Beneficios del ejercicio físico de baja intensidad durante la sesión de hemodiálisis en el paciente anciano

Quantifying the dose-response relationship between exercise and health-related quality of life in patients undergoing haemodialysis: A meta-analysis

Objective

This meta-analysis aims to explore the dose-response relationship of aerobic exercise or aerobic combined resistance exercise on cardiopulmonary function in maintenance hemodialysis（MHD）, with the goal of aiding in the formulation of precise exercise prescriptions.

Methods

A literature search up to August 18, 2023, was conducted in databases including Web of Science, among others, focusing on the effects of exercise interventions on cardiopulmonary function in hemodialysis patients.Two researchers independently conducted literature screening, data extraction, and an assessment of study methodology quality. A dose-response meta-analysis was carried out using a one-stage cubic spline mixed-effects model, followed by stratified analyses based on intervention period, intervention method, and exercise environment.

Results

A nonlinear dose-response relationship was observed between exercise and 6-minute walk test (6WMT) as well as peak oxygen uptake (VO2Peak) in hemodialysis patients. The optimal exercise dose for the 6WMT across the full exposure range was 922 METs-min/week, with VO2Peak increasing with the dose. The effects were influenced by the type of exercise, intervention period, and exercise environment. An exercise dose of 500 METs-min/week and 619 METs-min/week was found sufficient to achieve the minimal clinically important differences (MCID) for 6WMT and VO2Peak, respectively.

Conclusion

There is a significant association between the dose of exercise and its effects. With appropriate adjustment of variables, even low-dose exercise can lead to clinically significant improvements in cardiopulmonary function.

Impact of virtual reality exercises on anxiety and depression in hemodialysis

Renal replacement therapy is associated with reduced physical activity. The aim of the study was to assess the relationship between regular physical activity performed with the use of virtual reality and the occurrence of symptoms of anxiety and depression in hemodialysis patients. The study involved 85 patients from the dialysis station at the Department of Nephrology, Transplantology and Internal Medicine PUM. The examined patients were randomly divided into study group and control group. The study group consisted of patients undergoing renal replacement therapy by hemodialysis, whose task was to perform VR exercises using the prototype of the NefroVR system for 20 min during hemodialysis. The control group consisted of patients undergoing renal replacement therapy by hemodialysis who were not assigned an intervention. An intragroup analysis was performed for the Beck and GAD scales. After the end of the exercise cycle in the study group there was a decrease in the score while in the control group there was an increase in comparison to the first result. The research showed that after a 3-month exercises on a bicycle with the use of low-intensity virtual reality, a decrease in depression symptoms measured by the Beck Depression Inventory was observed. The research showed that regular physical activity using virtual reality may be associated with a reduction in the occurrence of anxiety and depression symptoms in patients included in the chronic hemodialysis program.

Age and sex differences in the effectiveness of intradialytic resistance training on muscle function

Previous research shows the beneficial effects of an intradialytic resistance training (IRT) on muscle function in haemodialysis patients. However, patients vary highly in their functional responses to IRT, may be due to effects of age and sex heterogeneities in adaptation. Therefore, the aim of this study was to investigate the degree to which the effects of IRT on the muscle function of haemodialysis patients vary by age and sex. We included 57 patients who completed a 12-week IRT (EXG) and 33 patients who received no IRT (CNG) during haemodialysis. Muscle function (MF) was assessed using dynamometry before and after a 12-week intervention and after a 12-week follow-up. After the 12-week intervention, we found a moderation effect of age in the relative (%) change (p = 0.011) and absolute (Δ) change (p = 0.027) of MF, and a moderation effect of sex in %MF (p = 0.001), but not in ΔMF (p = 0.069). Regarding patients' age, the change of MF was only significantly different between EXG and CNG patients aged 60-70 years (%MF, EXG: + 34.6%, CNG: - 20.1%, p < 0.001; ΔMF, EXG: + 44.4 N, CNG: - 22.1 N, p < 0.001). Regarding patients' sex, the change of MF was only significantly different between EXG and CNG female patients (%MF, EXG: + 23.9%, CNG: - 23.6%, p < 0.001). Age and sex did not significantly moderate changes in MF measures after 12 weeks of follow-up. We conclude that both age and sex of haemodialysis patients affect their functional response to IRT in the short term.Trial Registration: Intradialytic Resistance Training in Haemodialysis Patients (IRTHEP)-#NCT03511924, 30/04/2018, https://clinicaltrials.gov/ct2/show/NCT03511924 .

Importance of physical exercise prescription in patients with chronic kidney disease: results of the survey of the Grupo Español Multidisciplinar de Ejercicio Físico en el Enfermo Renal [Spanish Multidisciplinary Group of Physical Exercise in Kidney Patients] (GEMEFER)

INTRODUCTION

Despite the benefits of physical exercise (PE) for patients with chronic kidney disease (CKD), the number of Nephrology services that have PE programs is limited.

