Effect of intradialytic exercise on daily physical activity and sleep quality in maintenance hemodialysis patients
Physical inactivity and sleep disturbance are frequently observed and relate to poor clinical outcomes in maintenance hemodialysis patients. We aimed to investigate the effect of intradialytic exercise on daily physical activity and sleep quality, measured by an accelerometer, in maintenance hemodialysis patients.
This study randomly assigned ambulatory maintenance hemodialysis patients aged ≥ 20 years on dialysis ≥ 6 months, without a hospitalization history for the previous 3 months to 4 groups: aerobic exercise (AE), resistance exercise (RE), combination exercise (CE), and control. A stationary bike was used for AE and a TheraBand®/theraball for RE. A 12-week intradialytic exercise program (3 times/week) was completed in the AE (n = 11), RE (n = 10), and CE (n = 12) groups. The control group (n = 13) received only warm-up stretching. At baseline and 12-week follow-up, daily physical activity and sleep quality were measured with a triaxial accelerometer (wActiSleep-BT; ActiGraph, Pensacola, FL) during a continuous 7-day wear period.
We observed a significant increase in metabolic equivalent (MET; kcal/h/kg) in the AE (1.02 ± 0.03 vs 1.04 ± 0.04, P = 0.04) and CE (1.06 ± 0.05 vs 1.09 ± 0.08, P = 0.01) groups at 12 weeks compared with baseline. When comparing between-group changes in MET, there was a significant increase in METs in the CE group (0.03 ± 0.03 vs − 0.01 ± 0.04, P = 0.02) compared with the control group. The total number of sedentary bouts (per week) decreased significantly in the AE (200 ± 37 vs 174 ± 36, P = 0.01), RE (180 ± 31 vs 130 ± 49, P = 0.03), and CE groups (180 ± 45 vs 152 ± 46, P = 0.04) at 12 weeks compared with baseline. The average sleep fragmentation index, indicating poor sleep quality, decreased significantly at 12 weeks compared with baseline in the AE (51.4 ± 8.0 vs 44.5 ± 9.6, P = 0.03) and RE groups (52.3 ± 7.3 vs 40.0 ± 15.4, P = 0.01).
Intradialytic exercise appears to be clinically beneficial in improving daily physical activity and sleep quality in maintenance hemodialysis patients.
KeywordsEnd-stage renal disease Hemodialysis Exercise Sleep Accelerometry
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
Informed consent was obtained from all individual participants included in the study.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
- 2.Kim JC, Shapiro BB, Zhang M, Li Y, Porszasz J, Bross R, Feroze U, Upreti R, Kalantar-Zadeh K, Kopple JD (2014) Daily physical activity and physical function in adult maintenance hemodialysis patients. J Cachexia Sarcopenia Muscle 5(3):209–220. https://doi.org/10.1007/s13539-014-0131-4 CrossRefPubMedCentralPubMedGoogle Scholar
- 7.Lopes AA, Lantz B, Morgenstern H, Wang M, Bieber BA, Gillespie BW, Li Y, Painter P, Jacobson SH, Rayner HC, Mapes DL, Vanholder RC, Hasegawa T, Robinson BM, Pisoni RL (2014) Associations of self-reported physical activity types and levels with quality of life, depression symptoms, and mortality in hemodialysis patients: the DOPPS. Clin J Am Soc Nephrol 9(10):1702–1712. https://doi.org/10.2215/CJN.12371213 CrossRefPubMedCentralPubMedGoogle Scholar
- 14.Elias RM, Chan CT, Paul N, Motwani SS, Kasai T, Gabriel JM, Spiller N, Bradley TD (2013) Relationship of pharyngeal water content and jugular volume with severity of obstructive sleep apnea in renal failure. Nephrol Dial Transplant 28(4):937–944. https://doi.org/10.1093/ndt/gfs473 CrossRefPubMedGoogle Scholar
