Effects Of Intradialytic Resistance Exercise On Maintenance Hemodialysis Patients With Sarcopenia

BackgroundSarcopenia,a newly recognized geriatric syndrome,affectes the daily lives of people with chronic diseases.Maintenance hemodialysis patients(MHD)as representatives of sedentary groups are more likely to have symptoms associated with sarcopenia,such as muscle atrophy,decreased muscle strength,and decreased muscle function.Low exercise capacity caused by muscle atrophy is an independent predictor of death in patients with end-stage renal disease.Therefore,it is essential to understand the occurrence of sarcopenia and formulate exercise prescription to reduce MHD patients mortality.In recent years,medical personnel have generally applied nutritional interventions and medications which may be related to the slow effect of exercise intervention and poor patient compliance.However,a little of medical personnel have researched the effects of exercise interventions to control muscle atrophy in MHD patients.Foreign researches have shown that resistance exercise is an effective type of exercise to improve the symptoms of sarcopenia,but the relevant guidance have no specific guidance on exercise methods,time,intensity and cycle because of the particularity of the treatment methods and conditions of MHD patients.Therefore,the applicability and operability of intradialytic resistance exercise for MHD patients remains to be studied.How to use intradialytic resistance exercise to improve the intervention effect of MHD patients with sarcopenia has become an urgent problem to be solved.Objectives1.To investigate the status of MHD with sarcopenia,which will provide a basis for further intervention trials.2.Based on the research results at domestic and foreign,we formulated a reasonable exercise prescription for the intradialytic resistance exercise and explored the effects on sarcopenia-related symptoms(muscle mass,muscle strength),hemodialysis-related symptoms(micro-inflammatory state,dialysis adequacy),and quality of life in MHD patients with sarcopenia.MethodsRandomized controlled study design in this study: 341 MHD patients in total who were treated in the Blood Purification Center,The First People's Hospital of Lianyungang,from May 2017 to July 2017 were selected for the detection of sarcopenia.45 MHD patients with sarcopenia were detected as the study subjects.They were divided into intervention group(n=23)and control group(n=22)by the simple randomized method with the random number table.The control patients group only received routine hemodialysis care.The patients intervention group received progressive intradialytic resistance exercise with high or meddle intensity,for 12 weeks and 3 times per week(the weight of the lower limbs and the elastic ball movement of the upper limb)on the basis of routine hemodialysis care.Before the intervention,the 4th week of intervention,and the 12 th week of intervention,bioelectrical impedance analysis(bioinductive impedance analysis,BIA)was used to measure the nutritional components of body composition.Including body mass index,skeletal muscle mass index,skeletal muscle,fat mass,fat mass,lean body mass,lean body mass,waist-to-hip ratio.Before the intervention and after 12 weeks of intervention,we measured the grip strength,the daily pace and the patient's biochemical parameters which includes blood urea,serum creatinine,dialysis adequacy(Kt/V),hemoglobin,neutrophil ratio,serum albumin,standard protein degradation rate(nPCR),C-reactive protein(CRP)and inflammatory factors(IL-6,IL-10,TNF-?.).To assess the patient's physical activity status and quality of life.Thedatas of 41 patients(21 cases in the intervention group and 20 cases in the control group)were analyzed by SPSS 23.0 to evaluate the effect of intradialytic resistance exercise on physical activity status,dialysis efficacy,micro-inflammatory status,quality of life,and psychological status of MHD patients with sarcopenia.Results1.The incidence of sarcopenia in MHD patients: The prevalence of sarcopenia in all age groups in MHD patients was 13.2%.And the MHD patients with sarcopenia over50 years old(50-76 years old)and over 60 years old(60-76 years old)were 43.2%and 55.4% respectively.2.Effect of intradialytic resistance exercise intervention: After intradialytic resistance exercise intervention of 12 weeks,the physical activity status(maximum grip strength,daily pace,physical activity level),nutritional status(serum albumin),Kt/V,CRP,and the scores of the hospital anxiety and depression and quality of life were significant different between the two groups.In addition,the inflammatory factors(IL-6,IL-10,and TNF-?)increased and decreased more significantly in the intervention group than that in the control group.The research suggested that the intradialytic resistance exercise improves the micro-inflammatory state of MHD patients.Conclusions1.The incidence of MHD with sarcopenia is higher than that of the general population(13.2%~55.4%).2.The intradialytic resistance exercise can improve the quality of life by reducing micro-inflammatory reactions and improving the physical activity and nutritional status of sarcopenia in MHD patients.