Abstract
To investigate the effect of exercise on cardiopulmonary function and the life quality of maintenance hemodialysis patients. Eighty-four patients who underwent maintenance hemodialysis treatment for more than 3 months were randomly divided into experimental group and control group. The general data and nutritional indexes, including hemoglobin and plasma albumin, before and after the experiment. The differences in lung function, cardiac ultrasound, cardiopulmonary function, exercise endurance between the 2 groups before and after intervention were compared. The short form 36-item health survey (SF-36) and self-rating depression scale (SDS) were assessed. In our study, the experimental group had better Force vital capacity (FVC) and peak expiratory flow (PEF) after the intervention compared to the control group (P < .05). Anaerobic threshold and 6-minute walk test (6MWT) improved significantly in the experimental group (P < .05), and SF-36 showed better physical functioning, social functioning, general health, and vitality scores in the experimental group compared to the control group (P < .05). In addition, following 24 weeks of exercise, the Depression score of the exercise group showed a statistically significant improvement when compared to the control group (P < .05). After the intervention, hemoglobin improved significantly in the experimental group (P < .05). Intradialytic exercise can improve hemoglobin, Alb, pulmonary function, aerobic capacity, and exercise endurance in maintenance hemodialysis patients, so as to improve the quality of life, which is worthy of further promotion.
Keywords: aerobic exercise, cardiopulmonary function, depression, hemodialysis, nutritional status, quality of life
1. Introduction
Maintenance hemodialysis (MHD) serves as the primary treatment for individuals with chronic kidney disease. However, as MHD treatment duration increases, patients often experience a range of complications, including diminished physical activity, cardiac and pulmonary impairment, and cognitive dysfunction, ultimately affecting their overall quality of life.[1]
Reduced levels of physical activity are commonly observed in patients undergoing hemodialysis. Even minor changes in physical activity level can result in substantial benefits for patients, regardless of the intensity of exercise.[2] The Clinical Practice Guidelines on Exercise and Lifestyle in Chronic Kidney Disease, published by the British Kidney Society in 2021, recommend that MHD patients without contraindications be encouraged to engage in physical activity and sports, and aim for 150 minutes of moderate-intensity activity per week, 75 minutes of vigorous activity per week, or a combination of both, as per the UK Chief Medical Officers’ Guideline. This may include exercise during dialysis (intradialytic) or outside of dialysis (interdialytic).[3,4] Exercise rehabilitation therapy is one promising approach to improving the cardiopulmonary function and quality of life in MHD patients. A recent systematic review found that exercise rehabilitation programs can improve aerobic capacity, muscular strength, and physical function in MHD patients.[5] Additionally, exercise interventions have been shown to improve psychological outcomes, such as depression and anxiety, and cognitive function in MHD patients.[6,7] However, large sample, long-term, and randomized controlled studies on intradialytic exercise intensity in hemodialysis patients are currently lacking.
Therefore, this study aims to investigate the impact of exercise rehabilitation therapy, using an individualized exercise approach, on cardiopulmonary function and quality of life in MHD patients. The goal is to provide an essential basis for the development of standardized exercise prescriptions for MHD patients, and to promote their wider application in the future.
2. Materials and methods
2.1. Requirements
Maintenance hemodialysis ≥ 3 months.
Age ≥ 18 years and ≤ 75 years.
Hemodialysis 3 times a week.
Capable of ambulating autonomously, devoid of visual impairments, devoid of musculoskeletal injuries, and devoid of lower limb mobility disorders.
Participants must be volunteered to participate in this study and sign the informed consent form.
2.2. Exclusion criteria
If patients suffered from physical activity disorder.
If patients suffered from any central and peripheral nervous system diseases.
If patients suffered from serious complications, such as heart failure, severe infection and malignant tumor.
If patients who are unable to complete the exercise with muscle or joint disease.
2.3. General information
From January 2021 to May 2022, a total of 84 MHD patients from Songjiang District Central Hospital were selected and divided into 2 groups randomly. Randomization of the allocation sequence will be completed using the random number table method, whilst factoring in variables such as age, gender, duration of dialysis, and primary disease composition. This study obtained the informed consent of the subjects and was approved by the ethics committee of Songjiang District Central Hospital (2020-037).
