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Liu X, Chen S, Liu C, Dang X, Wei M, Xin X, Gao J. Novel risk-factor analysis and risk-evaluation model of falls in patients receiving maintenance hemodialysis. Ren Fail 2023; 45:2182608. [PMID: 36856312 PMCID: PMC9980417 DOI: 10.1080/0886022x.2023.2182608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
This study investigated the prevalence of falls in maintenance hemodialysis (MHD) patients, and established a nomogram model for evaluating the fall risk of MHD patients. This study enrolled 303 MHD patients from the dialysis department of a tertiary hospital in July 2021. The general data of the participants, as well as the scores on the FRAIL scale, Sarcopenia Screening Questionnaire (SARC-F), Short Physical Performance Battery (SPPB) Scale, and of anxiety and depression, and the occurrence of falls were recorded. Using R language, data were assigned to the training set (n = 212) and test set (n = 91), and a logistic regression model was established. The regression model was verified by the receiver operating characteristic (ROC) curve, area under the curve (AUC), and the calibration curve. As a result, the prevalence of falls in MHD patients was 20.46%. Risk factors for falls in the optimal multivariate logistic regression model included hearing impairment, the depression score, and the SPPB score, of which a higher depression score (odds ratio (OR): 1.28, 95% confidence interval (CI): 1.09-1.49, p = 0.002) and SPPB ≤ 6 (ORvsSPPB9-12: 3.69, 95% CI: 1.04-13.14, p = 0.043) conferred independent risk for falls. AUC of the nomogram in the training was 0.773, which in the test group was 0.663. The calibration and standard curves were fitted closely, indicated that the evaluation ability of the model was good. Thus, a higher depression score and SPPB ≤ 6 are independent risk factors for falls in MHD patients, and the nomogram with good accuracy and discrimination that was established in this study has clinical application value.
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Affiliation(s)
- Xiaomin Liu
- Department of Dialysis, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People’s Republic of China
| | - Sijie Chen
- Medical School of Yan'an University, Xi'an, People’s Republic of China
| | - Caifei Liu
- Medical School of Yan'an University, Xi'an, People’s Republic of China
| | - Xilong Dang
- Department of Dialysis, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People’s Republic of China
| | - Meng Wei
- Department of Dialysis, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People’s Republic of China
| | - Xia Xin
- Nursing Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People’s Republic of China
| | - Julin Gao
- Department of Dialysis, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People’s Republic of China,CONTACT Julin Gao Department of Dialysis, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People’s Republic of China
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2
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Bennett PN, Kohzuki M, Bohm C, Roshanravan B, Bakker SJL, Viana JL, MacRae JM, Wilkinson TJ, Wilund KR, Van Craenenbroeck AH, Sakkas GK, Mustata S, Fowler K, McDonald J, Aleamañy GM, Anding K, Avin KG, Escobar GL, Gabrys I, Goth J, Isnard M, Jhamb M, Kim JC, Li JW, Lightfoot CJ, McAdams-DeMarco M, Manfredini F, Meade A, Molsted S, Parker K, Seguri-Orti E, Smith AC, Verdin N, Zheng J, Zimmerman D, Thompson S. Global Policy Barriers and Enablers to Exercise and Physical Activity in Kidney Care. J Ren Nutr 2022; 32:441-449. [PMID: 34393071 PMCID: PMC10505947 DOI: 10.1053/j.jrn.2021.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 06/06/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Impairment in physical function and physical performance leads to decreased independence and health-related quality of life in people living with chronic kidney disease and end-stage kidney disease. Physical activity and exercise in kidney care are not priorities in policy development. We aimed to identify global policy-related enablers, barriers, and strategies to increase exercise participation and physical activity behavior for people living with kidney disease. DESIGN AND METHODS Guided by the Behavior Change Wheel theoretical framework, 50 global renal exercise experts developed policy barriers and enablers to exercise program implementation and physical activity promotion in kidney care. The consensus process consisted of developing themes from renal experts from North America, South America, Continental Europe, United Kingdom, Asia, and Oceania. Strategies to address enablers and barriers were identified by the group, and consensus was achieved. RESULTS We found that policies addressing funding, service provision, legislation, regulations, guidelines, the environment, communication, and marketing are required to support people with kidney disease to be physically active, participate in exercise, and improve health-related quality of life. We provide a global perspective and highlight Japanese, Canadian, and other regional examples where policies have been developed to increase renal physical activity and rehabilitation. We present recommendations targeting multiple stakeholders including nephrologists, nurses, allied health clinicians, organizations providing renal care and education, and renal program funders. CONCLUSIONS We strongly recommend the nephrology community and people living with kidney disease take action to change policy now, rather than idly waiting for indisputable clinical trial evidence that increasing physical activity, strength, fitness, and function improves the lives of people living with kidney disease.
