Intra‐Dialytic Electrostimulation of Leg Extensors May Improve Exercise Tolerance and Quality of Life in Hemodialyzed Patients

Abstract

Hemodialyzed (HD) patients with end-stage renal disease (ESRD) exhibit lower fitness as a consequence of chronic uremic changes that trigger various structural, metabolic, and functional abnormalities in skeletal muscles. The aim of this randomized study was to compare the effect of rehabilitation (RHB) training on a bicycle ergometer and electromyostimulation (EMS) of leg extensors in HD patients with ESRD. Thirty-two HD patients (18 men/14 women; mean age 61.1 ± 8.8 years) were randomized into three groups: (i) exercise training (ET; n = 11) on bicycle ergometer 2 × 20 min; (ii) EMS (n = 11) where stimulation (10 Hz) of leg extensors was applied for 60 min; and (iii) controls (CON; n = 10) without exercise. Exercising was performed between the 2nd and the 3rd hour of HD, three times a week, 20 weeks in total. Ergometric test was performed in order to evaluate peak workload (W(peak)), 6-min corridor walking test (CWT) to evaluate the distance walked, and dynamometry of leg extensors to assess muscle power (F(max)). Urea clearance was monitored and expressed as standard parameters: spKt/V, spKt/V equilibrated (spKt/V-e), and the urea removal ratio (URR). Quality of life (QoL) was assessed by the questionnaire SF-36. A significant increase of F(max) (P = 0.040 in group ET; P = 0.032 in group EMS), of 6-min CWT (P < 0.001 in ET group; P = 0.042 in EMS group), and of W(peak) (P = 0.041 in ET group) was observed. In both exercising groups, significant increase of spKt/V, spKt/V-e, and URR was found as compared with initial values (P < 0.05). In both exercising groups, highly significant changes in summarized mental functions were found (P = 0.001); in summarized physical components, significant improvement was observed in the ET group (P = 0.006). Intradialytic RHB showed comparable positive effects on functional parameters, urea clearance, and QoL. Intradialytic EMS might represent wide therapeutic possibility in the near future.

Effect of intradialytic exercise on fatigue, electrolytes level and blood pressure in hemodialysis patients: A randomized controlled trial

“…[19,20] 2.10 Ethical consideration Written permission was taken from the upper authorities in Mansoura University Hospital, dialysis unit and Hospital Nephrology and Urology, hemodialysis unit, Mitghamr interestingly Ethical research committee of faculty of nursing, Mansoura University, Written informed consent was taken from each participants. [20][21][22] 2.11 Limitations of study Small sample size because of that the researcher performs many tests outside the hospital at the expense of researcher.…”

Training with an Electric Exercise Bike versus a Conventional Exercise Bike during Hemodialysis for Patients with End-stage Renal Disease: A Randomized Clinical Trial

“…Consistent with our results, 12 weeks of Tex was previously reported to be effective in increasing MPQ. 6) Although the effects were not significant, after intervention in the Tex group, the subjects' balance ability (as measured by the TUG) and the endurance of the quadriceps (as measured by the CS-30) tended to increase (P=0.07). The small number of subjects in this study, as well as the relatively short intervention period and low exercise intensity, might have explained the absence of significant effects on CS-30 and TUG.…”

“…14) Furthermore, it is possible that the exercise intensity in the current study was insufficient to achieve the desired effect. In this study, we utilized the bike exercise training protocol described by Dobsak et al 6) However, the subjects had a mean age of 71.5 ± 1.6 years and an underweight body mass index of 20.5 ± 0.5. Therefore, our subjects probably had a lower muscle mass and may have been more prone to fatigue than the European subjects of the previous study.…”

Resultados de un programa de ejercicio físico combinado con electroestimulación neuromuscular en pacientes en hemodiálisis

“…Una menor evidencia científi ca se encuentra en relación al papel de la electroestimulación neuromuscular en el paciente renal, siendo muy limitados y escasos los estudios publicados en relación a éste tema (7)(8)(9)(10) . Merece la pena destacar un único estudio publicado a nivel nacional (8) en un grupo de 11 pacientes en programa de HD periódica que mostró una mejoría de la fuerza muscular, la capacidad funcional y la calidad de vida tras la realización de un programa de 5 semanas de duración de ejercicio físico de fuerza -resistencia asociado a electroestimulación neuromuscular de ambos cuádriceps en las sesiones de HD.…”

“…Hasta la fecha, escasos estudios acerca del papel de la EENM sobre la fuerza muscular en los pacientes en HD han sido publicados (7)(8)(9) . Por tanto, en nuestro estudio pretendemos analizar el efecto de un programa de entrenamiento físico intradiálisis combinado con EENM sobre la fuerza muscular y la capacidad funcional en nuestros pacientes en HD y analizar la seguridad, efi cacia y tolerancia de la EENM en nuestros pacientes.…”