2.4. Exercise intervention in hemodialysis
The control group received conventional MHD treatment. Within the context of hemodialysis, the experimental group underwent exercise via a horizontal treadmill (EMAX58, Nanjing Hanya Health Technology Co., Ltd.) for 24 weeks (3 times a week and 30 minutes each time). The exercise was carried out within 2 to 3 hours after the start of dialysis, and the exercise intensity had an ascending period of 5 minutes, a flat period of 15 minutes, and a descending period of 5 minutes. The volume of peak oxygen consumption (VO2 peak) was determined by an incremental cycling exercise tolerance protocol. According to the cardiopulmonary exercise test report by the rehabilitation doctor, the exercise intensity was maintained at 5 to 15 points, and the resistance of motion increased 10 N every 2 to 3 weeks, and a low intensity treadmill training (50% of VO2 peak) that could be tolerated by participants was maintained for 24 weeks. Stop exercise in the following circumstances: chest tightness; sweating; dizziness; paleness; muscle spasm; nausea; shortness of breath that does not correspond to the intensity of exercise.
2.5. Observation indicators and methods
2.5.1. Pulmonary function.
At the time of enrollment and 24 weeks after treatment, the exercise cardiopulmonary assessment system (AT104 ERGO) of SCHILLER (Germany) was used to measure the static lung function and record the forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), forced vital capacity ratio (FEV1/FVC) and peak expiratory flow (PEF).
2.5.2. Heart structure and function.
The structure and function of the left ventricle were measured by color Doppler ultrasonography at the time of enrollment and 24 weeks after treatment. Left ventricular ejection fraction (LVEF), left ventricular end systolic volume (LVESV) and left ventricular end diastolic volume (LVEDV) have also been recorded.
2.5.3. Cardiopulmonary function and exercise endurance.
Exercise cardiopulmonary evaluation system (AT104ERGO) was used for cardiopulmonary exercise testing, and patients can take regular cardiovascular drugs before the test. Sports load plan: The Ramp protocol was used (consisting of a rest (3 minutes), a warm-up (3 minutes treadmill without load), an incremental load treadmill (10 W or 15 W every minute, the treadmill speed was kept at 55–60 r/min until the end of the exercise test was reached), a recovery period (3 minutes treadmill without load, the treadmill speed was kept at 20–40 r/min until the rest was completely stopped). Cardiopulmonary function indicators including peak oxygen uptake (peakVO2) and anaerobic threshold (AT) were recorded. Before and following rehabilitation, all patients underwent a 6-minute walk test (6MWT).
2.5.4. Health-related quality of life.
The short-form 36-item health survey questionnaire (SF-36) was used to evaluate the patient’s health-related quality of life before and after intervention. The SF-36 accesses health-related quality of life in 8 areas: (1) limitations in physical activities because of health problems (physical functioning); (2) limitations in social activities because of physical or emotional problems (social functioning, SF); (3) limitations in usual role activities because of physical health problems (role-physical, RP); (4) bodily pain; (5) mental health (MH); (6) limitations in usual role of emotional problems (role-emotional); (7) vitality (VT); and (8) general health. Each area of the SF-36 has a full score of 100, and the score was positively correlated with the quality of life.
2.5.5. Depression.
Self-rating depression scale (SDS) is one of a handful of questionnaires used by therapists and clinicians to gauge the level of patients’ depressive disorders, containing 10 positively worded items and 10 negatively worded items and rated from 1 to 4 in each item. The patients with a score of more than 40 points were considered as being depressed.
2.5.6. Nutritional status.
An assessment of nutritional status in patients may include a comprehensive evaluation consisting of hemoglobin (Hb) levels before and after 24 weeks of intervention.
2.5.7. Adverse reactions.
The frequency and types of adverse events (AEs) of patients after the different intervention was recorded.
2.6. Statistical methods
SPSS22.0 statistical software was used for data processing. The quantitative variables are expressed as the mean and standard deviation (x̄ ± s), comparison between groups was performed by Student t test and comparison within groups was performed by paired t test. Enumeration data were represented as cases (%), and comparison between groups was performed by the chi-square test. P < .05 was considered statistically significant.
3. Results
3.1. The general characteristics of participants
The baseline characteristics of the included participants was showed in Table 1. The average age of the experimental group and control group was (56.3 ± 11.10) and (59.2 ± 10.41) years old. There were no significant differences in gender, age and dialysis duration between the experimental and control group (P > .05).
Table 1.
