Integrative Examination of Motor Abilities in Dialysis Patients and Selection of Tests for a Standardized Physical Function Assessment

Ponikvar

et al. 2020

Sci Rep

Self Cite

Intradialytic cycling is a widely used workout mode, whereas added benefit of other exercise modalities remains unknown. This is the first randomised controlled trial on the effects and sustainability of functional training and counselling in addition to intradialytic cycling. patients were randomly assigned to a kinesiologist-guided functional training in addition to intradialytic cycling (n = 20, experimental group) or intradialytic cycling only (n = 20, control group) over 16 weeks. The experimental group attended predialysis functional exercise in the first eight weeks and afterward performed functional training at home for the next eight weeks. The primary study endpoint was 10-repetition-sit-to-stand test time at eight weeks: at this test, the experimental group improved significantly better than controls (−4.5 ± 1.9 s, 95%CI −8.4 to −0.7; P = 0.021), which was maintained at week 16 (−4.7 ± 2.1 s, 95%CI −9.0 to −0.3; P = 0.037). At week 8, the experimental group significantly outperformed controls also at handgrip strength (P = 0.004), lower body flexibility test (P < 0.001), balance test (P < 0.001), and upper body flexibility test (P = 0.003). At week 16, superior results of the experimental group in secondary end-points remained preserved for handgrip strength, balance, and upper body flexibility tests. Functional training with exercise counselling meaningfully improves physical performance and successfully prepares patients for sustainable home exercise. Intradialytic exercise on a customized ergometer (cycling) is currently the most common mode of in-centre exercise among haemodialysis (HD) patients 1,2. This exercise mode is well feasible, time-efficient, can be easily supervised 1 and has shown numerous improvements in aerobic capacity 3-6 , functional performance 7-9 , HD efficiency (improved Kt/V) 1 , and quality of life 1,5,7. It could be perceived as the current standard of physical training in the HD population. However, the comparative data on the efficiency and sustainability of various types of exercise modes are lacking. With the previous studies showing a minimal efficacy of intradialytic cycling on the functional performance of HD patients 7,9-12 , we need innovative strategies to improve the outcome and sustainability of dialysis exercise programs. Functional training simulates activities of daily living 13 and targets the neuromuscular system to train movements that activate both the nervous system and the muscle groups 14. Functional training is performed as a combination of lower and upper body movements including various multi-joint activities 15. A systematic review among older adults, including 13 trials with 1139 participants, demonstrated positive effects of functional training on muscle strength, physical functioning, and activities of daily living 16. The authors stated that functional training, which imitates specific performance, confers the best performance gains. HD patients have largest functional deficits in flexibility, balance, and lower extremity functions 17. These are...

Section: Methodsmentioning

confidence: 99%

Kinesiologist-guided functional exercise in addition to intradialytic cycling program in end-stage kidney disease patients: a randomised controlled trial

Bogataj

Ponikvar

et al. 2020

Sci Rep

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“…A 10 repetition sit-to-stand test measures the time required to complete ten full stands from a sitting position. This test indicates lower limb strength endurance and is well associated with the activities of daily living [66]. The scores for ten repetition sit-to-stand test were considered to be a strong predictor of mortality among patients with chronic obstructive pulmonary disease [67].…”

Section: Discussionmentioning

confidence: 99%

Exercise-Based Interventions in Hemodialysis Patients: A Systematic Review with a Meta-Analysis of Randomized Controlled Trials

Bogataj

et al. 2019

JCM

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There is a lack of agreement on the efficacy of different exercise interventions in hemodialysis patients. We analyzed which exercise type is the most beneficial in terms of functional fitness and inflammation. A literature search of seven databases yielded 33 studies that met the inclusion criteria. Compared with an inactive control, the intervention group showed moderate effects (ES = 0.74; 95% CI 0.35 to 1.14; p < 0.001; and ES = 0.70; 95% CI 0.39 to 1.01; p < 0.001; respectively) on functional capacity (six-minute walk test) and oxygen consumption. Small nonsignificant effects were observed for aerobic (ES = −0.36; 95% CI −0.85 to 0.13; p = 0.154) and resistance (ES = −0.44; 95% CI −1.07 to 0.19; p = 0.169) training types, whereas moderate effects were found for combined (ES = −0.69; 95% CI −1.47 to 0.10; p = 0.088) training type based on a 10-repetition sit-to-stand test. Further, large and small effects were observed for aerobic (ES = −1.21; 95% CI −1.94 to −0.49; p = 0.001) and resistance training (ES = −0.54; 95% CI −0.90 to −0.17; p = 0.004) types on C-reactive protein. Overall, the results showed the numerically largest effect sizes for combined types compared to solely aerobic or resistance training types, with the differences between training types not reaching statistical significance. There was a significant modifying impact of age, training frequency, and session duration on performance and inflammatory outcomes.

“…The exact description of the research protocol and measurements was given previously [ 4 , 11 , 32 ]. In short, physical performance tests were performed in the afternoon hours on non-dialysis days (mean time lag from the last dialysis session was 25 ± 6 h).…”

Section: Methodsmentioning

confidence: 99%

“…The STS-10 time (in seconds) was measured as the time needed to perform rises from the chair of a standard height to the full leg extension and back to sitting position 10 times in a single attempt. HAP questionnaire is used to assess the level of physical activity, with the result reported as the adjusted activity score (AAS), on a scale of 1–94 points (larger values designate higher level of ability in everyday life) [ 32 , 34 , 35 ]. Previously, the HAP questionnaire was recognized as the single best substitute for quantitative measurement of habitual physical activity in hemodialysis patients [ 34 ].…”

Section: Methodsmentioning

confidence: 99%

Association of Uremic Toxins and Inflammatory Markers with Physical Performance in Dialysis Patients

Jerman

Osredkar

et al. 2018

Toxins

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Association of higher serum levels of uremic toxins and inflammatory markers with poorer physical performance is understudied. We measured the six-minute walk test (6MWT), 10 repetition sit-to-stand test (STS-10), handgrip strength (HGS), and Human Activity Profile (HAP) questionnaire score in 90 prevalent hemodialysis patents, with low comorbidity to reduce the potential confounding of concomitant disease. Midweek pre-dialysis serum levels of asymmetric dimethyl-arginine (ADMA), β2-microglobulin (B2M), high-sensitivity C-reactive protein (hs-CRP), indoxyl sulfate (IS), insulin-like growth factor 1 (IGF-1), interleukin 6 (IL-6), myostatin, and urea were analyzed as predictor parameters of physical performance measures in adjusted models. Serum levels of most measured toxins were not significantly related to performance, except for ADMA, which was significantly related to poorer performance in the STS-10 test (B = 0.11 ± 0.03 s, p < 0.01). Higher hs-CRP was associated with poorer results in the 6MWT (B = −2.6 ± 0.97 m, p < 0.01) and a lower HAP score (B = −0.36 ± 0.14, p = 0.01). There were no other significant associations found. We conclude that inflammation may be a more important pathway to physical impediment than uremic toxemia. This suggests that there is a large physical rehabilitation potential in non-inflamed uremic patients.