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Feasibility of long-term intradialytic exercise for older patients receiving hemodialysis: a retrospective single-center study

Abstract

Purpose

Decreased physical function and physical activity are associated with adverse outcomes among patients undergoing hemodialysis (HD). Although intradialytic exercise (IDEx) can help improve physical function, few studies have evaluated whether long-term IDEx could improve physical function or physical activity in older HD patients. This study aimed to investigate the effects of intradialytic exercise (IDEx) on physical function and physical activity in older HD patients over a 24-month period.

Methods

This retrospective study included clinically stable Japanese HD patients (aged ≥ 60 years) who visited our outpatient clinic. The patients were categorized into the IDEx (underwent IDEx) and non-IDEx (did not undergo IDEx) groups. The IDEx group underwent a 30–40 min low-intensity resistance training for three times/week during the HD period. Baseline, 12-month, and 24-month follow-up assessments were conducted to assess patient characteristics, physical function, and physical activity. Results were compared using generalized estimating equations.

Results

The study included 57 patients with complete follow-up data. Baseline, 12-month, and 24-month follow-up assessments revealed no significant inter-group differences concerning physical function, physical activity, and other measurements.

Conclusion

IDEx was shown to have limited effect on physical function and physical activity among older HD patients in a clinical setting. Future studies are needed to re-evaluate IDEx programs in HD patients by incorporating exercises performed before and after the HD session.

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Data availability

All data generated or analyzed during this study are included in this published article.

References

  1. 1.

    Nitta K, Goto S, Masakane I, Hanafusa N, Taniguchi M, Hasegawa T, Nakai S, Wada A, Hamano T, Hoshino J, Joki N, Abe M, Yamamoto K, Nakamoto H (2020) Annual dialysis data report for 2018, JSDT Renal Data Registry: survey methods, facility data, incidence, prevalence, and mortality. Ren Replace Ther. https://doi.org/10.1186/s41100-020-00286-9

    Article  Google Scholar 

  2. 2.

    Johansen KL, Chertow GM, Kutner NG, Dalrymple LS, Grimes BA, Kaysen GA (2010) Low level of self-reported physical activity in ambulatory patients new to dialysis. Kidney Int 78(11):1164–1170. https://doi.org/10.1038/ki.2010.312

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Painter P, Carlson L, Carey S, Paul SM, Myll J (2000) Physical functioning and health-related quality-of-life changes with exercise training in hemodialysis patients. Am J Kidney Dis 35(3):482–492. https://doi.org/10.1016/s0272-6386(00)70202-2

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Johansen KL, Chertow GM, Jin C, Kutner NG (2007) Significance of frailty among dialysis patients. J Am Soc Nephrol 18(11):2960–2967. https://doi.org/10.1681/ASN.2007020221

    Article  PubMed  Google Scholar 

  5. 5.

    McAdams-DeMarco MA, Law A, Salter ML, Boyarsky B, Gimenez L, Jaar BG, Walston JD, Segev DL (2013) Frailty as a novel predictor of mortality and hospitalization in individuals of all ages undergoing hemodialysis. J Am Geriatr Soc 61(6):896–901. https://doi.org/10.1111/jgs.12266

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Kutner NG, Zhang R, Huang Y, Painter P (2015) Gait speed and mortality, hospitalization, and functional status change among hemodialysis patients: a US renal data system special study. Am J Kidney Dis 66(2):297–304. https://doi.org/10.1053/j.ajkd.2015.01.024

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Matsuzawa R, Matsunaga A, Wang G, Yamamoto S, Kutsuna T, Ishii A, Abe Y, Yoneki K, Yoshida A, Takahira N (2014) Relationship between lower extremity muscle strength and all-cause mortality in Japanese patients undergoing dialysis. Phys Ther 94(7):947–956. https://doi.org/10.2522/ptj.20130270

    Article  PubMed  Google Scholar 

  8. 8.

    Matsuzawa R, Roshanravan B, Shimoda T, Mamorita N, Yoneki K, Harada M, Watanabe T, Yoshida A, Takeuchi Y, Matsunaga A (2018) Physical activity dose for hemodialysis patients: where to begin? Results from a prospective cohort study. J Ren Nutr 28(1):45–53. https://doi.org/10.1053/j.jrn.2017.07.004

    Article  PubMed  Google Scholar 

  9. 9.

    Heiwe S, Jacobson SH (2014) Exercise training in adults with CKD: a systematic review and meta-analysis. Am J Kidney Dis 64(3):383–393. https://doi.org/10.1053/j.ajkd.2014.03.020

    Article  PubMed  Google Scholar 

  10. 10.

    Smart N, Steele M (2011) Exercise training in haemodialysis patients: a systematic review and meta-analysis. Nephrology (Carlton) 16(7):626–632. https://doi.org/10.1111/j.1440-1797.2011.01471.x

    Article  Google Scholar 

  11. 11.