Baseline characteristics of the included patients.
| Characteristics | Experimental group | Control group | t | P |
|---|---|---|---|---|
| Age (yr) | 56.3 ± 11.10 | 59.2 ± 10.41 | 0.961 | .341 |
| Gender [n (%)] | ||||
| Male | 15 (35.7) | 26 (61.9) | 3.630 | .057 |
| Female | ||||
| Dialysis (mo) | 126.2 ± 74.08 | 113.1 ± 45.27 | 0.783 | .438 |
| Kt/V | 1.60 ± 0.292 | 1.49 ± 0.322 | 1.319 | .193 |
| Primary disease conditions [n (%)] | 2.159 | .367 | ||
| Chronic nephritis | 22 (28.6) | 19 (45.2) | ||
| Hypertension kidney disease | 12 (28.6) | 13 (30.9) | ||
| Diabetic nephropathy | 7 (16.7) | 6 (14.3) | ||
| Other | 1 (2.4) | 4 (9.5) |
3.2. Comparison of pulmonary function of MHD patients before and after rehabilitation exercise intervention
There was no significant difference in FVC, FEV1/FVC and PEF between the 2 groups before intervention (P > .05). In contrast, FVC and PEF in the experimental group were improved compared with those before intervention and higher than those in the control group (P < .05), and there was no statistical difference in the other indexes (Table 2).
Table 2.
Comparison of lung function before and after exercise intervention.
| Control group (n = 42) | Rehabilitation group (n = 42) | t | P | |
|---|---|---|---|---|
| FVC (L) | ||||
| Before the intervention | 2.41 ± 0.57 | 2.35 ± 0.66 | −0.303 | .763 |
| After the intervention | 0.49 ± 0.57 | 0.85 ± 0.62* | 0.124 | .037 |
| FEV1/FVC (%) | ||||
| Before the intervention | 76.52 ± 55.90 | 77.42 ± 7.22 | 0.440 | .662 |
| After the intervention | 76.00 ± 5.11 | 77.65 ± 3.59 | 1.348 | .184 |
| PEF (L/s) | ||||
| Before the intervention | 0.20 ± 0.78 | 0.11 ± 1.31 | −0.318 | .752 |
| After the intervention | 4.18 ± 02.7 | 0.95 ± 1.32* | 2.636 | .011 |
Data are presented as means ± SD.
FEV1/FVC = forced vital capacity ratio, FVC = forced vital capacity, PEF = peak expiratory flow.
Within-group when compared to pre-intervention, P<0.05.
3.3. Comparison of cardiac function between the 2 groups before and after rehabilitation intervention
There was no significant difference in LVEF, LVESV, LVESV and LVEDV between the 2 groups before intervention (P > .05). After intervention, there was still no statistical difference between the 2 groups and there were also no statistical differences in LVEF, LVESV and LVEDV in the experimental group before and after the intervention (P > .05) (Table 3).
Table 3.
Comparison of cardiac function before and after exercise intervention.
| Control group (n = 42) | Rehabilitation group (n = 42) | t | P | |
|---|---|---|---|---|
| LVEF (%) | ||||
| Before the intervention | 65.49 ± 5.11 | 64.08 ± 4.40 | −1.073 | .288 |
| After the intervention | 65.73 ± 4.64 | 64.68 ± 4.23 | −0.926 | .354 |
| LVESV (mL) | ||||
| Before the intervention | 48.96 ± 5.10 | 47.42 ± 5.46 | −1.040 | .303 |
| After the intervention | 49.19 ± 4.46 | 47.58 ± 4.98 | −1.245 | .219 |
| LVEDV (mL) | ||||
| Before the intervention | 31.81 ± 4.70 | 31.38 ± 5.01 | −0.310 | .758 |
| After the intervention | 32.64 ± 4.39 | 31.69 ± 4.65 | −0.766 | .844 |
Data are presented as means ± SD.
LVEDV = left ventricular end diastolic volume, LVEF = left ventricular ejection fraction, LVESV = left ventricular end systolic volume.
3.4. Comparison of exercise endurance before and after the exercise intervention between the 2 groups
The AT and 6MWT of the experimental group were improved compared with those before the intervention (P < .05) and higher than those of the control group (P < .05), and there was no statistical difference in the other indexes (Table 4).
Table 4.