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Affiliation(s)
- Paul N Bennett
- Medical and Clinical Affairs, Satellite Healthcare, San Jose, California; Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai City, Japan
| | - Clara Bohm
- University of Manitoba, Winnipeg, Canada
| | | | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center MC Groningen, University of Groningen, Groningen, the Netherlands
| | - João L Viana
- Research Center in Sports Sciences, Health Sciences and Human Development, University Institute of Maia, Maia, Portugal
| | - Jennifer M MacRae
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Kenneth R Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | | | - Giorgos K Sakkas
- Cardiff Metropolitan University, Cardiff, UK and University of Thessaly, Volos, Greece
| | - Stefan Mustata
- Faculty of Medicine, University of Calgary, Calgary, Canada
| | | | - Jamie McDonald
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | | | - Kirsten Anding
- Nephrology, KfH Nierenzentrum Bischofswerda, Bischofswerda, Germany
| | - Keith G Avin
- Indiana University Department of Physical Therapy, Indianapolis, Indiana
| | - Gabriela Leal Escobar
- Department of Nephrology Instituto Nacional de Cardiologia Ignacio Chávez, Mexico City, Mexico
| | - Iwona Gabrys
- University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Jill Goth
- Programs & Public Policy, The Kidney Foundation of Canada, Montreal, Quebec, Canada
| | | | | | - Jun Chul Kim
- Division of Nephrology, Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
| | - John Wing Li
- Renal Medicine, Nepean Hospital, Katoomba, New South Wales, Australia
| | | | | | - Fabio Manfredini
- Department of Biomedical Sciences and Surgical specialties, University of Ferrara, Ferrara, Italy
| | | | | | | | - Eva Seguri-Orti
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, Alfara del Patriarca, Valencia, Spain
| | - Alice C Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Jing Zheng
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, P.R. China
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3
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Ekramzadeh M, Santoro D, Kopple JD. The Effect of Nutrition and Exercise on Body Composition, Exercise Capacity, and Physical Functioning in Advanced CKD Patients. Nutrients 2022; 14:nu14102129. [PMID: 35631270 PMCID: PMC9143955 DOI: 10.3390/nu14102129] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022] Open
Abstract
Patients with stages 4 and 5 chronic kidney disease (CKD), and particularly chronic dialysis patients, commonly are found to have substantially reduced daily physical activity in comparison to age- and sex-matched normal adults. This reduction in physical activity is associated with a major decrease in physical exercise capacity and physical performance. The CKD patients are often physically deconditioned, and protein energy wasting (PEW) and frailty are commonly present. These disorders are of major concern because physical dysfunction, muscle atrophy, and reduced muscle strength are associated with poor quality of life and increased morbidity and mortality in CKD and chronic dialysis patients. Many randomized controlled clinical trials indicate that when CKD and chronic dialysis are provided nutritional supplements or undergo exercise training their skeletal muscle mass and exercise capacity often increase. It is not known whether the rise in skeletal muscle mass and exercise capacity associated with nutritional support or exercise training will reduce morbidity or mortality rates. A limitation of these clinical trials is that the sample sizes of the different treatment groups were small. The aim of this review is to discuss the effects of nutrition and exercise on body composition, exercise capacity, and physical functioning in advanced CKD patients.
