Comparing the Effects of Active and Passive Intradialytic Pedaling Exercises on Dialysis Efficacy, Electrolytes, Hemoglobin, Hematocrit, Blood Pressure and Health-Related Quality of Life

Abstract

Background:The effect of exercise during hemodialysis has been a controversial issue, however, there are just few studies about the effect of active exercise during hemodialysis. Objectives: This study aimed to compare the effects of passive and active intradialytic pedaling exercises on dialysis efficacy, electrolytes, hemoglobin, hematocrit, blood pressure and health-related quality of life in hemodialysis patients. Patients and Methods: This quasi-experimental study was conducted on 16 hemodialysis patients in Akhavan hemodialysis center in Kashan from April to November 2013. Active or passive intradialytic pedaling exercise was performed using a Mini-Bike for 30 minutes during the first two hours of the dialysis sessions. The quality of life (QOL) was assessed before and after the intervention. Blood pressure was examined at the beginning and then hourly during the dialysis sessions. Dialysis efficacy, levels of phosphorus, calcium, sodium, potassium and Blood urea nitrogen (BUN) were measured at the end of the intervention. Kolmogorov-Smirnov test, paired t test, Wilcoxon signed rank and Friedman tests and repeated measure analysis of variancewere used to analyze the data. Results: No significant changes were observed in serum potassium, phosphorus and calcium levels at the end of the passive exercise program compared to the baseline. However, phosphorus levels were significantly decreased in the active exercise program (P < 0.05). Moreover, the mean diastolic blood pressure was significantly decreased after the passive exercise (P = 0.039). Passive exercise did not significantly change the dialysis efficacy, urea reduction rate, hemoglobin and calcium levels. The mean overall QOL was 63.78 ± 21.15 at the beginning of the study, which was increased to 77.07 ± 21.14 at the end of eight weeks of the intradialytic exercise (P = 0.007). Conclusions: The passive intradialytic exercise had a positive effect on blood pressure. The active exercise could decrease the serum phosphorus and potassium levels. Moreover, both exercise programs could significantly improve the QOL. Both active and passive intradialytic exercises can have some beneficial effects.

The effects of intradialytic exercise on hemodialysis adequacy: A systematic review

“…Five of seven studies showed a statistically significant result or a large effect size for increased potassium clearance and/or reduced serum concentrations with intradialytic exercise.…”

“…One acute study implemented a randomized controlled design . Four of the intervention studies performed a randomized controlled trial, one study utilized a within subject crossover design, and two studies observed pre and post changes in an intervention group without a control comparison arm (1 group intervention) ).…”

Intradialytic virtual reality exercise: Increasing physical activity through technology

“…Intradialytic exercise can obtain higher adherence rates than interdialytic exercise, particularly if supported by exercise professionals . Literature in the field of renal rehabilitation recommends exercise implementation in the first part of the HD session to avoid hemodynamic instability. To test this theory, Parsons et al exercised through to the third hour of dialysis.…”

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

“…In 2005, Caner reported the lack of any effect of PE on the rebounds of urea, potassium, or creatinine, nor on urea clearance. Similarly, and more recently, Orcy (2014, Brazil) and Musavian (2015, Iran) have informed that there were no changes with ID PE.…”

“…Our results suggest that ID PE has no effect when practiced during the first two session hours on dialysis dose and postdialysis rebound. Thus our results support those reported by Caner , Orcy , and Musavian .…”