OBJECTIVES

To describe the degree of knowledge of PE benefits in patients with CKD among professionals, as well as the level of implementation and characteristics of PE programs in Nephrology services in Spain.

METHODS

A questionnaire on the degree of knowledge and prescription of PE in patients with CKD was designed and sent to members of the Spanish Nephrology and Nephrology Nursing Societies, as well as to physiotherapists and professionals in the Sciences of Physical Activity and Sport (PASS).

RESULTS

264 professionals participated. 98.8% agreed on the importance of prescribing PE, but only 20.5% carry out an assessment of functional capacity and 19.3% have a PE program for patients with CKD in their centre. The most frequent programs are performed for haemodialysis patients and strength and aerobic resistance exercises are combined. A physiotherapist or a PASS usually participates in its prescription. The main barriers were the absence of human and/or physical resources and the lack of training.

CONCLUSIONS

Healthcare workers know the benefits of PE in patients with CKD. However, the implementation of these programs in Spain is low, motivated by the lack of resources and training of professionals. We must establish strategies to guarantee an adequate functional capacity within the care of our patients.

Comparative efficacy of exercise modalities for cardiopulmonary function in hemodialysis patients: A systematic review and network meta-analysis

Background

To provide reliable evidence to exercise rehabilitation therapists and clinicians, we compared and analyzed the effects of different exercise modalities on cardiopulmonary function in hemodialysis patients using Bayesian network meta-analysis.

Methods

PubMed, OVID, Web of Science, Cochrane Library, Embase, Scopus, CINAHL, SPORT Discus, SinoMed, CNKI, Wanfang, and VIP were searched from inception to July 20, 2022. We included randomized controlled trials comparing 12 exercise modalities to improve cardiorespiratory fitness in hemodialysis patients. All statistical analysis was performed using STATA and R.

Result

A total of 82 randomized controlled trials involving 4146 maintenance hemodialysis patients were included in this study. The pair-wise meta-analysis showed that all exercise modalities had a positive effect on all indicators of cardiorespiratory capacity. The network meta-analysis demonstrated that Blood flow restriction training (BFRT), Cycle exercise (CE), Inspiratory muscle training (IMT), Combined aerobic and resistance training (CT), and Aerobic training (AT) were significantly better than usual care for 6-min walkability; Medium intensity continuous training (MICT), CT, CE, and AT were considerably better than usual care for VO₂Peak; body and mind training (MBT) and CT significantly improved SBP compared to usual care; and only MBT was significantly better than usual care for DBP. Both the two-dimensional plot and the radar plot demonstrated that CT had the best combined-effect on each index of cardiorespiratory fitness. Subgroup and sensitivity analyses demonstrated the robustness of the results. The evidence was mainly "low" to "very low" for this network meta-analysis.

Conclusion

There is no one exercise that can achieve the best effect on all of the outcomes. The benefits of MBT in decreasing arterial blood pressure are unsurpassed by other exercise methods. The intervention effect of the CT is better and more stable. Electrical muscle stimulation training (MEST) can be employed in individuals who do not wish to exercise actively but may cause an increase in blood pressure. On the basis of the characteristics of different exercise types, guidelines developers, clinicians, and patients may employ them appropriately.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/#recordDetails.

Effect of intradialytic exercise on geriatric issues in older patients undergoing hemodialysis: a single-center non-randomized controlled study

PURPOSE

This study investigated the effect of 1 year of intradialytic exercise on older hemodialysis patients with geriatric issues.

METHODS

Forty-six patients aged ≥ 70 years were non-randomly assigned to two groups (exercise group: 27, control group: 19). Intradialytic exercise consisted of 30 min of aerobic exercise using a cycle ergometer, and resistance training comprising four exercises using an elastic tube three times per week for 1 year. Handgrip strength, leg extremity muscle strength, 10-m walk speed, short physical performance battery, serum albumin, Geriatric Nutritional Risk Index (GNRI), geriatric depression scale, frailty, and mobility were each assessed before and after the intervention.

RESULTS

The control group exhibited a significant reduction in handgrip strength, 10-m walking speed, serum albumin, and GNRI after intervention compared to baseline (p < 0.05). Conversely, no significant reductions were observed in the exercise group. The ΔGNRI (effect size, 0.69; 95% confidence interval [CI]  - 5.21, - 0.1; p < 0.05) and Δserum albumin (effect size, 0.72; 95% CI - 0.31, - 0.02; p < 0.05) before and after the intervention declined significantly less in the exercise group than in the control group. Other between-group values were not significantly different. The number of frail patients and patients requiring walking assistance exhibited no significant intra-group or between-group differences before and after the intervention.