    Matsuzawa R, Hoshi K, Yoneki K, Harada M, Watanabe T, Shimoda T, Yamamoto S, Matsunaga A (2017) Exercise training in elderly people undergoing hemodialysis: a systematic review and meta-analysis. Kidney Int Rep 2(6):1096–1110. https://doi.org/10.1016/j.ekir.2017.06.008

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Nied RJ, Franklin B (2002) Promoting and prescribing exercise for the elderly. Am Fam Physician 65(3):419–426

    PubMed  Google Scholar 

  13. 13.

    Gomes Neto M, de Lacerda FFR, Lopes AA, Martinez BP, Saquetto MB (2018) Intradialytic exercise training modalities on physical functioning and health-related quality of life in patients undergoing maintenance hemodialysis: systematic review and meta-analysis. Clin Rehabil 32(9):1189–1202. https://doi.org/10.1177/0269215518760380

    Article  PubMed  Google Scholar 

  14. 14.

    Pu J, Jiang Z, Wu W, Li L, Zhang L, Li Y, Liu Q, Ou S (2019) Efficacy and safety of intradialytic exercise in haemodialysis patients: a systematic review and meta-analysis. BMJ Open 9(1):e020633. https://doi.org/10.1136/bmjopen-2017-020633

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Zhang F, Zhou W, Sun Q, Zhai Y, Zhang Y, Su H, Wang Z (2019) Effects of intradialytic resistance exercises on physical performance, nutrient intake and quality of life among haemodialysis people: a systematic review and meta-analysis. Nurs Open. https://doi.org/10.1002/nop2.274

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Yamamoto S, Matsuzawa R, Abe Y, Hoshi K, Yoneki K, Harada M, Watanabe T, Shimoda T, Suzuki Y, Matsunaga Y, Kamiya K, Yoshida A, Matsunaga A (2018) Utility of regular management of physical activity and physical function in hemodialysis patients. Kidney Blood Press Res 43(5):1505–1515. https://doi.org/10.1159/000494016

    Article  PubMed  Google Scholar 

  17. 17.

    Liu J, Huang Z, Gilbertson DT, Foley RN, Collins AJ (2010) An improved comorbidity index for outcome analyses among dialysis patients. Kidney Int 77(2):141–151. https://doi.org/10.1038/ki.2009.413

    Article  PubMed  Google Scholar 

  18. 18.

    Yamada K, Furuya R, Takita T, Maruyama Y, Yamaguchi Y, Ohkawa S, Kumagai H (2008) Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr 87(1):106–113. https://doi.org/10.1093/ajcn/87.1.106

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH (2001) A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis 38(6):1251–1263. https://doi.org/10.1053/ajkd.2001.29222

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49(2):M85-94. https://doi.org/10.1093/geronj/49.2.m85

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Crouter SE, Schneider PL, Karabulut M, Bassett DR Jr (2003) Validity of 10 electronic pedometers for measuring steps, distance, and energy cost. Med Sci Sports Exerc 35(8):1455–1460. https://doi.org/10.1249/01.MSS.0000078932.61440.A2

    Article  PubMed  Google Scholar 

  22. 22.

    Matsufuji S, Shoji T, Yano Y, Tsujimoto Y, Kishimoto H, Tabata T, Emoto M, Inaba M (2015) Effect of chair stand exercise on activity of daily living: a randomized controlled trial in hemodialysis patients. J Ren Nutr 25(1):17–24. https://doi.org/10.1053/j.jrn.2014.06.010

    Article  PubMed  Google Scholar 

  23. 23.

    Baggetta R, D’Arrigo G, Torino C, ElHafeez SA, Manfredini F, Mallamaci F, Zoccali C, Tripepi G, group EW, (2018) Effect of a home based, low intensity, physical exercise program in older adults dialysis patients: a secondary analysis of the EXCITE trial. BMC Geriatr 18(1):248. https://doi.org/10.1186/s12877-018-0938-5

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Chung YC, Yeh ML, Liu YM (2017) Effects of intradialytic exercise on the physical function, depression and quality of life for haemodialysis patients: a systematic review and meta-analysis of randomised controlled trials. J Clin Nurs 26(13–14):1801–1813. https://doi.org/10.1111/jocn.13514

    Article  PubMed  Google Scholar 

  25. 25.