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Affiliation(s)
- Maryam Ekramzadeh
- Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran;
- Division of Nephrology and Hypertension, Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine, Nephrology and Dialysis, University of Messina, 98100 Messina, Italy;
| | - Joel D. Kopple
- Division of Nephrology and Hypertension, Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
- David Geffen School of Medicine, University of California, Los Angeles UCLA, Los Angeles, CA 90095, USA
- Fielding School of Public Health, University of California, Los Angeles UCLA, Los Angeles, CA 90095, USA
- Correspondence: ; Tel.: +1-310-968-5668
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Usui N, Yokoyama M, Nakata J, Suzuki Y, Tsubaki A, Kojima S, Inatsu A, Hisadome H, Uehata A. Association between social frailty as well as early physical dysfunction and exercise intolerance among older patients receiving hemodialysis. Geriatr Gerontol Int 2021; 21:664-669. [PMID: 34164894 DOI: 10.1111/ggi.14223] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/25/2021] [Accepted: 06/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recently, social frailty has been increasingly recognized as a factor associated with adverse health outcomes, including physical disability and mortality. However, there are no studies about the importance of this factor among hemodialysis patients. Therefore, we investigated the relationship between social frailty and early physical dysfunction in this group of patients. METHODS This was a two-center cross-sectional study. Older patients receiving hemodialysis were prospectively enrolled. Moreover, participants were evaluated for social frailty based on the definition of previous study and for physical function, peak oxygen uptake (peak VO2 ), ventilatory equivalent for carbon dioxide (VE/VCO2 ) slope and heart rate reserve. Then, they were divided into two groups based on the presence of physical frailty. RESULTS Data collected from 158 individuals were statistically analyzed. The prevalence rate of social frailty was 59.5%. In the non-physical frailty group, social frailty was found to be independently associated with reduced gait speed (P = 0.007), leg strength (P = 0.040) and peak VO2 (P = 0.023), but not with hand grip strength (P = 0.36). In the physical frailty group, there was no association between social frailty and physical function. Moreover, in patients without physical and social frailty, physical function was maintained at above accepted threshold levels, whereas peak VO2 (14.1 ± 3.3 mL/kg/min), VE/VCO2 slope (32.3 ± 5.5) and heart rate reserve (50.8% ± 21.7%) were substantially impaired. CONCLUSIONS Patients receiving hemodialysis can present with social frailty and exercise intolerance with cardiac dysfunction in the early phase, which may contribute to subsequent dysfunction. Geriatr Gerontol Int 2021; 21: 664-669.
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Affiliation(s)
- Naoto Usui
- Department of Rehabilitation, Kisen Hospital, Tokyo, Japan.,Department of Nephrology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | | | - Junichiro Nakata
- Department of Nephrology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Sho Kojima
- Department of Rehabilitation, Kisen Hospital, Tokyo, Japan.,Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | | | | | - Akimi Uehata
- Division of Cardiology, Kisen Hospital, Tokyo, Japan
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5
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Hoshino J. Renal Rehabilitation: Exercise Intervention and Nutritional Support in Dialysis Patients. Nutrients 2021; 13:1444. [PMID: 33923264 PMCID: PMC8145577 DOI: 10.3390/nu13051444] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 12/17/2022] Open
Abstract
With the growing number of dialysis patients with frailty, the concept of renal rehabilitation, including exercise intervention and nutrition programs for patients with chronic kidney disease (CKD), has become popular recently. Renal rehabilitation is a comprehensive multidisciplinary program for CKD patients that is led by doctors, rehabilitation therapists, diet nutritionists, nursing specialists, social workers, pharmacists, and therapists. Many observational studies have observed better outcomes in CKD patients with more physical activity. Furthermore, recent systematic reviews have shown the beneficial effects of exercise intervention on exercise tolerance, physical ability, and quality of life in dialysis patients, though the beneficial effect on overall mortality remains unclear. Nutritional support is also fundamental to renal rehabilitation. There are various causes of skeletal muscle loss in CKD patients. To prevent muscle protein catabolism, in addition to exercise, a sufficient supply of energy, including carbohydrates, protein, iron, and vitamins, is needed. Because of decreased digestive function and energy loss due to dialysis treatment, dialysis patients are recommended to ingest 1.2-fold more protein than the regular population. Motivating patients to join in activities is also an important part of renal rehabilitation. It is essential for us to recognize the importance of renal rehabilitation to maximize patient satisfaction.