CONCLUSION

Intradialytic exercise prevented the worsening of nutritional status and physical function in the exercise group compared to the control group. Exercise therapy during dialysis is an important aspect of patient care that helps prevent functional decline in older patients.

Impact of measurement timing on reproducibility of testing among haemodialysis patients

Accurate evaluation of physical function in patients undergoing haemodialysis is crucial in the analysis of the impact of exercise programs in this population. The aim of this study was to evaluate the reproducibility of several physical functional tests, depending on the timing of their implementation (before the HD session vs. non-HD days). This is a prospective, non-experimental, descriptive study. Thirty patients in haemodialysis were evaluated twice, 1 week apart. The test session was performed before the haemodialysis session started and a retest was performed in non-dialysis day. The testing battery included the short physical performance battery, sit-to-stand tests, 6 min walk test, one-leg stand test, timed up and go, and handgrip strength with and without forearm support. The intra-rater reproducibility was determined by the intraclass correlation coefficients and the agreement was assessed by Bland–Altman analysis. The intraclass correlation coefficients values ranged from 0.86 to 0.96, so that all tests showed good to very good relative reliability. The mean differences between trials of sit to stand 10 and 60, timed up and go and all the handgrip tests were close to zero, indicating no systematic differences between trials. Large range of values between trials was observed for the 6 min walk test, gait speed, one-leg stand test and short physical performance battery, indicating a systematic bias for these four tests. In conclusion,  the sit to stand 10 and 60, timed up and go and handgrip tests had good to excellent test–retest reliability in measuring physical function in different dialysis days of patients undertaking haemodialysis. The minimal detectable change values are provided for this population. Bias were found for the 6 min walk test, gait speed, Short physical performance battery or one-leg stand test when the testing day changed.

Effects of intradialytic exercise for advanced-age patients undergoing hemodialysis: A randomized controlled trial

Previous reports have shown the benefits of intradialytic exercise to patients undergoing hemodialysis. However, most of those studies assessed the effects of exercise in middle-aged patients and little is known about advanced-age patients undergoing hemodialysis. Therefore, the present randomized controlled trial was performed to determine the effectiveness of exercise therapy in advanced-age patients undergoing hemodialysis. This non-blinded, randomized controlled parallel trial enrolled a total of 101 patients who were randomly assigned to intradialytic exercise (n = 51) or usual care (n = 50) groups. The training program included both resistance and aerobic exercises and was performed three times per week for 6 months. The aerobic exercise intensity was adjusted to a target Borg score of 13 for 20 minutes. Four types of resistance exercises were performed using elastic tubing, with three sets of 10 exercises performed at moderate intensity (13/20 on the Borg scale). The usual care group received standard care. Lower extremity muscle strength, Short Physical Performance Battery score, and 10-m walking speed were the outcomes and were evaluated before the hemodialysis session and after 6 months of training. There were statistically significant improvements in Short Physical Performance Battery score (effect size, 0.57; 95% confidence interval, 0.15‒1.95) in the exercise group relative to the control group. There were no statistically significant differences in lower extremity muscle strength or in the 10-m walking speed between the two groups. These findings suggest that 6 months of intradialytic training could improve physical function in older patients undergoing hemodialysis.

Impact and safety outcomes of an intradialytic physical exercise program

INTRODUCTION

Patients undergoing hemodialysis (HD) are characterized by a poor physical condition and a substantial sedentary profile. The implementation of physical exercise programs in the hemodialysis units is usually limited by the inherent safeness and the lack of appropriate resources.

OBJECTIVES

We aimed to evaluate the impact and safety outcomes of the implementation of an intradialytic physical exercise program (IPE) by a multidisciplinary team (physiotherapist and nursing assistant) in the physical condition of the patients.

MATERIAL AND METHODS

This six months single-centre and experimental pre-post prospective study was carried out in 34 patients. A two day-week combined IPE intervention was implemented. The cardiopulmonary capacity (6MWT), muscular strength (HG, leg dynamometry and 10STS), body composition (bioimpedance) and coordination capacity (Timed Up and Go test) was assessed at the beginning and at the end of the study. Safety was evaluated by means of the number of issues regarding the vascular access, the hemodynamic stability as well as the vascular refilling profile (RBV) in each session. The adhesion to the program was also registered. Additionally, analytical parameters were recorded.

RESULTS

The adhesion to an IPE program was high (70.8%). A significant improvement of the cardiopulmonary capacity (6MWT average increase 47 m; p < 0.001), superior limbs (HG average increase of 1.6 kg; p = 0.007) as well as the lower extremities (10STS; p = 0.003; dynamometry p < 0.05). Regarding safeness, there were no incidences neither significant difference in the RBV.

CONCLUSIONS

A combined IPE may contribute to the improvement of the physical condition of the patients as well as ensures a safe development of the HD treatment. We suggest a multidisciplinary team in order to efficiently establish an IPE program.

