Track topics on Twitter Track topics that are important to you
Hemodialysis (HD) is an important and commonly used renal replacement therapy (RRT) for End-Stage Renal Disease (ESRD) patients worldwide. Inadequate HD, impaired exercise capacity and declined peripheral muscular strength resulted by HD and ESRD are still disturbing problems, which also predicts poor renal prognosis and poor quality of life. The results of systematic reviews by the investigators have shown that aerobic exercise and combined exercise can improve dialysis efficacy (alleviate uremia symptoms), improve aerobic exercise capacity and muscle strength, and improve patients' quality of life, which also supports the notion that the National Kidney Foundation Disease Outcomes Quality Initiative (K/DOQI) recommends exercise as cornerstone of ESRD rehabilitation. Therefore, this study used the effective exercise type of the systematic review results - combined exercise as an intervention method to observe its effects on dialysis efficacy, blood pressure, aerobic exercise capacity, muscle strength and quality of life.
The study hypothesized that combined exercise can not only improve dialysis efficacy, but also has an interaction effect with intervention duration, which deserves researches' attention. Combined exercise will also improve blood pressure (including systolic blood pressure and diastolic blood pressure) in patients with ESRD and reduce the symptoms of renal hypertension. It will also improve the exercise capacity and muscle strength of ESRD patients and improve their quality of life.
Hemodialysis (HD) is an important and commonly used renal replacement therapy (RRT) for End-Stage Renal Disease (ESRD) patients worldwide. Single-pool Kt/V (sp Kt/V) is a quantified indicator of HD adequacy and has been recommended should be more than 1.2 by The National Kidney Foundation Disease Outcomes Quality Initiative (K/DOQI). Inadequate HD predicted increased hospitalization time and cost and reduced survival time. Increasing dose or frequency were common clinical therapies to improve HD adequacy but were limited by patients' poor compliance and greater finical burden. Economical and affordable methods to increase urea and other toxins are urgent clinically.
Physical fitness decline, often accompanied with sedentary lifestyle are also disturbing issues for ESRD. And physical fitness reduction would exacerbate with the extension of HD years. In addition, patients should sit or lie still for 4 hours during HD and post-dialysis fatigue worsened physical function. Exercise capacity and peripheral muscular strength had 40% to 50% reduction compared to same age and gender, which resulted from metabolic disorders and physiological deterioration of HD. Then muscle functionality and cardiorespiratory capacity declined and reflected in reduction of physical function which was a risk factor of poor renal prognosis and poor quality of life.
Exercise was an economical way and was recommended by K/DOQI as cornerstone of rehabilitation for HD patients. There are kinds of exercise intervention, including aerobic exercise, resistance exercise and aerobic and resistance exercise (combined exercise), which showed obvious beneficial effects on the recovery for HD patients, such as mitigating patients' uremic symptoms, elevating their physical fitness and improving quality of life (QoL) in recent 30 years' studies. Previous studies showed that sp Kt/V can be elevated not only by single exercise intervention, but also by long term intervention. But there are few studies observed the interaction between time and exercise in the long term exercise intervention. About physical fitness, exercise, especially aerobic exercise, can increase patients' aerobic capacity, such as maximal peak oxygen and walking ability. Exercise also has a marked effect on muscle strength, with resistance exercise reducing muscle wasting and enhancing muscle strength.
According to the investigators' previous meta-analysis, both aerobic exercise and combined exercise can increase patients' exercise capacity and QoL. Investigators prefer choosing combined exercise because few researches regard combined exercise as intervention exercise type which can provide more information to future systematic reviews. About the exercise time, investigators chose intradialytic exercise for good compliance, professional guidance and clinical professional guarantee. As for the duration, intensity and frequency, 6 months, moderate intensity and 3 times per week may good for restore blood vessel structure, physical function and quality of life from the investigator's previous result. Above all, this study aimed to invest the effect of intradialytic combined exercise on sp Kt/V, walking ability, muscle strength and QoL.
