Exercise training during hemodialysis in Brazil: A national survey

Abstract

To evaluate the availability and characteristics of exercise training during hemodialysis in Brazil and to identify the reported barriers to exercise program implementation and maintenance. All dialysis units were assessed for eligibility using the database of the Brazilian Society of Nephrology. Each dialysis unit was contacted by telephone and the questions were administered. In dialysis units with exercise training, questions related to personnel involved, exercise components, and program delivery were included. Additionally, the barriers to exercise program implementation and maintenance were evaluated. This study included 261 dialysis units that responded to the survey. Forty‐one dialysis units reported exercise training during hemodialysis in Brazil (prevalence of 15.7%). We identified 66 physiotherapists and 10 exercise physiologists in dialysis units with exercise training. Resistance training was the most common program component (92.7%). Hypotension (90.5%) and muscle cramps (85.7%) were the most common adverse events reported. In dialysis units with exercise training, poor patients’ adherence to exercise was the most commonly reported barrier. The most prevalent barrier in dialysis units that tried or never tried to implement the exercise programs was a lack of resources. The number of dialysis units that have exercise training during hemodialysis in Brazil is low, and the most common program component is resistance training. A lack of resources was the most prevalent barrier in dialysis units that tried or never tried to implement the exercise programs.

Profile of professionals working in intradialytic exercise programs in Brazil: a national survey

“…The most recent Brazilian dialysis census indicated that an estimated 136,691 individuals were on dialysis in Brazil. Our study found that only 5,360 patients were on IEPs 8 , 11 .Another relevant finding was the biased geographic distribution of the 70 included professionals, who were simply inexistent in nine Brazilian States. The absence of a legal requirement to make physical rehabilitation professionals available in dialysis centers might serve as an explanation for the incredibly low number of such professionals in dialysis centers 12 .…”

“…This cross-sectional study was conducted from April 2019 to June 2020. It was part of a large survey involving dialysis centers in Brazil 8 . Consent from study participants was given over the phone or via the electronic form.…”

“…However, the implementation of intradialytic exercise programs (IEPs) is not an obstacle-free endeavor. Our national survey found that only 41 dialysis centers in Brazil offer IET to their patients, with lack of resources ranking atop the list of barriers faced by centers offering IEPs and centers that have tried and failed to implement IEPs 8 . Ma et al also found that lack of resources was the main barrier to the establishment of IEPs in dialysis centers in Ontario, Canada 9 .…”

Implementing a resistance training programme for patients on short daily haemodialysis: A feasibility study

“…The presence of exercise professionals within the dialysis staff may ensure effective and sustainable intradialytic exercise programmes as a clinical routine (Barros, et al, 2021; Bennett et al, 2010). A recent survey study performed in Brazil showed that only 16% of the dialysis centres had an intradialytic exercise programme integrated into the clinical routine (Barros et al, 2021). The most commonly reported barriers to the implementation were a lack of budgetary and experienced human resources along with a void in standardized clinical protocols or guidelines in the field.…”

“…Adherence of patients to intradialytic exercise programmes is strongly associated with the presence of exercise professionals, and patients are twice as likely to exercise if an exercise professional is present (Parker et al, 2021). The presence of exercise professionals within the dialysis staff may ensure effective and sustainable intradialytic exercise programmes as a clinical routine (Barros, et al, 2021;Bennett et al, 2010). A recent survey study performed in Brazil showed that only 16% of the dialysis centres had an intradialytic exercise programme integrated into the clinical routine (Barros et al, 2021).…”