Impact and safety outcomes of an intradialytic physical exercise program

INTRODUCTION

Patients undergoing hemodialysis (HD) are characterized by a poor physical condition and a substantial sedentary profile. The implementation of physical exercise programs in the hemodialysis units is usually limited by the inherent safeness and the lack of appropriate resources.

OBJECTIVES

We aimed to evaluate the impact and safety outcomes of the implementation of an intradialytic physical exercise program (IPE) by a multidisciplinary team (physiotherapist and nursing assistant) in the physical condition of the patients.

MATERIAL AND METHODS

This six months single-centre and experimental pre-post prospective study was carried out in 34 patients. A two day-week combined IPE intervention was implemented. The cardiopulmonary capacity (6MWT), muscular strength (HG, leg dynamometry and 10STS), body composition (bioimpedance) and coordination capacity (Timed Up and Go test) was assessed at the beginning and at the end of the study. Safety was evaluated by means of the number of issues regarding the vascular access, the hemodynamic stability as well as the vascular refilling profile (RBV) in each session. The adhesion to the program was also registered. Additionally, analytical parameters were recorded.

RESULTS

The adhesion to an IPE program was high (70.8%). A significant improvement of the cardiopulmonary capacity (6MWT average increase 47m; p<0.001), superior limbs (HG average increase of 1.6kg; p=0.007) as well as the lower extremities (10STS; p=0.003; dynamometry p<0.05). Regarding safeness, there were no incidences neither significant difference in the RBV.

CONCLUSIONS

A combined IPE may contribute to the improvement of the physical condition of the patients as well as ensures a safe development of the HD treatment. We suggest a multidisciplinary team in order to efficiently establish an IPE program.

Resultados de un programa de ejercicio físico domiciliario en pacientes con enfermedad renal

Introducción: Cada vez es más frecuente la literatura que nos muestra los beneficios de los programas de ejercicio físico para mejorar la capacidad funcional y la calidad de vida relacionada con la salud de los pacientes con enfermedad renal crónica. Sin embargo, la implementación de estos programas no es una tarea fácil. Objetivo: Evaluar la efectividad de un programa de ejercicio físico domiciliario sobre la fuerza de agarre de las manos, capacidad funcional y calidad de vida en pacientes con enfermedad renal crónica avanzada en estadíos 4-5. Material y Método: Estudio prospectivo experimental. Los pacientes realizaron un programa completo de ejercicio domiciliario de 3 sesiones semanales durante 12 semanas. Principales datos analizados: dinamometría manual (HG) y la prueba Short Physical Performance Battery (SPPB) y calidad de vida mediante el Euroqol 5D. Resultados: 62 pacientes incluidos. 34 eran hombres con una edad media 67,4 ±14,9 años. La velocidad de la marcha en 4metros aumentó en 0,18 m/s (IC95% 0,08–0,28). Los resultados del SPPB aumentaron en 1,4 puntos (IC95% 0.6–2,2 puntos). No se observan cambios significativos ni en la dinamometría manual (de 26,1Kg a 26,4Kg) ni en la calidad de vida relacionada con la salud (de 67,8 a 71,3 puntos). Conclusión: Un programa de ejercicio físico domiciliario de 12 semanas de duración fue seguro y mejoró la capacidad funcional de los pacientes en enfermedad renal crónica avanzada en estadíos 4-5.

The Effects of Exercise Training on Physical Performance and Self-efficacy in Hemodialysis Patients: A Randomized Controlled Clinical Trial

BACKGROUND

Hemodialysis patients are faced with challenges in carrying out their daily activities. Self-efficacy is a social cognitive concept that can affect behavioral control in these patients. Hence, the purpose of the present study was to investigate the effects of exercise training on physical performance and self-efficacy in hemodialysis patients.

MATERIALS AND METHODS

This randomized controlled clinical trial was conducted on 60 hemodialysis patients who visited hospitals affiliated to Mazandaran University of Medical Sciences in Sari, Iran. The participants were randomly divided into two groups. The patients in the intervention/exercise group received the 8-week exercise program. Patients in the control group received routine care. The Six-Minute Walk Test (6MWT) was used to assess the patients' functional ability and the Exercise Self-Efficacy Scale (ESES) and Chronic Disease Self-Efficacy Scale (CDSES) were used to assess their self-efficacy before and 2 and 8 weeks after the intervention. For statistical analysis, independent t-test and paired t-test were used.

RESULTS

The comparison of self-efficacy between the exercise group and control group after 8 weeks of intervention showed a significant difference between the groups in terms of the CDSES (F1,43= 22.92, p < 0.001) and ESES (F1,38= 10.84, p < 0.001) results. Moreover, the comparison of mean distance walked based on the 6MWT showed significant changes in this variable (F1= 2.05, p = 0.015).