Comparison of exercise endurance indexes before and after exercise intervention.
| Control group (n = 42) | Rehabilitation group (n = 42) | t | P | |
|---|---|---|---|---|
| Peak VO2 (mL/min × kg) | ||||
| Before the intervention | 14.87 ± 3.07 | 14.16 ± 3.98 | −0.701 | .486 |
| After the intervention | 15.06 ± 3.60 | 16.78 ± 4.94 | 156.4 | .154 |
| AT (mL/min × kg) | ||||
| Before the intervention | 11.32 ± 2.32 | 10.83 ± 2.17 | −0.802 | .174 |
| After the intervention | 11.26 ± 2.14 | 13.62 ± 3.53* | 2.908 | .005 |
| 6 MWT (m) | ||||
| Before the intervention | 424.50 ± 55.29 | 422.88 ± 60.59 | −0.163 | .872 |
| After the intervention | 430.79 ± 48.14 | 460.65 ± 50.39* | 0.128 | .034 |
Data are presented as means ± SD.
6MWT = 6-minute walk test, AT = anaerobic threshold, Peak VO2 = volume of peak oxygen consumption.
Within-group when compared to pre-intervention, P < .05.
3.5. Life-quality of MHD patients in 2 groups
There was no statistical significance in the total score of health-related quality of life between the 2 groups (P > .05) (Table 5). After 24 weeks of exercise intervention, the scores of physical functioning, social functioning, general health and vitality after intervention were higher than those of the control group, and the differences were statistically significant (P < .05). However, there were no significant differences in the other 4 areas of role-physical, bodily pain, mental health and role-emotional (P > .05) (Table 6).
Table 5.
Comparison of the baseline SF-36 scale scores between the 2 groups.
| Experimental group | Control group | t | P | |
|---|---|---|---|---|
| PF | 75 (60,85) | 75 (50,80) | −0.609 | .543 |
| RP | 75 (50,100) | 50 (25,100) | −1.144 | .253 |
| BP | 80 (60,90) | 70 (50,90) | −1.389 | .165 |
| GH | 30 (15,45) | 30 (25,60) | −0.894 | .371 |
| VT | 44.3 + 16.68 | 44.6 + 18.39 | −0.078 | .939 |
| SF | 100 (62.5100) | 87.5 (62.5100) | −1.059 | .290 |
| RE | 100 (33.3100) | 66.7 (33.3100) | −1.471 | .141 |
| MH | 60.4 + 17.41 | 61.6 + 12.71 | −0.286 | .776 |
Data are presented as means ± SD.
BP = bodily pain, GH = general health, MH = mental health, PF = physical functioning, RE = role-emotional, RP = role-physical, SF-36 = 36-item health survey questionnaire, VT = vitality.
Table 6.
Comparison of SF-36 scale scores between 2 groups after intervention.
| Experimental group | Control group | t | P | |
|---|---|---|---|---|
| PF | 75.7 + 13.64 | 65.9 + 20.6 | 2.063 | .044 |
| RP | 50 (25, 100) | 50 (25, 100) | −0.009 | .993 |
| BP | 60 (50, 70) | 70 (50, 90) | −0.442 | .673 |
| GH | 50 (35, 65) | 30 (25, 60) | −2.120 | .034 |
| VT | 52.2 + 13.47 | 43.1 + 17.9 | 2.107 | .040 |
| SF | 87.5 (75, 100) | 75 (50, 100.00) | −2.358 | .018 |
| RE | 100 (33.30, 100) | 66.70 (33.30, 100) | −0.952 | .341 |
| MH | 61.9 + 18.58 | 60.3 + 13.85 | 0.365 | .716 |
Data are presented as means ± SD.
BP = bodily pain, GH = general health, MH = mental health, PF = physical functioning, RE = role-emotional, RP = role-physical, SF-36 = 36-item health survey questionnaire, VT = vitality.
3.6. Psychological status of MHD patients in 2 groups
The Self-rating Depression Scale (SDS) was utilized to assess the psychological condition of patients, with a total score of 100 points. A lower score indicates better mental well-being. Before the exercise intervention, no significant difference was observed in the Depression score between the 2 groups. However, following 24 weeks of exercise, the Depression score of the exercise group showed a statistically significant improvement when compared to the control group (P < .05), as shown in Table 7.
Table 7.