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Affiliation(s)
- Junichi Hoshino
- Nephrology Center, Toranomon Hospital, Tokyo 105-8470, Japan
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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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7
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Omonaiye O, Smyth W, Nagle C. Impact of virtual reality interventions on haemodialysis patients: A scoping review. J Ren Care 2021; 47:193-207. [PMID: 33491276 DOI: 10.1111/jorc.12362] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/29/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND An understanding of the potential of virtual reality to affect the level of engagement in self-care and health-related quality of life is required for patients receiving haemodialysis. OBJECTIVE This scoping review aimed to collate, summarise, and report on related study findings to identify evidence gaps and draw conclusions from the existing literature. METHODS The methodological steps outlined in the Arksey and O'Malley framework combined with modifications of Levac and colleagues guided this systematic scoping review. MEDLINEComplete, Embase, CINAHLComplete and PsychINFO databases were searched. Additionally, hand searches of key articles and journals were performed. RESULTS From the database searches, 610 studies were identified with 11 meeting the inclusion criteria; another study was added after searching reference lists of included articles, resulting in 12 included articles. The quality, study design and type of virtual reality intervention varied. Only three studies used immersive virtual reality. Several studies demonstrated significant improvement in the physical activity level and a reduction in fatigue in patients during haemodialysis, with no adverse events. Despite the demands of haemodialysis sessions, this study showed that virtual reality interventions may improve the level of haemodialysis patients' adherence and engagement with treatment. CONCLUSIONS Findings favour the use of virtual reality to improve physical health and engagement with treatment. However, there is a need for more rigorous study designs within different clinical settings to provide high-quality evidence regarding other ways that virtual reality interventions could improve the quality of life of haemodialysis patients.
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Affiliation(s)
- Olumuyiwa Omonaiye
- Centre for Nursing and Midwifery Research, James Cook University, Townsville, Queensland, Australia.,School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Burwood, Victoria, Australia
| | - Wendy Smyth
- Centre for Nursing and Midwifery Research, James Cook University, Townsville, Queensland, Australia.,Institute of Health Research and Innovation, Townsville Hospital and Health Service, Douglas, Queensland, Australia
| | - Cate Nagle
- Centre for Nursing and Midwifery Research, James Cook University, Townsville, Queensland, Australia.,Institute of Health Research and Innovation, Townsville Hospital and Health Service, Douglas, Queensland, Australia
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8
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Wilkinson TJ, McAdams-DeMarco M, Bennett PN, Wilund K. Advances in exercise therapy in predialysis chronic kidney disease, hemodialysis, peritoneal dialysis, and kidney transplantation. Curr Opin Nephrol Hypertens 2020; 29:471-479. [PMID: 32701595 PMCID: PMC7526394 DOI: 10.1097/mnh.0000000000000627] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Chronic kidney disease (CKD) is characterized by poor levels of physical activity which contribute to increased morbidity across the disease trajectory. The short nature, small samples, and poor methodology across most studies have failed to translate the role of exercise in CKD into its adoption as a frontline adjunct therapeutic option. This review focuses on recent advances surrounding the benefits of exercise interventions across the CKD spectrum. RECENT FINDINGS Key recent advances in exercise studies have focused on the efficacy of novel intervention strategies across the CKD spectrum. These include high-intensity interval training, virtual reality gaming, intradialytic yoga, electrical stimulation of muscles, blood flow restriction training, and protocols combining exercise with nutritional supplementation. Research is also beginning to explore the role of prehabilitation for patients prior to dialysis and kidney transplantation. SUMMARY Studies continue to demonstrate wide-ranging benefits of exercise across CKD; however, implementation of exercise remains scarce. Future research needs include evaluating the efficacy of larger and/or more comprehensive interventions on clinically important outcomes. It is hoped with increasing global evidence, high-quality clinical studies, and sustained clinician and patient engagement, exercise programs will become better prioritized in the nephrology field.