CONCLUSIONS

The designed exercise program can improve self-efficacy and physical performance in hemodialysis patients. This intervention is recommended for hemodialysis patients due to its effectiveness, simplicity, and uncomplicated characteristics.

Effect of a Supervised Peridialytic Exercise Program on Serum Asymmetric Dimethylarginine in Maintenance Hemodialysis Patients

End-stage renal disease (ESRD) patients treated with maintenance haemodialysis (MHD) have alarmingly high atherosclerotic cardiovascular disease morbidity and mortality. Nitric oxide (NO) is the principal endogenous antiatherosclerotic molecule. Increased asymmetric dimethylarginine (ADMA), an endogenous NO synthase inhibitor, was strongly implicated in endothelial dysfunction, premature atherosclerosis, vascular events, and mortality. Regular physical exercise effectively decreased serum ADMA in several patient cohorts, but this potential benefit has not been specifically explored among MHD patients. Forty-four middle-aged ESRD patients treated with thrice-weekly MHD for ≥6 months completed a 6-months regimen of peridialytic lower limb exercise comprising predialytic 10-12 stretching cycles and 20-30 minutes of intradialytic pedaling cycles. Before and after the study, predialytic haemoglobin, serum ADMA, urea, creatinine, calcium, phosphorus, and C-reactive protein (CRP) were measured. Dialysis adequacy was assessed by single-pool Kt/V. The average total physical activity (PA) level was assessed by the International Physical Activity Questionnaire (IPAQ). P values <0.05 denoted a statistical significance. The overall level of PA, on both categorical and continuous scales, has significantly increased after application of the exercise program. However, S. ADMA increased from a median of 2375 to 3000 ng/mL (P=0.016). Thirty-one patients sustained an increase in S. ADMA (ADMA_Inc), whereas 13 patients had a declining or stable S. ADMA (ADMA_Dec). Compared with ADMA_Inc, ADMA_Dec patients had significantly higher Kt/V (P=0.02), higher grade of the basal general PA level (P=0.017), and significantly fewer intradialytic hypotension episodes (IDHs) (P=0.019). The increase in the S. ADMA and the poststudy S. ADMA level had statistically significant positive correlations with the number of IDHs (r = 0.401, P=0.007 and r = 0.305, P=0.044, respectively). A 6-month program of combined aerobic and resistance peridialytic exercise failed to reduce S. ADMA in most MHD patients studied. A modest S. ADMA decline, however, occurred in patients with higher basal PA levels, higher Kt/V, and less IDHs. A potential exercise benefit may be promoted by a multidisciplinary approach targeting increased PA, improved dialysis efficiency, and prevention of IDHs.

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

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

Uremic Sarcopenia: Clinical Evidence and Basic Experimental Approach

Sustained physical activity extends healthy life years while a lower activity due to sarcopenia can reduce them. Sarcopenia is defined as a decrease in skeletal muscle mass and strength due not only to aging, but also from a variety of debilitating chronic illnesses such as cancer and heart failure. Patients with chronic kidney disease (CKD), who tend to be cachexic and in frail health, may develop uremic sarcopenia or uremic myopathy due to an imbalance between muscle protein synthesis and catabolism. Here, we review clinical evidence indicating reduced physical activity as renal function deteriorates and explore evidence-supported therapeutic options focusing on nutrition and physical training. In addition, although sarcopenia is a clinical concept and difficult to recapitulate in basic research, several in vivo approaches have been attempted, such as rodent subtotal nephrectomy representing both renal dysfunction and muscle weakness. This review highlights molecular mechanisms and promising interventions for uremic sarcopenia that were revealed through basic research. Extensive study is still needed to cast light on the many aspects of locomotive organ impairments in CKD and explore the ways that diet and exercise therapies can improve both outcomes and quality of life at every level.

Comparison of intradialytic versus home-based exercise programs on physical functioning, physical activity level, adherence, and health-related quality of life: pilot study

Intradialytic exercise (ID) programs are effective and safe for hemodialysis (HD) patients to avoid functional deterioration. However, exercise is not routinely undertaken in most HD units, and we do not know if home-based (HB) programs are as effective as ID programs. The purpose of this study was to compare the effects of 16 weeks of ID exercise versus a HB exercise program for HD patients. A total of 46 patients were randomly assigned to the ID group (n = 24) or HB group (n = 22). They completed a 16-week combined exercise program 3 times/week. We measured physical activity level, physical functioning, depression level, and health-related quality of life at baseline and after 16 weeks. A significant time effect was found in both groups for the physical activity level (p = 0.012). There was also a significant group-time interaction effect for the one-leg standing test (OLST) (p = 0.049) and a significant time effect for the Short Physical Performance Battery (p = 0.013), timed up-and-go test (p = 0.005), sit-to-stand-10 (p = 0.027), right and left hand handgrip (p = 0.044, p < 0.001), one-heel left leg raise (p = 0.019), and 6-minute walking (p = 0.006), depression (p = 0.017). HRQoL remained unchanged. There was no difference between the two interventions on the tested outcomes (besides OLST). Both interventions were associated with positive changes of the physical activity levels and physical function.

