Five Months of Physical Exercise in Hemodialysis Patients: Effects on Aerobic Capacity, Physical Function and Self-Rated Health

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Abstract

Background: The number of chronic renal failure patients treated by hemodialysis (HD) is continuously increasing. Most patients have reduced physical capacity and have a high risk of cardiac and vascular diseases. The aim of this study was to determine the effects of 5 months physical exercise of HD patients’ physical capacity, self-rated health and risk factors for cardiovascular disease. Methods: 33 HD patients were included in the study. Inclusion criteria: HD for more than 3 months, age >18 years. Exclusion criteria: Diabetes mellitus, symptomatic cardiovascular disease, musculoskeletal limitations, severe peripheral polyneuropathy, inability to speak Danish or English, dementia or other mental disorders. The patients were randomly assigned to an exercise group (EG, n = 22) or a control group (CG, n = 11). Prior to randomization, baseline testing was performed. The effects were measured by aerobic capacity, ‘2-min stair climbing’, ‘squat test’, self-rated health (SF36), blood pressure and lipids. All tests were carried out by blinded testers. The intervention consisted of 1 h of physical exercise twice a week for 5 months. Results: 20 patients completed the intervention. Attendance was 74% of all sessions. There were no dropouts caused by complications related to the intervention. The EG had a significant increase in aerobic capacity, ‘squat test’ and Physical Function and Physical Component Scale (SF36). No significant changes were observed in any of the parameters in the CG. Conclusion: Physical exercise twice a week for 5 months increases physical function and aerobic capacity in HD patients. An exercise program with only two exercise sessions per week seems easy to implement in clinical practice with high attendance among participants. Further investigation is needed to determine the effects on blood pressure and lipids. There were no medical complications related to the exercise program.

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Effects of Exercise on Glycemic Control and Body Mass in Type 2 Diabetes Mellitus

Normand Boulé, Elizabeth Haddad, Glen P Kenny … (2001)

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Physical activity levels in patients on hemodialysis and healthy sedentary controls.

Megan K. Mulligan, Krisztina K. Johansen, Carla A Ng … (2000)

Patients on dialysis have reduced exercise tolerance compared with age-matched sedentary controls. The reasons for this debility have not been fully elucidated, but physical inactivity could be a contributing factor. The purpose of the current study was to determine whether patients on hemodialysis are less active than healthy sedentary controls and to explore clinical correlates of physical activity level in a group of hemodialysis patients. Thirty-four hemodialysis patients and 80 healthy sedentary individuals participated in the study. Physical activity was measured for seven days with a three-dimensional accelerometer and with an activity questionnaire. Vector magnitude values from the accelerometer for the dialysis and control subjects were 104,718 +/- 9631 and 161,255 +/- 6792 arbitrary units per day, respectively (P < 0.0001, mean +/- SEM). The estimated energy expenditure values derived from the questionnaire were 33.6 +/- 0.5 kcal/kg/day and 36.2 +/- 0.5 kcal/kg/day (P = 0.002). The difference between patients on dialysis and controls increased with advancing age. Among the dialysis subjects, some measures of nutritional status correlated with physical activity level, including serum albumin concentration (r = 0.58, P = 0.003), serum creatinine concentration (r = 0.37, P = 0. 03), and phase angle derived from bioelectrical impedance analysis (r = 0.40, P = 0.02). Patients on hemodialysis are less active than healthy sedentary controls, and this difference is more pronounced among older individuals. There is an association between the level of physical activity and nutritional status among patients on dialysis. These findings are of great concern, given the trend toward increasing age in incident dialysis patients and the well-known association between inactivity and increased mortality in the general population.

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Decreased survival among sedentary patients undergoing dialysis: results from the dialysis morbidity and mortality study wave 2.

Peter Bacchetti, Kirsten Johansen, Ann O’Hare … (2003)

Sedentary behavior is associated with an increased risk for death in the general population. However, the association between inactivity and mortality has not been studied in a large cohort of dialysis patients despite the high prevalence of sedentary behavior in this group. We used the Dialysis Morbidity and Mortality Study Wave 2, a prospective study of a national sample of 4,024 incident peritoneal dialysis and hemodialysis patients from 1996 to 1997, to determine whether sedentary behavior is associated with increased mortality during a 1-year period in this group after adjusting for confounding variables. The study population consisted of the 2,837 patients with accurate survival data who were able to ambulate and transfer. Eleven percent of the sedentary patients died during the study period compared with 5% of nonsedentary patients. In a survival analysis, sedentary behavior (hazard ratio, 1.62; 95% confidence interval, 1.16 to 2.27) was associated with an increased risk for death at 1 year after adjusting for all variables that we postulated might be associated with survival and for differences between sedentary and nonsedentary patients. Sedentary behavior is associated with an increased risk for mortality among dialysis patients similar in magnitude to that of other well-established risk factors, such as a one-point reduction in serum albumin concentration. More attention should be given to exercise behavior in dialysis patients, and controlled clinical trials are needed to further define the association of sedentary behavior with mortality. Copyright 2003 by the National Kidney Foundation, Inc.

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Author and article information

Journal

Journal ID (publisher-id): NEC

Journal ID (nlm-ta): Nephron Clin Pract

Journal ID (doi): 10.1159/issn.1660-2110

Title: Nephron Clinical Practice

Publisher: S. Karger AG

ISSN (Electronic): 1660-2110

Publication date Subscription-year: 2004

Publication date (Print): March 2004

Publication date (Electronic): 17 November 2004

Volume: 96

Issue: 3

Pages: c76-c81

Affiliations

Departments of ^aMedical Orthopaedic and Rehabilitation, and ^bNephrology P, Copenhagen University Hospital, Rigshospitalet, Denmark

Article

Publisher ID: 76744 Other ID: Nephron Clin Pract 2004;96:c76–c81

DOI: 10.1159/000076744

PubMed ID: 15056989

SO-VID: f9531be6-fef9-4891-81dc-fff9fce246ad

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 19 January 2003

Date accepted : 20 October 2003

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Tables: 4, References: 27, Pages: 1

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Five Months of Physical Exercise in Hemodialysis Patients: Effects on Aerobic Capacity, Physical Function and Self-Rated Health

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Karger: Nephrology

Most cited references 5

Effects of Exercise on Glycemic Control and Body Mass in Type 2 Diabetes Mellitus

Physical activity levels in patients on hemodialysis and healthy sedentary controls.

Decreased survival among sedentary patients undergoing dialysis: results from the dialysis morbidity and mortality study wave 2.

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