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      Effectiveness of exercise on fatigue in hemodialysis patients: a randomized controlled trial

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          Abstract

          Background

          Hemodialysis is one of the common therapies in patients with end-stage renal disease. Even patients who receive regular treatment suffer from fatigue, which is one of the main factors leading to poor quality of life. This study aimed to determine the effectiveness of exercising on mini-bikes on fatigue in hemodialysis patients.

          Methods

          This study is a randomized controlled clinical trial. Thirty-seven hemodialysis patients participated in the study. The patients were randomly allocated to either the intervention group ( n = 20) or the control group ( n = 17). The participants in the intervention group exercised on mini-bikes for 20 min twice a week for 3 months. The patients’ fatigue was measured four times during and after the intervention. Multidimensional Fatigue Inventory was used to measure the fatigue level. The total score in the MFI is 4 to 20 for each domain, with the resulting total fatigue score ranging from 20 to 100; thus, the higher the score, the higher the level of fatigue. Data were analyzed by SPSS 18. The repeated measures ANOVA was used to compare the fatigue scores within each group and between the groups at different times.

          Results

          The mean score of fatigue in the intervention group at the beginning was 58.80 ± 15.29, which steadily decreased to 58.78 ± 13.54, 58.75 ± 14.73, 54.20 ± 15.16, and 54.23 ± 13.60 for the 3 months of intervention and 1 month post-intervention, respectively. In contrast, in the control group, this score was 62.53 ± 16.32 in the beginning, increasing to 64.03 ± 13.91, 64.22 ± 13.07, 69.53 ± 9.22, for the 3 months of intervention and 70.34 ± 7.69 one-month post-intervention. There were significant differences between the intervention group and the control group in the third month ( P = 0.001) and 1 month after the intervention ( P < 0.001).

          Conclusions

          The results showed that rehabilitation through exercising using mini-bikes had a significant impact on preventing further fatigue build-up in hemodialysis patients, making the mini-bike an effective non-pharmaceutical intervention preventing the increase in fatigue experienced by patients undergoing hemodialysis.

          Trial registration

          Iranian Registry of Clinical Trials: IRCT20180314039100N1. Registered 10 June 2018.

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          Most cited references36

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          Barriers to exercise participation among dialysis patients.

          Kirsten Johansen, Cynthia Delgado (2012)
          Physical inactivity is a strong predictor of mortality in patients with end-stage renal disease and is associated with poor physical functioning. Patients with end-stage renal disease are inactive even compared to sedentary individuals without kidney disease. We sought to identify patient barriers to physical activity. Adult patients on hemodialysis in the San Francisco Bay Area were recruited and asked to complete a study survey composed of questions about self-reported level of physical functioning, physical activity participation, patient physical activity preference and barriers to physical activity. Univariate and multivariable linear regression analyses were performed to study the association between barriers to physical activity and participation in physical activity. A total of 100 patients participated in the study, the majority of whom were male (73%), with a mean age of 60 ± 15 years. Twenty-seven percent identified themselves as white, 30% black and 21% Hispanic. The majority of participants strongly agreed that a sedentary lifestyle was a health risk (98%) and that increasing exercise was a benefit (98%). However, 92% of participants reported at least one barrier to physical activity. The most commonly reported barriers were fatigue on dialysis days and non-dialysis days (67 and 40%, respectively) and shortness of breath (48%). In multivariate analysis, a greater number of reported barriers was associated with lower levels of physical activity (P < 0.02). Post-dialysis fatigue was not associated with differences in activity level in multivariate analysis. Lack of motivation was associated with less physical activity. Endorsement of too many medical problems and not having enough time on dialysis days were also associated with less activity in adjusted analysis. We have identified a number of barriers to physical activity that can be addressed in studies aimed at increasing levels of physical activity. Inconsistent with nephrologists' reported assumptions, dialysis patients were interested in physical activity.
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            A modified yoga-based exercise program in hemodialysis patients: a randomized controlled study.