    Chen JL, Godfrey S, Ng TT, Moorthi R, Liangos O, Ruthazer R, Jaber BL, Levey AS, Castaneda-Sceppa C (2010) Effect of intra-dialytic, low-intensity strength training on functional capacity in adult haemodialysis patients: a randomized pilot trial. Nephrol Dial Transplant 25(6):1936–1943. https://doi.org/10.1093/ndt/gfp739

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Anding K, Bar T, Trojniak-Hennig J, Kuchinke S, Krause R, Rost JM, Halle M (2015) A structured exercise programme during haemodialysis for patients with chronic kidney disease: clinical benefit and long-term adherence. BMJ Open 5(8):e008709. https://doi.org/10.1136/bmjopen-2015-008709

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Jeong JH, Biruete A, Tomayko EJ, Wu PT, Fitschen P, Chung HR, Ali M, McAuley E, Fernhall B, Phillips SA, Wilund KR (2019) Results from the randomized controlled IHOPE trial suggest no effects of oral protein supplementation and exercise training on physical function in hemodialysis patients. Kidney Int 96(3):777–786. https://doi.org/10.1016/j.kint.2019.03.018

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Martin-Alemañy G, Valdez-Ortiz R, Olvera-Soto G, Gomez-Guerrero I, Aguire-Esquivel G, Cantu-Quintanilla G, Lopez-Alvarenga JC, Miranda-Alatriste P, Espinosa-Cuevas A (2016) The effects of resistance exercise and oral nutritional supplementation during hemodialysis on indicators of nutritional status and quality of life. Nephrol Dial Transplant 31(10):1712–1720. https://doi.org/10.1093/ndt/gfw297

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    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

    Article  PubMed  Google Scholar 

  30. 30.

    Delgado C, Johansen KL (2010) Deficient counseling on physical activity among nephrologists. Nephron Clin Pract 116(4):c330-336. https://doi.org/10.1159/000319593

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Johansen KL (2007) Exercise in the end-stage renal disease population. J Am Soc Nephrol 18(6):1845–1854. https://doi.org/10.1681/ASN.2007010009

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Painter P, Marcus RL (2013) Assessing physical function and physical activity in patients with CKD. Clin J Am Soc Nephrol 8(5):861–872. https://doi.org/10.2215/CJN.06590712

    Article  PubMed  Google Scholar 

  33. 33.

    Fang HY, Burrows BT, King AC, Wilund KR (2019) A comparison of intradialytic versus out-of-clinic exercise training programs for hemodialysis patients. Blood Purif. https://doi.org/10.1159/000503772

    Article  PubMed  Google Scholar 

  34. 34.

    Johansen KL (2016) Resistance exercise in the hemodialysis population—who should do the heavy lifting? Am J Nephrol 44(1):29–31. https://doi.org/10.1159/000446866

    Article  PubMed  Google Scholar 

  35. 35.

    Johansen KL, Painter PL, Sakkas GK, Gordon P, Doyle J, Shubert T (2006) Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis: a randomized, controlled trial. J Am Soc Nephrol 17(8):2307–2314. https://doi.org/10.1681/ASN.2006010034

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Knight EL, Ofsthun N, Teng M, Lazarus JM, Curhan GC (2003) The association between mental health, physical function, and hemodialysis mortality. Kidney Int 63(5):1843–1851. https://doi.org/10.1046/j.1523-1755.2003.00931.x

    Article  PubMed  Google Scholar 

  37. 37.

    Lowrie EG, Curtin RB, LePain N, Schatell D (2003) Medical outcomes study short form-36: a consistent and powerful predictor of morbidity and mortality in dialysis patients. Am J Kidney Dis 41(6):1286–1292. https://doi.org/10.1016/s0272-6386(03)00361-5

    Article  PubMed  Google Scholar 

  38. 38.

    Johansen KL, Dalrymple LS, Delgado C, Chertow GM, Segal MR, Chiang J, Grimes B, Kaysen GA (2017) Factors associated with frailty and its trajectory among patients on hemodialysis. Clin J Am Soc Nephrol 12(7):1100–1108. https://doi.org/10.2215/CJN.12131116

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors thank the patients and the hemodialysis staff at the Tokyo Ayase Kidney Center for their contributions to this study.

Funding

This research was supported by JSPS KAKENHI [19K11372].

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Affiliations

Authors

Contributions

KI, YS, SY, RM, and AM analyzed and interpreted the data and contributed significantly to the preparation of the manuscript. KI, YS, SY, MH, and SY performed the physical function measurements. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Yuta Suzuki.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This study’s retrospective protocol was approved by the Ethics Committee of Kitasato University School of Allied Health Sciences and complied with the standards set forth by the latest revision of the Declaration of Helsinki.

Consent to participate

All patients received a detailed explanation of the study protocol and provided informed consent.

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Not applicable.

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Imamura, K., Suzuki, Y., Yamamoto, S. et al. Feasibility of long-term intradialytic exercise for older patients receiving hemodialysis: a retrospective single-center study. Int Urol Nephrol (2021). https://doi.org/10.1007/s11255-021-02955-y

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Keywords

  • Hemodialysis
  • Intradialytic exercise
  • Older patients
  • Physical activity
  • Physical function