± 28.6 vs. 3.2 ± 20.1 min/day); sitting time (20.8 ± 58.9 vs. -30.0 ± 53.0 min/day); lying down time (-9.3 ± 57.9 vs. 34.6 ± 54.0 min/day); number of steps taken [-147 (1834) vs. -454 (2066)] and muscle strength in training and control group, respectively. There was a significant increase in the six-minute walking test distance (48.8 ± 35.9 vs. 6.9 ± 45.9 m, p < 0.05) and some domains of QoL in the training compared to the control group.Conclusions: PADL was not modified after 12 weeks of intradialytic resistance training in hemodialysis patients. However, the exercise program was able to increase the physical capacity and some domains of QoL.Implications for rehabilitationPhysical activity in daily life was not modified after 12 weeks of intradialytic resistance training in hemodialysis patients.The exercise program was able to increase the physical capacity, efficacy of dialysis and some domains of quality of life in hemodialysis patients.The protocol used in this study was safe since no complications were observed during and after resistance training.These results should be interpreted with caution because we applied a moderate resistance training in both lower limbs and in the contralateral arteriovenous fistula upper limb, using perceived exertion by Borg scale to exercise prescription. Moreover, the safety protocol evaluation was not conducted.
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Affiliation(s)
- Felipe Martins do Valle
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Bruno Valle Pinheiro
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil.,School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | | | - William Ferreira Mendonça
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Ana Carla de Oliveira
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Gustavo de Oliveira Werneck
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | | | - Maycon Moura Reboredo
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil.,School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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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] [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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Moorman D, Suri R, Hiremath S, Jegatheswaran J, Kumar T, Bugeja A, Zimmerman D. Benefits and Barriers to and Desired Outcomes with Exercise in Patients with ESKD. Clin J Am Soc Nephrol 2019; 14:268-276. [PMID: 30696660 PMCID: PMC6390914 DOI: 10.2215/cjn.09700818] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/28/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients with ESKD are sedentary. When patient-identified barriers to exercise are addressed, recruitment and retention in exercise trials remain low, suggesting that the trial design may not resonate with them. Therefore, we conducted a survey of patients on dialysis to assess perceived benefits and barriers to exercise and discover preferred outcomes and exercise type by dialysis modality and age in anticipation of designing future randomized, controlled trials. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS English- and French-speaking patients with ESKD treated with hemodialysis or peritoneal dialysis were recruited from two tertiary care hospitals in Ottawa and Montreal, Canada. Summary descriptive statistics were used to describe patient responses; then, they were separated by dialysis modality and age category. RESULTS The survey was completed by 423 participants. Current activity levels were similar across modalities (P=0.35); 78% of younger patients walked at least 10 minutes at a time on 3 or more days compared with only 58% of older patients (P=0.001). The two most desired benefits of exercise were improved energy (18%) and strength (14%). The third priority differed, such that improved sleep, maintenance of independence, and longevity were selected by patients on peritoneal dialysis, patients on in-center hemodialysis, and patients on home hemodialysis, respectively. Older patients were most interested in improvements in energy, strength, and maintenance of independence, whereas younger patients were interested in improving energy, longevity, and transplant candidacy. Only 25% of patients were able to exercise without difficulty; the major barriers for the remaining patients were feeling patients were feeling too tired (55%), short of breath (50%), and too weak (49%). If patients were to exercise, they wanted to exercise at home (73%) using a combination of aerobic and resistance training (41%), regardless of modality or age category. CONCLUSIONS The majority of patients undergoing maintenance dialysis in two tertiary hospitals in Ottawa and Montreal report similar desired outcomes and barriers, with greater differences by age category than modality.
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Affiliation(s)
- Danielle Moorman
- Department of Medicine, University of Ottawa, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rita Suri
- Division of Nephrology, Department of Medicine, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; and.,Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Januvi Jegatheswaran
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; and
| | - Teerath Kumar
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; and
| | - Ann Bugeja
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; and
| | - Deborah Zimmerman
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; and .,Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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