Comparison of depression.
| Before the intervention | After the intervention | t | P | |
|---|---|---|---|---|
| Experimental group (n = 42) | 36.59 ± 10.23 | 30.39 ± 10.41 | 2.166 | .035 |
| Control group (n = 42) | 37.59 ± 9.28 | 38.65 ± 9.20 | −0.414 | .681 |
| t | −0.369 | −3.032 | ||
| P | .714 | .004 |
Data are presented as means ± SD.
3.7. Nutritional indicators
After intervention, the Hb levels in the experimental group were significantly improved compared with the control group (P < .05) (Table 8).
Table 8.
Comparison of Hb between the 2 groups before and after the intervention.
| Before the intervention | After the intervention | t | P | |
|---|---|---|---|---|
| The experimental group (n = 42) | 113.78 ± 9.97 | 121.31 ± 11.19 | −2.562 | .013 |
| Control group (n = 42) | 112.22 ± 14.49 | 113.44 ± 12.52 | −0.325 | .747 |
| t | 0.452 | −2.390 | ||
| P | .653 | .021 |
Data are presented as means ± SD.
Hb = hemoglobin.
4. Discussion
The primary mechanisms through which exercise rehabilitation confers benefits upon dialysis patients include the amelioration of blood pressure, blood lipid levels, insulin resistance, and other conventional risk factors of chronic kidney disease. Furthermore, aerobic exercise can decrease oxidative stress, augment muscle protein synthesis while curbing its breakdown, and ultimately enhance health-related quality of life.[5]
Studies have indicated that irrespective of whether they are receiving dialysis, aerobic exercise can impede the decline of physiological function in chronic kidney disease patients undergoing dialysis. In terms of psychological interventions, a Polish study (n = 86) demonstrated that resistance and endurance training for 6 months improved anxiety and depression in hemodialysis patients.[6] Additionally, the study indicated that exercise could enhance patients’ blood oxygen content, 6-minute walking distance, and other parameters. However, all of the aforementioned studies implemented exercise during the interval of dialysis. Thus, it remains unclear whether exercise can be carried out during dialysis, how to formulate exercise prescriptions, and whether there exists a standardized protocol for the intensity of rehabilitation training in MHD patients.[7–11] Research on rehabilitation exercises in hemodialysis patients dates back to the 1980s. Rehabilitation exercise can be categorized into resistance exercise, aerobic exercise, and combined exercise based on the type of exercise.[12]Multiple studies have demonstrated that aerobic exercise during dialysis, such as treadmill exercise, can ameliorate health-related quality of life, decrease the level of microinflammation, and improve the nutritional status of patients with chronic kidney disease.[13,14] Besnier confirmed that an exercise training program during dialysis sessions involving recycling and working intensity based on AT appears to be safe and an effective alternative for enhancing functional capacity in hemodialysis patients. Moreover, there were no exercise-related adverse events during the training.
To accurately evaluate the cardiopulmonary exercise function of patients, it is necessary to formulate a standard and suitable exercise prescription. In our study, prior to the intervention, all patients underwent a cardiopulmonary exercise test, and their peakVO2 and AT values were recorded to create individualized, moderate intensity exercise prescriptions. The results demonstrated that regular aerobic exercise improved the strength of respiratory muscles and pulmonary ventilation function, as evidenced by the higher FVC of the experimental group compared to the control group after intervention. Previous studies have also shown that rehabilitation exercise can improve cardiac function and exercise tolerance of MHD patients with cardiac dysfunction.[15,16] In this study, no significant difference was observed in ejection fraction indexes between the 2 groups of patients before and after intervention. However, this result should be interpreted with caution due to the small sample size and short intervention time. Further studies with larger sample sizes and multi-center collaborations are needed to confirm these findings.
VO2peak is an important indicator for evaluating cardiopulmonary function, while the AT value is crucial in the formulation of exercise prescriptions for MHD patients. It comprehensively reflects cardiopulmonary function, muscle oxidative capacity, and skeletal muscle metabolism level. Our study found that the AT and 6MWT of the rehabilitation group were improved after intervention and higher than the control group. This may be attributed to the increase in albumin levels, improved nutritional status, improved muscle contraction efficiency, and alleviation of weakness and fatigue in MHD patients resulting from regular aerobic exercise. Exercise can also significantly increase Hb levels, improve oxygen-carrying capacity, reduce oxidative stress, and improve aerobic exercise capacity through an increase in the number and function of muscle mitochondria.
