The Effect Of Exercise Programs On Cardiac Function And Quality Of Life Of The Maintenance Hemodialysis Patients

Background and ObjectivesExercise training (ET) rehabilitation program confers beneficialeffects on cardiac function and quality of life (QoL) in patients withchronic heart failure (CHF), this has become a hot topic in the area of theCHF treatment. The hemodialysis patients who were end stage renal disease(ESRD) with CHF are a special group of patients with heart failure. It stillremains unclear whether the planned rehabilitation exercise training is able toimprove their cardiac function and QoL safely and profitably, while thehemodialysis patients are treated with stable maintenance hemodialysis (MHD);and there are few reports on them at home and abroad. In our study, this group ofpatients with CHF was treated by exercise training. We want to investigate the leftventricular ejection fraction (LVEF), the level of the BNP in serum, the distance ofsix-minute walk test (6MWT), the classification of heart function and the score ofSF-36before and after treatment and compare them, to explore the effect of ETintervention on these patient and provide clinic and experimental evidences for CHFtreatment by ET.Methods66MHD patients with CHF were randomly divided into two groups: Routinetreatment group (n=33) and ET treatment group (n=33). All of them were treated withthe same hemodialysis and regular treatments, and the latter group was additionallytreated with ET of home-based combined walking (or jogging) and resistanceprogram, with a course of treatment of10weeks. Serum venous samples were takenfrom the patients before and after treatment. BNP in serum were quantitatively estimated by enzyme-linked immunoabsorbent assay (ELISA). Before and aftertreatment, the classification of heart function, LVEF, the distance of6MWT, the levelof BNP in serum and the score of SF-36between the two groups were compared.Results1. There was no adverse events occurred during or immediately after ET in thosepatients.2. In the routine treatment group, the proportion of Class II patients based on NYHAheart function classification decreased from42.42%before treatment to39.39%, butthere was no significant difference（P＞0.05）；after ET, the proportion of Class IIpatients based on NYHA heart function classification increased from39.39%beforetreatment to63.64%, and there was significant difference （P<0.05）；after treatment,there was significant difference of the proportion of Class II patients between the twogroups（P<0.05）.3. The level of LVEF increased from34.2±6.5%before treatment to35.3±7.1%inthe routine treatment group；after ET, the level of LVEF increased from34.9±7.7%to36.9±6.4%, and there was no significant difference; there was no significantdifference of the level of LVEF between the two groups(P＞0.05）.4. The distance of6MWT increased from351.5±76.6m to366.5±73.4m in theroutine treatment group, but there was no significant difference（P>0.05）；after ET,the distance of6MWT increased from349.5±84.2m to408.4±93.7m and there wassignificant difference（P<0.01）; there was significant difference of the distance of6MWT between the two groups（P<0.05）.5. The levels of the BNP increased from1120.9±310.6to1143.9±282.3afterroutine treatment, but there was no significant difference（P>0.05）；after ET, thelevels of the BNP decreased from1083.3±294.3to928.8±299.7, and there wassignificant difference（P<0.05）; there was significant difference of the levels of the BNP after treatment between two groups(P<0.01）.6. The scores of SF-36increased from63.3±10.8to64.8±8.9after routine treatment,but there was no significant difference（P>0.05）；after ET, the scores of SF-36increased from65.2±8.9to71.1±9.7, and there was significant difference（P<0.05）;there was significant difference of the scores of SF-36after treatment between twogroups(P<0.01).Conclusions1. The rehabilitation program of home-based walk (or slow running) incombination with resistance training is safe for the MHD patients with CHF.2. The ET program has positive effect on the classification of heart function, thedistance of6MWT, the levels of the BNP in serum and the scores of SF-36of theMHD patients with CHF.3. The ET program can safely and profitably improve the cardiac function and QoLof the MHD patients with CHF.