Training with elastic and conventional devices on body composition: systematic review and meta-analysis

Abstract Introduction: Given the practicality and low cost of elastic devices, a comparison with conventional devices may be able to quantify gains from both tools for further conclusions. Objective: Compare the effect of resistance training with elastic (tubes and resistance band) and conventional (weight machines and dumbbells) devices on body composition. Method: This is a systematic review and meta-analysis. The PubMed/MEDLINE, Embase, PEDro and CENTRAL databases were searched from the earliest records to July 25, 2018. Data were described in standardized mean difference (SMD) with a 95% confidence interval (95% CI). Results: Four studies were included. The results of the meta-analysis did not show superiority among the analyzed methods for the variables investigated (SMD = -2.04, 95% CI -7.56, 3.48, p < 0.00001, lean mass: SMD = 0.28, 95% CI -0.29, 0.85, p = 0.97, body fat: SMD = 2.77, 95% CI -0.05, 5.59, p = 0.92, body mass: SMD = 1.22, 95% CI -0.29, 2.74, p = 0.11). Conclusion: The results of the meta-analysis showed superiority of outcome from training in conventional devices only for the variable fat mass. For the other variables, no statistically significant differences were found. Elastic resistance can promote similar outcomes to resistance in different population profiles and from various protocols on variables related to body composition.

Opinión de los pacientes tras un programa de ejercicio físico domiciliario

Introducción. Las personas con enfermedad renal deben recibir una atención integral que incluya programas de ejercicio físico adaptado a sus necesidades. Objetivo. Evaluar la satisfacción de los pacientes con enfermedad renal crónica en estadios IV y V ante un programa de ejercicio físico domiciliario. Material y métodos. Estudio descriptivo transversal en pacientes que realizaron un programa completo de entrenamiento físico domiciliario de 12 semanas de duración. Tras esta intervención, respondieron de forma anónima a un cuestionario ad-hoc validado por expertos, sobre su opinión acerca del programa. Resultados. Participaron 62 pacientes. 24 estaban en programa de hemodiálisis, 17 en diálisis peritoneal y 7 en situación de enfermedad renal crónica estadio IV. 34 eran hombres. La edad media fue de 67,4±14,9 años. 52 pacientes realizaron el programa solos en su domicilio. 33 de los pacientes les pareció muy correcto que el programa fuera domiciliario, 15 correcto y 2 poco correcto. 47 de los participantes consideraron muy correcto que la persona que dirigiera el programa fuera una enfermera conocida. 19 consideró que tras el programa habían mejorado mucho, 14 que habían mejorado, 9 que habían mejorado poco y 3 que no habían mejorado. 39 estuvieron muy satisfechos de haber podido participar en el programa, 6 satisfechos, 1 poco satisfecho y 1 de los pacientes no estuvo satisfecho. No hubo diferencias significativas en las respuestas en relación al sexo, edad, tipo de tratamiento, o realizar el programa solo o acompañado. Conclusiones. 

A Review of the Development and Application of Generic Preference-Based Instruments with the Older Population

Older people (aged 65 years and over) are the fastest growing age cohort in the majority of developed countries, and the proportion of individuals defined as the oldest old (aged 80 years and over) living with physical frailty and cognitive impairment is rising. These population changes put increasing pressure on health and aged care services, thus it is important to assess the cost effectiveness of interventions targeted for older people across health and aged care sectors to identify interventions with the strongest capacity to enhance older peoples' quality of life and provide value for money. Cost-utility analysis (CUA) is a form of economic evaluation that typically uses preference-based instruments to measure and value health-related quality of life for the calculation of quality-adjusted life-years (QALYS) to enable comparisons of the cost effectiveness of different interventions. A variety of generic preference-based instruments have been used to measure older people's quality of life, including the Adult Social Care Outcomes Toolkit (ASCOT); Health Utility Index Mark 2 (HUI2); Health Utility Index Mark 3 (HUI3); Short-Form-6 Dimensions (SF-6D); Assessment of Quality of Life-6 dimensions (AQoL-6D); Assessment of Quality of Life-8 dimensions (AQoL-8D); Quality of Wellbeing Scale-Self-Administered (QWB-SA); 15 Dimensions (15D); EuroQol-5 dimensions (EQ-5D); and an older person specific preference-based instrument-the Investigating Choice Experiments Capability Measure for older people (ICECAP-O). This article reviews the development and application of these instruments within the older population and discusses the issues surrounding their use with this population. Areas for further research relating to the development and application of generic preference-based instruments with populations of older people are also highlighted.