Although VO2peak in the experimental group was improved after intervention, there was no statistical difference. Some studies[17] have suggested that the combination of aerobic and resistance training may be more effective in improving patients’ muscle strength and muscle content than aerobic training alone. Therefore, further long-term observation of the effects of aerobic combined resistance training on motor function in MHD patients is necessary in future studies. Additionally, future studies should increase the sample size and conduct multi-center joint studies to further improve our understanding of the effects of rehabilitation exercise on MHD patients.
In this study, the experimental group engaged in horizontal treadmill exercise during 24 weeks of dialysis, which led to positive outcomes. Firstly, after the exercise intervention, there was a statistically significant improvement in physical functioning, social functioning, general health, and vitality scores compared to the control group (P < .05). Although there was no significant improvement in the other 4 areas of role-physical, bodily pain, mental health, and role-emotional, the total score of 8 areas showed a significant improvement, which was positively correlated with the quality of life. Secondly, studies have indicated[18,19] that many maintenance hemodialysis patients experience psychological problems such as anxiety and depression. Regular exercise can decrease anxiety and depression in these patients by increasing the levels of serotonin, norepinephrine, and dopamine, which stimulates the brain to produce endorphins, leading to feelings of relaxation and happiness. Exercise can also alleviate fatigue and musculoskeletal pain.[20,21] Liu et al measured the depression score of patients using the Baker Depression Scale and found that there was a significant difference in the scores of patients between the 2 groups before and after exercise, indicating that aerobic treadmill exercise during dialysis can reduce anxiety and depression and improve psychological status.[22] In this study, the depression score of the experimental group decreased from 36.59 ± 10.23 to 30.39 ± 10.41 by SDS after 24 weeks of treadmill exercise. Thirdly, malnutrition is a prevalent issue among patients undergoing hemodialysis. This study showed significant changes in hemoglobin and albumin levels, which aligns with previous research.[23–31] The sample size can be expanded in future studies to investigate whether exercise can help to control anemia in hemodialysis patients. It is important to note that adequate dialysis and complication management are essential for exercise and psychological rehabilitation. The Kt/V of patients must also reach the standard, and patients must receive dietary guidance. Only when patients have normal erythrocyte counts and other indicators, such as calcium, phosphorus, and albumin, can exercise and psychological rehabilitation be effectively carried out. Exercise and psychological rehabilitation can improve the quality of life and prognosis of patients, enabling them to return to their families and society.
However, the study had limitations such as a small sample size and a simple research method. Future studies should expand the sample size and explore different exercise methods to provide more conclusive evidence.
5. Conclusion
In short, this study found that treadmill exercise, with appropriate intensity and supervised guidance during dialysis, can improve patients’ physical strength and behavior, ultimately leading to improved health-related quality of life and reduced depression. The exercise compliance of the patients was relatively good, with most patients engaging in aerobic exercise 3 to 5 times a week for over 30 minutes each time, totaling≥ 500–1000 METS-min/week. It is worth noting that adequate dialysis, complication management, and adherence to dietary guidance are crucial for successful exercise and psychological rehabilitation in hemodialysis patients. Ultimately, such interventions can help patients return to their normal lives and improve their overall prognosis.
Acknowledgments
We thank all the volunteer who participated in the study.
Author contributions
Conceptualization: Haiying Liu and Xiujuan Zang.
Data curation: Haiying Liu.
Formal analysis: Haiying Liu and Feng Zheng.
Investigation: Weixing Yao.
Methodology: Juanmei Zhu.
Project administration: Xiu Du.
Resource: Xiujuan Zang.
Software: Haiying Liu.
Supervision: Haiyan Shi, Xuelian Zhu and Xiujuan Zang.
Validation: Haiyan Shi.
Visualization: Xuelian Zhu.
Writing—original draft: Haiying Liu.
Writing—review & editing: Xiujuan Zang.
Abbreviations:
- 6MWT
- 6-minute walk test
- AT
- anaerobic threshold
- BP
- bodily pain
- FEV1
- forced expiratory volume in the first second
- FEV1/FVC
- forced vital capacity ratio
- FVC
- forced vital capacity
- LVEDV
- left ventricular end diastolic volume
- LVEF
- left ventricular ejection fraction
- LVESV
- left ventricular end systolic volume
- MHD
- maintenance hemodialysis
- PEF
- peak expiratory flow
- RE
- role-emotional
- RP
- role-physical
- SF
- social functioning
- SF-36
- 36-item health survey questionnaire
- VT
- vitality
This study was supported by Songjiang district scientific and technological project (20SJKJGG108 to Haiying Liu) and the Shanghai Songjiang District Science and Technology Project (19sjkjgg71 to Xiujuan Zang).