The randomized, parallel-controlled trial aimed to compare the effect of 24 weeks combined exercise and usual care on hemodialysis efficacy, functional capacity and quality of life in patients with ESRD on HD. The protocol of this study was conducted in accordance with the Declaration of Helsinki and was reviewed and approved by the Human Research Ethics Committee of the Xi'an Jiaotong University Health Science Center (No 2018538), China. Informed consent was obtained from participants in this study.
Data analysis Continuous data were expressed as mean and standard deviation (SD) or median and interquartile range according to the normality results. Proportion data were expressed as percentage frequency. The demographics of patient in two groups were compared. The Student T-test or Mann-Whitney U test where appropriate for the continuous data, and the Chi-square test was used for proportion data. The intragroup differences analysis was detected with the paired Student T-test or Wilcoxon rank test. Unpaired Student T-test or Mann-Whitney U test was evaluated the intergroup difference. In order to compare monthly data of sp Kt/V, two-way factorial analysis of variance on two factors: group (presence or absence of intervention) and time (every week) was performed. The differences were considered as statistical significant when P-values were ≤0.05. BMI. EpiData 3.1 (Odense, Denmark) was used for data entry, and the analyses were carried out using Statistical Product and Service Solutions (SPSS) 13.0 for Windows (Chicago, U.S.A).
Kidney Failure, Chronic
Usual care with sham intervention, Intradialytic Combined Exercise
The First Affiliated Hospital of Xi'an Jiaotong University
Health Science Center of Xi’an Jiaotong University
Published on BioPortfolio: 2019-10-16T10:39:13-0400
The objective of this study is to compare the rate of low blood pressure events (Intradialytic Hypotension: IDH) when intradialytic exercise is performed in the first half of the hemodialy...
DiaTT is an interventional, cluster-randomized (1:1), multicenter trial for patients with chronic kidney disease undergoing hemodialysis (n=1,100). This trial will test the effectiveness (...
Low physical activity is associated with in hemodialysis and hemodiafiltration (HDF) patients. Previous studies showed the benefits of intradialytic exercise for improvement of physical fi...
The purpose of this pilot study is to evaluate 1) the effect of intradialytic pedaling exercise on arterial stiffness and other arterial hemodynamic parameters over 4 months, and 2) the lo...
The purpose of this study is to evaluate whether radial extracorporeal shockwave therapy (rESWT), sham rESWT or standardized exercise program is more effective on heel pain than usual care...
Intradialytic exercise can improve physical function and health-related quality of life (HRQoL) in hemodialysis (HD) patients, but is not implemented in routine clinical practice. Virtual reality (VR)...
Inactivity, uremia, and malnutrition in dialysis patients may lead to decreased muscle mass and physical capacity. As a preventative measure, dialysis patients are provided with an intradialytic exerc...
Motivating Structured walking Activity in people with Intermittent Claudication (MOSAIC): protocol for a randomised controlled trial of a physiotherapist-led, behavioural change intervention versus usual care in adults with intermittent claudication.
Walking exercise is a recommended but underused treatment for intermittent claudication caused by peripheral arterial disease (PAD). Addressing the factors that influence walking exercise may increase...
HeART of Stroke: randomised controlled, parallel-arm, feasibility study of a community-based arts and health intervention plus usual care compared with usual care to increase psychological well-being in people following a stroke.
People often experience distress following stroke due to fundamental challenges to their identity.
To determine whether the LINC strengths-based case management intervention was more effective than usual care for linking people who inject drugs (PWID) to HIV care and improving HIV outcomes.
The exercise capacity of an individual as measured by endurance (maximal exercise duration and/or maximal attained work load) during an EXERCISE TEST.
Children with mental or physical disabilities that interfere with usual activities of daily living and that may require accommodation or intervention.
Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate.
Organization of medical and nursing care according to the degree of illness and care requirements in the hospital. The elements are intensive care, intermediate care, self-care, long-term care, and organized home care.
A study in which observations are made before and after an intervention, both in a group that receives the intervention and in a control group that does not.
Nephrology - kidney function
Nephrology is a specialty of medicine and pediatrics that concerns itself with the study of normal kidney function, kidney problems, the treatment of kidney problems and renal replacement therapy (dialysis and kidney transplantation). Systemic conditions...