Attitudes of hemodialysis patients, medical and nursing staff towards patients' physical activity

PURPOSE

Patients with end-stage renal disease (ESRD) seem to have a negative attitude towards physical activity, which is mainly favored by the lack of counseling provided by the medical and nursing staff. The aim of this study was to investigate the attitudes of both ESRD patients and medical staff on the participation and promotion of physical activity and identify the obstacles that discourage patients' involvement in intervention programs.

STUDY DESIGN

Subjective assessment questionnaires and the International Physical Activity Questionnaire were administrated to hemodialysis patients and medical staff, to investigate the association between patient's barriers to physical activity, the total intensity level of physical activity, and attitudes of both ESRD patients and medical staff on the participation and promotion of physical activity.

RESULTS

A total of 103 ESRD patients (61 men, 59.2%), 20 nephrologists (12 men, 60.0%), and 72 nurses (61 women, 84.7%) participated in the study. Most commonly reported patient's barriers were fatigue on dialysis (97.4%) and non-dialysis days (55.1%). Healthcare staff showed positive attitude towards renal rehabilitation exercise programs. However, most of physicians (85.0%) and nurses (83.3%) did not have previous experience with interventional exercise rehabilitation programs. Binary logistic regression revealed significant association between patients' inactivity, demographic data, and barriers towards physical activity, such as fatigue and pain in dialysis and non-dialysis days (p < 0.05), family's and physician's concern (p < 0.05), too many medical problems (p < 0.05), the fear of getting hurt (p = 0.01), and unwillingness for exercise (p < 0.05). Interestingly, healthcare staff's negative attitudes toward patient's physical activity seem to be strongly associated with patient's inactivity status.

CONCLUSION

Healthcare staff negative attitudes and multiple related barriers especially fatigue on dialysis and non-dialysis days, towards ESRD patient's physical activity, suppress desire for exercise and active patients' status, leading them to abstain from it.

Frailty, Quality of Life, Anxiety, and Other Factors Affecting Adherence to Physical Activity Recommendations by Hemodialysis Patients

Hemodialysis patients perform little physical activity. We formulated a hypothesis that some factors, i.e., frailty, medical and functional factors, psychological factors, quality of life, awareness of recommendations, and sociodemographic factors influence the decisions of taking up physical activity. This prospective study comprised 72 dialysis patients aged 57.8 ± 16.0 ( x ¯ ± SD; in the range of 19-87 years of age). The following research tools were used: an interview about awareness of the physical activity recommendations, the Canadian Study of Health and Aging Scale (CSHA-CFS), scales for the assessment of functional status, State-Trait Anxiety Inventory (STAI), Acceptance of Illness Scale (AIS), and the questionnaire of Kidney Disease Quality of Life (KDQOL-SF 1.3). The majority of patients diagnosed with frailty did not follow the physical activity recommendations (79.3%). Quality of life was better in active patients compared to inactive patients, especially in the domains of sleep and physical performance. The severity of trait anxiety was significantly higher in patients who did not follow the recommendations compared to patients who adhered to physical activity recommendations (46.0 ± 10.5 vs. 40.0 ± 8.2; p = 0.021 ). The likelihood of adherence decreased by 1% after each subsequent month of dialysis (odds ratio = 0.99; 95% confidence interval = 0.972-0.999; p = 0.047 ). Adherence was most limited by frailty. Adherence to recommendations on physical activity was affected by: motivation, lower levels of trait anxiety, and better quality of life. Age modified the effect of awareness and acceptance of the disease on adherence to physical activity recommendations.

Physical activity increases the resistin concentration in hemodialyzed patients without metabolic syndrome

BACKGROUND

Resistin (RES) concentration increases in end-stage renal disease patients. However, there have been no studies defining the role of physical activity in RES concentrations in hemodialyzed (HD) patients. This study was aimed to determine metabolic and inflammatory effects, including RES, of 4-week supervised rehabilitation program in HD patients, with or without metabolic syndrome (MS).

METHODS

The study was completed by 28 patients aged 56.9±13.3 years ( x ¯ ± SD ) who were HD for 50.6±73.4 months, and 30 controls aged 61.5±8.3 years with normal renal function. Both the groups were divided into two subgroups with respect to MS. Individualized supervised rehabilitation program based on physiotherapy, including exercises, was provided to each subject for 4 weeks. Baseline and post-intervention complete blood count, glycated hemoglobin (HbA1c) and levels of serum RES, leptin, adiponectin, cystatin C, erythropoietin, high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor alpha (TNF-α), interleukin-6, transforming growth factor- β1, plasminogen activator inhibitor-1 homocysteine, insulin, albumin, parathyroid hormone (PTH), and phosphorus were measured.