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
The authors have no conflict of interests to disclose.
How to cite this article: Liu H, Zheng F, Yao W, Zhu J, Du X, Shi H, Zhu X, Zang X. The impact of aerobic exercise on health-related quality of life among patients undergoing maintenance hemodialysis. Medicine 2023;102:45(e35990).
Contributor Information
Haiying Liu, Email: 18918288071@163.com.
Feng Zheng, Email: zf9621@sohu.com.
Weixing Yao, Email: 466462067@qq.com.
Juanmei Zhu, Email: hanjiagooddays@163.com.
Xiu Du, Email: jixiantaoyi@163.com.
Haiyan Shi, Email: shihaiyan19850117@163.com.
Xuelian Zhu, Email: hanjiagooddays@163.com.
References
- [1].Johansen KL, Chertow GM, Ng AV, et al. Physical activity levels in patients on hemodialysis and healthy sedentary controls. Kidney Int. 2000;57:2564–70. [DOI] [PubMed] [Google Scholar]
- [2].Pu J, Jiang Z, Wu W, et al. Efficacy and safety of intradialytic exercise in haemodialysis patients: a systematic review and meta-analysis. BMJ Open. 2019;9:e020633. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [3].Mactier R. Renal association clinical practice guideline development policy manual. Nephron Clin Pract. 2011;118:c13–25. [DOI] [PubMed] [Google Scholar]
- [4].Baker LA, March DS, Wilkinson TJ, et al. Clinical practice guideline exercise and lifestyle in chronic kidney disease. BMC Nephrol. 2022;23:75. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [5].Lim K, McGregor G, Coggan AR, et al. Cardiovascular functional changes in chronic kidney disease: integrative physiology, pathophysiology and applications of cardiopulmonary exercise testing. Front Physiol. 2020;11:1–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [6].Roshanravan B, Patel KV. Assessment of physical functioning in the clinical care of the patient with advanced kidney disease. Semin Dial. 2019;32:351–60. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [7].Clarkson MJ, Fraser SF, Bennett PN, et al. Efficacy of blood flow restriction exercise during dialysis for end stage kidney disease patients: protocol of a randomised controlled trial. BMC Nephrol. 2017;18:294. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [8].Abreu CC, Cardozo L, Stockler-Pinto MB, et al. Does resistance exercise performed during dialysis modulate Nrf2 and Nf-Kappab in patients with chronic kidney disease? Life Sci. 2017;188:192–7. [DOI] [PubMed] [Google Scholar]
- [9].Hiraki K, Shibagaki Y, Izawa KP, et al. Effects of home-based exercise on pre-dialysis chronic kidney disease patients: a randomized pilot and feasibility trial. BMC Nephrol. 2017;18:198. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [10].Chigira Y, Oda T, Izumi M, et al. Effects of exercise therapy during dialysis for elderly patients undergoing maintenance dialysis. J Phys Ther Sci. 2017;29:20–3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [11].Manfredini F, Mallamaci F, D’Arrigo G, et al. Exercise in patients on dialysis: a multicenter, randomized clinical trial. J Am Soc Nephrol. 2017;28:1259–68. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [12].Liao MT, Liu WC, Lin FH, et al. Intradialytic aerobic cycling exercise alleviates inflammation and improves endothelial progenitor cell count and bone density in hemodialysis patients. Medicine (Baltim). 2016;95:e4134. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [13].Hargrove N, El Tobgy N, Zhou O, et al. Effect of aerobic exercise on dialysis-related symptoms in individuals undergoing maintenance hemodialysis: a systematic review and meta-analysis of clinical trials. Clin J Am Soc Nephrol. 2021;16:560–74. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [14].Fathi M, Hejazi K. The effect of six months aerobic exercise during dialysis on liver enzymes, cystatin c and quality of life of hemodialysis patients. J Sports Med Phys Fitness. 2021;61:1515–22. [DOI] [PubMed] [Google Scholar]