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Affiliation(s)
- Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mara McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Paul N Bennett
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California, USA
- Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Kenneth Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
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Bennett PN, Hussein WF, Matthews K, West M, Smith E, Reiterman M, Alagadan G, Shragge B, Patel J, Schiller BM. An Exercise Program for Peritoneal Dialysis Patients in the United States: A Feasibility Study. Kidney Med 2020; 2:267-275. [PMID: 32734246 PMCID: PMC7380403 DOI: 10.1016/j.xkme.2020.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND People with end-stage kidney disease receiving peritoneal dialysis (PD) are generally physically inactive and frail. Exercise studies in PD are scarce and currently there are no PD exercise programs in the United States. The primary objective of this study was to test the feasibility of a combined resistance and cardiovascular exercise program for PD patients under the care of a dedicated home dialysis center in the United States. STUDY DESIGN Parallel randomized controlled feasibility study. SETTING & PARTICIPANTS PD patients were recruited from a single center and randomly assigned to the intervention (exercise; n = 18) or control (nonexercise; n = 18) group. INTERVENTION The intervention group received monthly exercise physiologist consultation, exercise prescription (resistance and aerobic exercise program using exercise bands), and 4 exercise support telephone calls over 12 weeks. The control group received standard care. OUTCOMES The primary outcome was study feasibility as measured by eligibility rates, recruitment rates, retention rates, adherence rates, adverse events, and sustained exercise rates. Secondary outcome measures were changes in physical function (sit-to-stand test, timed-up-and-go test, and pinch-strength tests) and patient-reported outcome measures. RESULTS From a single center with 75 PD patients, 57 (76%) were deemed eligible, resulting in a recruitment rate of 36 (63%) patients. Participants were randomly assigned into 2 groups of 18 (1:1). 10 patients discontinued the study (5 in each arm), resulting in 26 (72%) patients, 13 in each arm, completing the study. 10 of 13 (77%) intervention patients were adherent to the exercise program. A t test analysis of covariance found a difference between the treatment groups for the timed-up-and-go test (P = 0.04) and appetite (P = 0.04). No serious adverse events caused by the exercise program were reported. LIMITATIONS Single center, no blinded assessors. CONCLUSIONS A resistance and cardiovascular exercise program appears feasible and safe for PD patients. We recommend that providers of PD therapy consider including exercise programs coordinated by exercise professionals to reduce the physical deterioration of PD patients. FUNDING None. TRIAL REGISTRATION NCT03980795.
