A Study Of Progressive Intradialytic Resistance Exercise On Physical Function In Maintenance Hemodialysis Patients

Objectives To investigate the effects of 12 weeks intradialytic progressive resistance exercise intervention on physical function,muscle mass,dialysis adequacy and quality of life in maintenance hemodialysis(MHD)patients.Methods This study was a randomized controlled trial of 90 patients undergoing MHD at the hemodialysis center of Long Hua Hospital affiliated to Shanghai University of Traditional Chinese Medicine.According to the random number generated by computer software,they were divided into intervention group(n=45)and control group(n=45).Patients in the control group received routine hemodialysis,and the intervention group received progressive intradialytic resistance exercise intervention.Intervention measures: within 2 hours before the beginning of each dialysis,sandbags and dumbbells were used as resistance,and the patients were received upper and lower extremity resistance exercise.Week 1?4: 2 times/week,2 groups/time,10 sets/group,40 min/times,week 5?12,3 times/week,3 groups/time,12 sets/group,50 min/times.Before and after 3 months of intervention,the data of physical function,muscle mass,dialysis adequacy and quality of life score were collected and evaluated.Results After 12 weeks of intervention,2 cases fell off in the intervention group and 1 case in the control group.All the data were collected in 87 patients.The results of the study found that:(1)During the intervention period,adverse events occurred in both groups,but did not pose a risk to life,and continued to participate in the trial.The main adverse events were skeletal muscle injury(muscle soreness: 4 vs.1;cramp: 3 vs.0)and cardiovascular events(hypotension: 3 vs.3;palpitation: 1vs.1).There was no significant difference in the incidence of adverse events between groups(P=0.087).;(2)After 12 weeks,6-minute walking test(6MWT)and handgrip strength(HGS)in the intervention group were significantly higher than those before intervention,while sit-to-stand-to-sit 10 test(STS 10)was significantly lower than before(P<0.05).There was no statistically significant difference in 6MWT and HGS in the control group compared with that before intervention(P>0.05),but STS 10 was significantly increased,and the difference was statistically significant(P<0.05).After 12 weeks,there were statistically significant differences in the levels of 6MWT,STS 10 and HGS between the two groups(P<0.05).(3)After 12 weeks,the overhydration(OH),fat tissue index(FTI)and extracellular water(ECW)in the intervention group were compared with those before intervention,the difference was statistically significant(P<0.05),but there was no statistically significant difference in the rest(P>0 05).There were significant differences in OH,FTI,tissue mass(LTM),ECW and total body water(TBW)in the control group as compared with those before intervention(P<0.05),but there was no significant difference in the rest(P>0 05).After 12 weeks,there was no significant difference in the changes of body composition between the two groups(P>0 05).(4)After 12 weeks,the triceps skinfold thickness(TSF)in the intervention group were higher than those before intervention,and the mid-arm circumference(MAC)and upper mid-arm muscle circumference(MAMC)were lower than before with no statistically significant.The TSF,MAC and MAMC in the control group were lower than those before intervention with no significant difference(P>0 05).After 12 weeks,there was no statistically significant difference in the levels of TSF,MAC and MAMC between the two groups(P>0 05).(5)After 12 weeks,there was no statistically significant difference in dialysis adequacy(sp Kt/V)between the two groups(intervention group: P>0.05;control group: P>0.05).After 12 weeks,there was no significant difference in sp Kt/V level between the two groups(P>0.05).(6)After 12 weeks,except for c-reactive protein(CRP),calcium(Ca)and phosphorus(P),the differences in the intervention group were not statistically significant(P>0 05).In the control group,except for urea nitrogen(BUN),CRP,Ca and P,the differences were not statistically significant(P>0.05),the rest were statistically significant(P<0.05).After 12 weeks,there was no statistically significant difference in the changes of biochemical indexes between the two groups(P>0.05).(7)After 12 weeks,the scores of all dimensions scores of intervention group were compared with those before intervention.Except for mental component score,other dimensions were higher.There were significant differences in the dimension of effect of kidney disease and burden of kidney disease(P<0.05),but there was no significant difference in others(P>0.05).In the control group,the scores of each dimension were lower than those before intervention.After 12 weeks,there were statistically significant differences in quality of life between the two groups(P<0.05)but the physical component score.Conclusion(1)Intradialytic progressive resistance exercise is safe and feasible for MHD patients.(2)Intradialytic progressive resistance exercise may improve the level of physical function,maintain muscle mass and improve the quality of life of MHD patients.However,it did not significantly improve the dialysis adequacy.(3)This study provides a certain reference and basis for the future research on intradialytic exercise carried out by medical staff in dialysis centers,as well as a further reference for the management of MHD patients.It is suggested to adopt a more accurate measurement method for muscle mass in the future,and extend the follow-up time to evaluate the influence of the indicators.At the same time,it can increase the diversity of the resistance apparatus and provide reference and basis for future research.