- 15.Elder SJ, Pisoni RL, Akizawa T, Fissell R, Andreucci VE, Fukuhara S, Kurokawa K, Rayner HC, Furniss AL, Port FK, Saran R (2008) Sleep quality predicts quality of life and mortality risk in haemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 23(3):998–1004. https://doi.org/10.1093/ndt/gfm630 CrossRefPubMedGoogle Scholar
- 18.Tentori F, Elder SJ, Thumma J, Pisoni RL, Bommer J, Fissell RB, Fukuhara S, Jadoul M, Keen ML, Saran R, Ramirez SP, Robinson BM (2010) Physical exercise among participants in the Dialysis Outcomes and Practice Patterns Study (DOPPS): correlates and associated outcomes. Nephrol Dial Transplant 25(9):3050–3062. https://doi.org/10.1093/ndt/gfq138 CrossRefPubMedGoogle Scholar
- 32.Koh KP, Fassett RG, Sharman JE, Coombes JS, Williams AD (2010) Effect of intradialytic versus home-based aerobic exercise training on physical function and vascular parameters in hemodialysis patients: a randomized pilot study. Am J Kidney Dis 55(1):88–99. https://doi.org/10.1053/j.ajkd.2009.09.025 CrossRefPubMedGoogle Scholar
- 33.Saitoh M, Ogawa M, Dos Santos MR, Kondo H, Suga K, Itoh H, Tabata Y (2016) Effects of intradialytic resistance exercise on protein energy wasting, physical performance and physical activity in ambulatory patients on dialysis: a Single-Center Preliminary Study in a Japanese Dialysis Facility. Ther Apher Dial 20(6):632–638. https://doi.org/10.1111/1744-9987.12447 CrossRefPubMedGoogle Scholar
- 35.Koch BC, Nagtegaal JE, Hagen EC, van der Westerlaken MM, Boringa JB, Kerkhof GA, Ter Wee PM (2009) The effects of melatonin on sleep-wake rhythm of daytime haemodialysis patients: a randomized, placebo-controlled, cross-over study (EMSCAP study). Br J Clin Pharmacol 67(1):68–75. https://doi.org/10.1111/j.1365-2125.2008.03320.x CrossRefPubMedCentralPubMedGoogle Scholar
- 42.Giannaki CD, Hadjigeorgiou GM, Karatzaferi C, Maridaki MD, Koutedakis Y, Founta P, Tsianas N, Stefanidis I, Sakkas GK (2013) A single-blind randomized controlled trial to evaluate the effect of 6 months of progressive aerobic exercise training in patients with uraemic restless legs syndrome. Nephrol Dial Transplant 28(11):2834–2840. https://doi.org/10.1093/ndt/gft288 CrossRefPubMedGoogle Scholar
- 49.Morgenthaler T, Alessi C, Friedman L, Owens J, Kapur V, Boehlecke B, Brown T, Chesson A Jr, Coleman J, Lee-Chiong T, Pancer J, Swick TJ, Standards of Practice C, American Academy of Sleep M (2007) Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007. Sleep 30(4):519–529CrossRefPubMedGoogle Scholar
- 52.Fonseca NT, Urbano JJ, Nacif SR, Silva AS, Peixoto RA, Urbano GJ, Oliveira EF, Santos IR, Oliveira CS, Insalaco G, Oliveira LV (2016) A systematic review of sleep disorders in patients with chronic kidney disease undergoing hemodialysis. J Phys Ther Sci 28(7):2164–2170. https://doi.org/10.1589/jpts.28.2164 CrossRefPubMedCentralPubMedGoogle Scholar
- 53.Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Loube DL, Owens J, Pancer JP, Wise M (2005) Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 28(4):499–521CrossRefPubMedGoogle Scholar
- 54.Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, Zucconi M, Ferri R, Trenkwalder C, Lee HB, International Restless Legs Syndrome Study G (2014) Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria–history, rationale, description, and significance. Sleep Med 15(8):860–873. https://doi.org/10.1016/j.sleep.2014.03.025 CrossRefPubMedGoogle Scholar