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Affiliation(s)
- Paul N. Bennett
- Satellite Healthcare, San Jose, CA
- Deakin University, Melbourne, VIC, Australia
| | - Wael F. Hussein
- Satellite Healthcare, San Jose, CA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | | | - Mike West
- Satellite Wellbound, Sacramento, CA
- College of Health and Human Services, California State University, Sacramento, CA
| | | | | | | | | | | | - Brigitte M. Schiller
- Satellite Healthcare, San Jose, CA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
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10
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Ju A, Scholes-Robertson N, Johnson DW, Cho Y, van Zwieten A, Manera K, Howell M, Viecelli AK, Jesudason S, Evangelidis N, Polkinghorne K, Gutman T, Wyburn K, Craig JC, Tong A, Charalambous A, Beach B, Larkin B, Beach C, Clive C, Dingle D, Thomas D, Blake D, Baker D, Underwood D, McLaren D, Demagante F, Jennings G, Jeff H, Mewburn I, Wooldridge J, Ellis J, Widders K, Young K, McLaren K, Yew K, Ellis M, Blake M, Scholes-Robertson N, Scholes-Robertson N, Grant P, Kennedy P, Walter P, Yew P, Jeff R, Wooldridge W. Patient-led identification and prioritization of exercise interventions for fatigue on dialysis: a workshop report. Clin Kidney J 2020; 14:831-839. [PMID: 34840732 PMCID: PMC8612136 DOI: 10.1093/ckj/sfz200] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/19/2019] [Indexed: 12/04/2022] Open
Abstract
Background Fatigue is one of the most important symptoms among patients receiving dialysis and is nominated as a core outcome to be reported in all clinical trials in this setting. However, few trials of interventions targeting fatigue have been conducted. Patients historically have rarely been involved in the design of interventions, which can limit acceptability and uptake. When asked, they have indicated a preference for lifestyle interventions, such as exercise, to improve fatigue. While some research has focussed on intradialytic exercise for patients receiving haemodialysis, patients have also indicated a preference for a convenient method of exercising with guidance, but on their own time outside of dialysis hours. In response to this, a mobile phone application was proposed as the method of delivery for a home-based exercise intervention targeting fatigue. Methods We convened a workshop with five breakout group sessions in Australia, with 24 patients on dialysis (16 haemodialysis and 8 peritoneal dialysis) and 8 caregivers to identify, prioritize and discuss exercise interventions for fatigue in patients receiving dialysis and the delivery of this through a mobile application. Results Of the 21 types of exercise identified, the top-ranked were walking outdoors, walking on a treadmill and cardio and resistance training. Six themes were identified: (i) ‘an expectation of tangible gains from exercise’, including strengthening and protecting against bodily deterioration related to dialysis; (ii) ‘overcoming physical limitations’, meaning that comorbidities, baseline fatigue and fluctuating health needed to be addressed to engage in exercise; (iii) ‘fear of risks’, which reinforced the importance of safety and compatibility of exercise with dialysis; (iv) ‘realistic and achievable’ exercise, which would ensure initial readiness for uptake; (v) ‘enhancing motivation and interest’ , which expected to support sustained use of the exercise intervention and (vi) ‘ensuring usability of the mobile application’ , which would require simplicity, convenience and comprehensibility. Conclusion Exercise interventions that are expected by patients to improve health outcomes and that are safe, realistic and easy to adopt may be more acceptable to patients on dialysis.
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Affiliation(s)
- Angela Ju
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Anita van Zwieten
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Karine Manera
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Shilpanjali Jesudason
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Kevan Polkinghorne
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Talia Gutman
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Kate Wyburn
- Department of Transplantation, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - Jonathan C Craig
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
- Colleges of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
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Zeng J, Bennett PN, Hill K, Borlace M, Xu Q. The Exercise Perceptions of People Treated with Peritoneal Dialysis. J Ren Care 2020; 46:106-114. [PMID: 31943794 DOI: 10.1111/jorc.12313] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Individuals receiving peritoneal dialysis (PD) report low levels of physical activity, which increases their risk of morbidity and mortality. Little is known about their perceptions towards barriers and benefits of exercise or physical activity. AIM The aim of this study was to explore the perceptions of exercise among people receiving PD. STUDY DESIGN Cross-sectional survey. PARTICIPANTS Thirty-nine adults (12 female and 27 male) with a mean age of 65 years and a median of 8 months receiving PD from one Australian dialysis service. MEASUREMENTS The 26-item Dialysis Patient-Perceived Exercise Benefits and Barriers Survey was adapted to PD in order to measure self-reported barriers and benefits of exercise for people being treated with PD. RESULTS The majority of the respondents reported positive perceptions towards exercise with 84.6% of the participants agreeing that exercise prevents muscular wasting; 71.8% agreed that exercise can postpone a decline in body function; and 69.2% agreed that exercise improves general well-being. In terms of barriers, symptoms including tiredness (69.2%) and body pain (43.6%), worrying about a fall (33.3%) and lack of exercise-related information (25.6%) were the main perceived barriers to exercise. Only 10% agreed that exercise may affect their PD catheter with 23% agreeing that fluid in their peritoneum was a barrier to exercise. CONCLUSION People on PD hold positive perceptions towards exercise but face a number of perceived barriers to physical activity. Clinicians can acknowledge these barriers and focus on helping people on PD to overcome their perceived barriers to encourage sustained exercise participation.
