Factors Related To Frailty In Elderly Patients With Maintenance Hemodialysis And Evaluation Of The Effect Of Regular Bicycle Exercise Intervention

ObjectiveThe purpose of this study was to investigate the incidence and influencing factors of frailty in elderly maintenance hemodialysis patients and to further clarify the effects of regular pedal bike exercise during 12 weeks of dialysis on the degree of frailty,physical function,quality of life,and biochemical indicators in elderly maintenance hemodialysis patients,to provide future insight into the true level of frailty occurrence in elderly hemodialysis patients and further evaluation of the intervention effect of exercise interventions for the prevention and treatment of frailty.Methods1.Investigation phaseThe blood purification department of a tertiary care hospital in Xi’an was used as the trial site,the FRAIL scale and Simple Physical Function Scale Score(SPPB)Sarcopenia Rapid Screening Questionnaire(SARC-F)were firstly used to conduct a questionnaire survey on elderly maintenance hemodialysis patients in the hemodialysis unit to understand the occurrence of debilitation in elderly maintenance hemodialysis patients and analyze its influencing factors.2.Intervention phaseFifty-six elderly patients with MHD with frailty were selected from the pre-investigation period and divided into 28 cases each in the intervention group and control group according to the random number table method.The control group received routine care and was given appropriate exercise instructions;the intervention group received 12 weeks of regular bicycle exercise in dialysis on the basis of routine care.After 12 weeks of intervention,the patients were assessed for changes in the Frailty Assessment Inventory score(FRAIL),Simple Physical Function Scale score(SPPB),Sarcopenia Rapid Screening Questionnaire(SARC-F),Quality of Life Scale(SF-36)score,grip strength value,and biochemical indexes of laboratory tests(Hemoglobin,Red Blood Cell count,Serum Albumin,Serum Total Protein,C-reactive protein,etc.).Results1.Occurrence and influencing factors of frailty: Among 146 MHD patients,the incidence of frailty and pre-frailty was divided into 18.5% and 58.9%.The regression equation showed that age,gender,body size,and SARC-F were independent influencing factors of debilitation in elderly maintenance hemodialysis patients(P < 0.05).2.Comparison of frailty between MHD patients and MHD patients after intervention:the frailty score of the observation group was(0.72±0.84),which was lower than that of the control group(1.72±1.14),and the difference was statistically significant(P<0.01),and the difference in the degree of frailty was statistically significant(P<0.05).3.The differences in grip strength,physical function,and sarcopenia between the two groups of MHD patients after intervention were statistically significant: after 12 weeks of exercise intervention,the grip strength level of MHD patients in the control group was(21.32±8.29)kg and in the intervention group was(25.38±6.11)kg,with statistically significant differences(P<0.05);the physical score in the intervention group was(9.76±1.69)The difference was statistically significant(P<0.01),and the difference was statistically significant(P<0.05)in the percentage of subtypes with normal and reduced physical function.The sarcopenia score in the intervention group was 1.00(0.00±3.00),which was lower than the 1.50(1.00±2.00)score in the control group,with a statistically significant difference(P<0.05).4.Variation in quality of life of MHD patients in the two groups after intervention:after 12 weeks of regular rehabilitation exercise intervention,there were statistically significant differences between the SF-36 scale in 6 dimensions of physical function,somatic pain,emotional function,social function,mental health,energy,and health change in the two groups of MHD patients in the intervention and control groups(P <0.05);while the differences in 3 dimensions of physical function,emotional function,and average health were not statistically significant(P > 0.05).5.Changes in biochemical indexes of MHD patients in the two groups after the intervention: after 12 weeks of exercise training,there was no significant improvement in hemoglobin,red blood cell count,serum albumin,serum total protein,C-reactive protein,calcium,phosphorus and parathyroid hormone in the two groups of patients in the intervention and control groups(P > 0.05).Conclusion1.The incidence of frailty is higher in elderly maintenance hemodialysis patients,and the occurrence of frailty is influenced by gender,age,body size,and sarcopenia.2.Regular bicycle exercise during dialysis is beneficial in reducing the degree of frailty and reversing frailty in elderly maintenance hemodialysis patients,and the improvement effect is more significant in MHD patients in the pre-frailty stage.3.Bicycle exercise can improve the grip strength level,enhance the somatic function and improve the quality of life in MHD patients,but it has no significant effect on the biochemical indexes of elderly MHD patients.