            M Yurtkuran, A Alp, K Dilek (2007)
            To evaluate the effects of a yoga-based exercise program on pain, fatigue, sleep disturbance, and biochemical markers in hemodialysis patients. In 2004 a randomized controlled trial was carried out in the outpatient hemodialysis unit of the Nephrology Department, Uludag University Faculty of Medicine. Clinically stable hemodialysis patients (n=37) were included and followed in two groups: the modified yoga-based exercise group (n=19) and the control group (n=18). Yoga-based exercises were done in groups for 30 min/day twice a week for 3 months. All of the patients in the yoga and control groups were given an active range of motion exercises to do for 10 min at home. The main outcome measures were pain intensity (measured by the visual analogue scale, VAS), fatigue (VAS), sleep disturbance (VAS), and grip strength (mmHg); biochemical variables-- urea, creatinine, calcium, alkaline phosphatase, phosphorus, cholesterol, HDL-cholesterol, triglyceride, erythrocyte, hematocrit--were evaluated. After a 12-week intervention, significant improvements were seen in the variables: pain -37%, fatigue -55%, sleep disturbance -25%, grip strength +15%, urea -29%, creatinine -14%, alkaline phosphatase -15%, cholesterol -15%, erythrocyte +11%, and hematocrit count +13%; no side-effects were seen. Improvement of the variables in the yoga-based exercise program was found to be superior to that in the control group for all the variables except calcium, phosphorus, HDL-cholesterol and triglyceride levels. A simplified yoga-based rehabilitation program is a complementary, safe and effective clinical treatment modality in patients with end-stage renal disease.
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              The psychometric properties of the Swedish Multidimensional Fatigue Inventory MFI-20 in four different populations.

              C Lundh Hagelin, Carl-Johan Fürst, Sara Runesdotter … (2006)
              The Multidimensional Fatigue Inventory (MFI-20) scale is widely used for measuring fatigue in cancer care. This questionnaire has been translated into Swedish and used in Swedish cancer populations, and the aim of this study was to test the validity and reliability of the Swedish version in four populations, with a total of 584 patients. The participants were classified into four groups: palliative cancer patients, cancer patients receiving radiation therapy, non-cancer outpatients, and a group of hospital staff. The MFI-20 consists of five subscales of fatigue: General Fatigue (GF), Physical Fatigue (PF), Reduced Motivation (RM), Reduced Activity (RA) and Mental Fatigue (MF). We have tested the convergent validity of the MFI-20 using the Category Ratio instrument (CR-10). The validity and the reliability of MFI-20 were acceptable. All subscales of the MFI-20 were correlated, and all were also correlated with the CR-10 score (p < or = 0.001). General Fatigue was highly correlated with Physical Fatigue for the three patient groups, but this was not the fact for healthy staff. Deleting some items increased Cronbach's alpha of the subscale to which these items belonged (where alpha measures the reliability of the results). The level of non-response was low (less than 1.2%) and there was no pattern to the items omitted. We conclude that the MFI-20 is a valid and reliable instrument for measuring fatigue in patients and in healthy individuals. The results support, to some extent, earlier findings and one item can be removed from the Swedish version of the MFI-20.
              Article 0 comments Cited 46 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Farzaneh Salehi: farzaneh.salehi3@yahoo.com
                Mahlagha Dehghan:
                ORCID: https://orcid.org/0000-0002-4205-829X
                m_dehghan@kmu.ac.ir
                Parvin Mangolian Shahrbabaki: mangolian167@yahoo.com , p_mangolian@kmu.ac.ir
                Mohammad Reza Ebadzadeh: m.ebadzadeh@gmail.com
                Journal
                Journal ID (nlm-ta): BMC Sports Sci Med Rehabil
                Journal ID (iso-abbrev): BMC Sports Sci Med Rehabil
                Title: BMC Sports Science, Medicine and Rehabilitation
                Publisher: BioMed Central (London )
                ISSN (Electronic): 2052-1847
                Publication date (Electronic): 18 March 2020
                Publication date PMC-release: 18 March 2020
                Publication date Collection: 2020
                Volume: 12
                Electronic Location Identifier: 19
                Affiliations
                [1 ]GRID grid.412105.3, ISNI 0000 0001 2092 9755, Clinical Research Unit, , Shafa Hospital, Kerman University of Medical Sciences, ; Kerman, Iran
                [2 ]GRID grid.412105.3, ISNI 0000 0001 2092 9755, Nursing Research Center, , Kerman University of Medical Sciences, ; Kerman, Iran
                [3 ]GRID grid.412105.3, ISNI 0000 0001 2092 9755, Nursing Research Center, , Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, ; Kerman, Iran
                [4 ]GRID grid.412105.3, ISNI 0000 0001 2092 9755, Department of Urology, , Bahonar Hospital, Kerman University of Medical Sciences, ; Kerman, Iran
                Author information
                https://orcid.org/0000-0002-4205-829X
                Article
                Publisher ID: 165
                DOI: 10.1186/s13102-020-00165-0
                PMC ID: 7081561
                PubMed ID: 31938548
                SO-VID: 2e11e9f6-c4c7-4c31-a66f-58915d2c9976
                Copyright © © The Author(s) 2020
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 7 September 2019
                Date accepted : 21 February 2020
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                Keywords: fatigue,hemodialysis,exercise,cycling
                Data availability:
                Keywords: fatigue, hemodialysis, exercise, cycling

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