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Affiliation(s)
- Jie Zeng
- Central Northern Adelaide Renal and Transplantation Service (CNARTS)-Lyell McEwin Hospital Dialysis Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Kathleen Hill
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Monique Borlace
- Home Dialysis Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Qunyan Xu
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
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Lou X, Li Y, Shen H, Juan J, He Q. Physical activity and somatic symptoms among hemodialysis patients: a multi-center study in Zhejiang, China. BMC Nephrol 2019; 20:477. [PMID: 31878896 PMCID: PMC6933661 DOI: 10.1186/s12882-019-1652-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/29/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Somatic symptoms are commonly reported by patients on maintenance hemodialysis. Based on evidence that exercise can improve psychological state among the general population, we aimed to evaluate the effects of physical activity on somatic symptoms specifically in this clinical population. METHODS This was a multicenter, cross-sectional study that included patients receiving hemodialysis treatment ≥3 times per week for > 3 months, aged 18 years or older, and who were willing to complete our study questionnaires and wear a pedometer; they were recruited from four hemodialysis centers in Zhejiang, China. Physical activity was quantified using pedometer data, with somatic symptoms quantified using the Symptom Checklist-90 (SCL-90). Hemodialysis information and blood laboratory tests were obtained from patients' medical record. The score on the somatic dimension of the SCL-90 (S1-score) subdivided into tertiles for analysis: ≤1.17 (Q1), 1.17-1.58 (Q2) and ≥ 1.58 (Q3). A multivariate logistic regression analysis was performed to estimate the crude and adjusted odd ratios (ORs) and 95% confidence intervals (CIs) for the S1- somatic score according to the physical activity level during the last week. For this analysis, patients were stratified in a high and low exercise group using a cutoff of 3000 MET-min/week. Model 1 was adjusted for skinfold thickness of the triceps, upper arm circumference, grip strength, 5-m walking time, and 30-s sit-to-stand test. In model 2, we further adjusted for the leukocyte count, high-sensitivity C-reactive protein level, and albumin level. RESULTS After screening, 320 patients were enrolled into the study group (37.50% male, average age of 58.60 ± 14.2 years and mean average number of steps per day of 3725.92 ± 2663.47). The S1-score (1.51 ± 0.39) was significantly higher for patients than for the normal reference population (P < 0.001). As the S1-score increased, the average number of steps per day decreased, both on dialysis and non-dialysis days. Total physical activity, measured by pedometry, showed the best correlation to S1 scores (r = - 0.813; P < 0.01). The OR of a high S1-score was 1.97 [95% CI, 0.63-4.08] for patients in the low physical activity group. CONCLUSION Higher S1 (somatic symptom) score was related to low physical activity among patients on maintenance hemodialysis.
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Affiliation(s)
- Xiaowei Lou
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310014, People's Republic of China.,Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China.,Peoples' Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, 310014, People's Republic of China.,Chinese Medical Nephrology Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Yiwen Li
- Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China.,Peoples' Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, 310014, People's Republic of China.,Chinese Medical Nephrology Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Huajuan Shen
- Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China.,Peoples' Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, 310014, People's Republic of China.,Chinese Medical Nephrology Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Jin Juan
- Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China.,Peoples' Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, 310014, People's Republic of China.,Chinese Medical Nephrology Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Qiang He
- Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, People's Republic of China. .,Peoples' Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, 310014, People's Republic of China. .,Chinese Medical Nephrology Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang, 310014, People's Republic of China.
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Junqué Jiménez A, Molina Moreno Y, Fernández Parra Y, Andreu-Periz D, Segura Ortí E. Opinión de los pacientes tras un programa de ejercicio físico domiciliario. ENFERMERÍA NEFROLÓGICA 2019. [DOI: 10.4321/s2254-28842019000400007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
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.
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