RESULTS

Compared to controls, HD patients showed higher baseline leucocytes count and higher serum concentrations of RES, leptin, cystatin C, hs-CRP, TNF-α, homocysteine, phosphorus, PTH while hemoglobin, glucose, and albumin concentrations. A positive correlation between serum albumin and RES concentrations was observed in HD patients. Post-intervention RES increase was observed in HD patients without MS (post-intervention 34.22±8.89 vs baseline 30.16±11.04 ng/mL; P=0.046) while no change was observed in patients with MS and in the control group.

CONCLUSION

MS modifies a RES response to the rehabilitation program in HD patients.

Influence of Physical Exercise on the Dialytic Adequacy Parameters of Patients on Hemodialysis

It has been suggested that physical exercise in chronic hemodialysis could improve dialysis dose and reduce postdialysis rebound. A randomized controlled trial was performed to compare a group of patients doing physical exercise during the first 2 h of hemodialysis sessions and another group doing physical exercise at home. The descriptive variables, dialysis doses measured by KtV, and rebounds (urea, creatinine, potassium, phosphorus), were recorded. For 69 patients: the mean KtV was 1.84; the 30-min rebound of creatinine was 32.37%, urea 24.39%, potassium 15.31%, and phosphorus 51.29%. For each patient, the basal measurement was compared with those determined when performing physical exercise; no statistically significant differences were observed between the changes determined to dose and rebound in the group with hemodialysis exercise compared to those of the home exercise group. In conclusion, performing physical exercise during the first 2 hours of hemodialysis sessions neither lowered postdialysis molecules rebound nor improved dialysis dose.

Physical Activity Dose for Hemodialysis Patients: Where to Begin? Results from a Prospective Cohort Study

OBJECTIVE

Greater physical activity is associated with lower risk of mortality in persons with kidney disease; however, little is known about the appropriate dose of physical activity among hemodialysis patients. Here detected the minimum level of habitual physical activity to help inform interventions aimed at improving outcomes in the dialysis population.

DESIGN

The design was prospective cohort study.

SUBJECTS

Clinically stable outpatients in a hemodialysis unit from October 2002 to March 2014 were assessed for their eligibility to be included in this 7-year prospective cohort study. We used the Youden index to determine the optimal cutoff points for physical activity. The prognostic effect of physical activity on survival was estimated by Cox proportional hazards regression analysis. The number of steps per nondialysis day was recorded by accelerometer at study entry.

MAIN OUTCOME MEASURE

The main outcome measure was all-cause mortality.

RESULTS

There were 282 participants who had a mean age of 65 ± 11 years and 45% were female. A total of 56 deaths occurred during the follow-up period (56 months [interquartile range: 29-84 months]). The cutoff value for the physical activity discriminating those at high risk of mortality was 3,752 steps. After adjustment for the effect of confounders, the hazard ratio in the group of <4,000 steps was 2.37 (95% confidence interval: 1.22-4.60, P = .01) compared with the others.

CONCLUSIONS

Engaging in physical activity is associated with decreased mortality risk among hemodialysis patients. Our findings of a substantial mortality benefit among those who engage in at least 4,000 steps provide a basis for as a minimum initial recommendation kidney health providers can provide for mobility disability-free hemodialysis patients.

Exercise Training in Elderly People Undergoing Hemodialysis: A Systematic Review and Meta-analysis

Introduction

Previous reviews have indicated the effectiveness of exercise in people undergoing hemodialysis. However, these analyses did not take into account whether the subjects were elderly. We performed a systematic review of the effects of exercise training in elderly people undergoing hemodialysis and updated the evidence of exercise for people undergoing hemodialysis by adding recent research data.

Methods

We searched 8 electronic databases up to June 2016. Inclusion criteria were as follows: randomized controlled trial, English publication, subjects aged 18 and older undergoing hemodialysis, evaluation of physical function as an outcome of exercise intervention. We defined elderly as age 60 years and older. The main outcomes were exercise tolerance (peak/maximum oxygen consumption) and walking ability (6-minute walk distance). Secondary outcomes were lower extremity muscle strength and quality of life.

Results

After screening of 10,923 references, 30 comparisons were entered into the analysis. However, because we found only 1 study in which elderly subjects were treated, we could not perform a meta-analysis for these people. For the general population undergoing hemodialysis, supervised exercise training was shown to significantly increase peak/maximum oxygen consumption (standard mean difference, 0.62; 95% confidence interval 0.38-0.87; P < 0.001), 6-minute walk distance (standard mean difference, 0.58; 95% confidence interval 0.24-0.93; P < 0.001), lower extremity muscle strength (standard mean difference, 0.94; 95% confidence interval 0.67-1.21; P < 0.001), and quality of life (standard mean difference, 0.53; 95% confidence interval 0.52-0.82; P < 0.001).

Discussion

Our analysis on the effectiveness of exercise training in elderly people undergoing hemodialysis as compared with nonelderly people was somewhat inconclusive. Future studies should be carried out for elderly people to identify the most favorable exercise program for this population.