- [15].Singh AS, Chinapaw MJ, Uijtdewilligen L, et al. Test-retest reliability and construct validity of the energy-parent questionnaire on parenting practices, energy balance-related behaviours and their potential behavioural determinants: the energy-project. BMC Res Notes. 2012;5:434. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [16].Singh AS, Vik FN, Chinapaw MJ, et al. Test-retest reliability and construct validity of the energy-child questionnaire on energy balance-related behaviours and their potential determinants: the energy-project. Int J Behav Nutr Phys Act. 2011;8:136. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [17].Byrkjeland R, Njerve IU, Anderssen S, et al. Effects of exercise training on Hba1c and Vo2peak in patients with type 2 diabetes and coronary artery disease: a randomised clinical trial. Diab Vasc Dis Res. 2015;12:325–33. [DOI] [PubMed] [Google Scholar]
- [18].Jain N, Carmody T, Minhajuddin AT, et al. Prognostic utility of a self-reported depression questionnaire versus clinician-based assessment on renal outcomes. Am J Nephrol. 2016;44:234–44. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [19].Weiss M, Mettang T, Tschulena U, et al. Health-related quality of life in haemodialysis patients suffering from chronic itch: results from Gehis (German epidemiology haemodialysis itch study). Qual Life Res. 2016;25:3097–106. [DOI] [PubMed] [Google Scholar]
- [20].Bargiel-Matusiewicz K, Lys A, Stelmachowska P. The positive influence of psychological intervention on the level of anxiety and depression in dialysis patients: a pilot study. Int J Artif Organs. 2019;42:167–74. [DOI] [PubMed] [Google Scholar]
- [21].Dziubek W, Kowalska J, Kusztal M, et al. The level of anxiety and depression in dialysis patients undertaking regular physical exercise training--a preliminary study. Kidney Blood Press Res. 2016;41:86–98. [DOI] [PubMed] [Google Scholar]
- [22].Liu YM, Chung YC, Chang JS, et al. Effects of aerobic exercise during hemodialysis on physical functional performance and depression. Biol Res Nurs. 2015;17:214–21. [DOI] [PubMed] [Google Scholar]
- [23].Sanchez-Tocino ML, Gonzalez-Parra E, Miranda Serrano B, et al. Evaluation of the impact of an intradialytic exercise programme on sarcopaenia in very elderly haemodialysis patients. Clin Kidney J. 2022;15:1514–23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [24].Hu H, Liu X, Chau PH, et al. Effects of intradialytic exercise on health-related quality of life in patients undergoing maintenance haemodialysis: a systematic review and meta-analysis. Qual Life Res. 2022;31:1915–32. [DOI] [PubMed] [Google Scholar]
- [25].Li T, Lv A, Xu N, et al. Barriers and facilitators to exercise in haemodialysis patients: a systematic review of qualitative studies. J Adv Nurs. 2021;77:4679–92. [DOI] [PubMed] [Google Scholar]
- [26].Krase AA, Terzis G, Giannaki CD, et al. Seven months of aerobic intradialytic exercise training can prevent muscle loss in haemodialysis patients: an ultrasonography study. Int Urol Nephrol. 2022;54:447–56. [DOI] [PubMed] [Google Scholar]
- [27].Greenwood SA, Koufaki P, Macdonald JH, et al. Exercise programme to improve quality of life for patients with end-stage kidney disease receiving haemodialysis: the pedal rct. Health Technol Assess. 2021;25:1–52. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [28].Zhang F, Huang L, Wang W, et al. Effect of intradialytic progressive resistance exercise on physical fitness and quality of life in maintenance haemodialysis patients. Nurs Open. 2020;7:1945–53. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [29].Zanotto T, Mercer TH, van der Linden ML, et al. The relative importance of frailty, physical and cardiovascular function as exercise-modifiable predictors of falls in haemodialysis patients: a prospective cohort study. BMC Nephrol. 2020;21:99. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [30].Young HML, March DS, Graham-Brown MPM, et al. Effects of intradialytic cycling exercise on exercise capacity, quality of life, physical function and cardiovascular measures in adult haemodialysis patients: a systematic review and meta-analysis. Nephrol Dial Transplant. 2018;33:1436–45. [DOI] [PubMed] [Google Scholar]
- [31].Molina-Robles E, Colomer-Codinachs M, Roquet-Bohils M, et al. Effectiveness of an educational intervention and physical exercise on the functional capacity of patients on haemodialysis. Enferm Clin (Engl Ed). 2018;28:162–70. [DOI] [PubMed] [Google Scholar]