Does Intradialytic Group Exercise Programme Influence Patient-Reported Outcomes, Laboratory Parameters, and Anthropometric Parameters in Maintenance Hemodialysis Patients? A Single-Group Repeated-Measures Trial

Abstract

Background Maintenance hemodialysis(MHD) patients often suffer from fatigue and are recommended to undertake physical activities. The optimal format of exercise rehabilitation for MHD patients remains uncertain despite demonstrated health benefits. This study aimed to evaluate the effectiveness of an intradialytic group exercise programme for MHD patients. Methods This was a single-centre, single-group repeated-measures design study. The 12-week, three times per-week intradialytic group exercise programme was conducted for around 30 min during the first 2 hours of each dialysis session. Patient-reported outcomes including fatigue, anxiety, depression and health-related quality of life, laboratory parameters including haemoglobin, albumin, pre-albumin and hypersensitive C-reactive protein, and anthropometric parameters including triceps skinfold thickness, mid-upper arm circumference, mid-arm muscle circumference and handgrip strength, were measured at baseline, immediately post-intervention and 12-weeks post-intervention. The repeated-measures analysis of variance and Friedman test were used to compare the parametric and non‐parametric data across time points, respectively. Results Ninety patients were enrolled and 75 completed. Participants reported significant improvements across time points in fatigue ( F = 10.19, p < 0.01), depression ( F = 19.20, p < 0.001), health-related quality of life ( F = 5.36, p = 0.006), haemoglobin ( F = 3.43, p = 0.047), albumin ( F = 4.42, p = 0.032), hypersensitive C-reactive protein ( χ 2 = 50.39, p < 0.001), pre-albumin ( χ 2 = 11.85, p = 0.003), triceps skinfold thickness ( F = 25.03, p < 0.001), mid-upper arm circumference ( F = 6.32, p = 0.005), mid-arm muscle circumference ( F = 4.89, p = 0.02), and handgrip strength ( F = 13.59, p < 0.001). Although the mean anxiety score tended to reduce, the difference across time points was nonsignificant ( F = 1.33, p = 0.27). Conclusion The findings suggested that the intradialytic group exercise programme could improve MHD patients’ fatigue, depression, health-related quality of life, nutritional status, and inflammation. Trial Registration Chinese Clinical Trial Registry ChiCTR2000034394 (04/07/2020).

Effect of exercise on fatigue in patients receiving maintenance hemodialysis treatment: A systematic review and network meta-analysis

“…In addition, exercise intervention for MHD patients can be categorized as interdialytic period exercise and exercise during dialysis; according to exercise time, exercise during dialysis is defined as exercise training performed during the MHD session to increase the patient's strength and endurance, with several key benefits: (a) patients can exercise under the supervision of medical staff and ensure patient safety, (b) patients can exercise during dialysis without additional time, and (c) it can increase dialysis adequacy. 13,51 In this study, when DDAR and IPAR were compared with the routine care respectively, the effect value of DDAR was higher than IPAR, analyzing the reason that exercise during dialysis was preferred considering the lower physical activity level on dialysis days compared with interdialytic period exercise 54,55 ; moreover, because of the social atmosphere in dialysis units and the supervision of medical staff, DDAR was superior to IPAR in terms of patient adherence and safety. 56,57 However, aerobic-resistance combined exercise or aerobic combined exercise must be individualized, and consideration should be given to the principles, modalities, frequency, and intensity of exercise, 58 particularly for patients with potential cardiovascular and cerebrovascular risks, to avoid unanticipated complications due to fatigue conditions aggravated by excessive exercise.…”

“…Aerobic exercise increases endurance, resistance exercise increases muscle strength, and aerobic-resistance combined exercise is a common paradigm in exercise prescription, which embraces advantages of these two exercise ways. 51 Moreover, aerobic-resistance combined exercise may be related to a more rigorous exercise program, higher adherence, and anti-inflammatory mechanisms. 52,53 Thus, it is not difficult to explain that the aerobic-resistance combined exercise was the highest effect value compared with the routine care, followed by aerobic exercise in this study.…”

“…Aerobic-resistance combined exercise or aerobic exercise alone did not reach statistical significance, but the aerobic-resistance combined exercise resulted the largest effect value compared with the routine care. Aerobic exercise increases endurance, resistance exercise increases muscle strength, and aerobic-resistance combined exercise is a common paradigm in exercise prescription, which embraces advantages of these two exercise ways 51 . Moreover, aerobic-resistance combined exercise may be related to a more rigorous exercise program, higher adherence, and anti-inflammatory mechanisms 52,53 .…”

“…Thus, it is not difficult to explain that the aerobic-resistance combined exercise was the highest effect value compared with the routine care, followed by aerobic exercise in this study. In addition, exercise intervention for MHD patients can be categorized as interdialytic period exercise and exercise during dialysis; according to exercise time, exercise during dialysis is defined as exercise training performed during the MHD session to increase the patient’s strength and endurance, with several key benefits: ( a ) patients can exercise under the supervision of medical staff and ensure patient safety, ( b ) patients can exercise during dialysis without additional time, and ( c ) it can increase dialysis adequacy 13,51 . In this study, when DDAR and IPAR were compared with the routine care respectively, the effect value of DDAR was higher than IPAR, analyzing the reason that exercise during dialysis was preferred considering the lower physical activity level on dialysis days compared with interdialytic period exercise 54,55 ; moreover, because of the social atmosphere in dialysis units and the supervision of medical staff, DDAR was superior to IPAR in terms of patient adherence and safety 56,57 .…”

The effects of exercise training interventions on depression in hemodialysis patients

“…A total of 1,059 patients were included in this study. Furthermore, all the studies were published in the English language from 1983 to 2023, and were conducted in China ( n = 4) ( 17 – 20 ), United States ( n = 3) ( 21 – 23 ), Greece ( n = 5) ( 24 – 28 ), Japan ( n = 1) ( 29 ), Brazil ( n = 1) ( 30 ), Spain ( n = 1) ( 31 ), Poland ( n = 1) ( 32 ), Iran ( n = 2) ( 33 , 34 ), Korea ( n = 1) ( 35 ), Netherlands ( n = 2) ( 36 ), New Zealand ( n = 1) ( 37 ) and Turkey ( n = 1) ( 38 ). Sixteen studies were randomized controlled trials, and 6 studies were quasi-experimental trials.…”