Comprehensive exercise intervention seen as acceptable, safe for patients on hemodialysis
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Key takeaways:
- Patients completed 88% of the exercise training sessions with no reported adverse effects.
- Participants reported improvements in fatigue, pain and depressive symptoms.
Researchers at the University of Pittsburgh developed a comprehensive exercise intervention for patients on hemodialysis that was found to be acceptable and safe in a study.
“To address the need for an intra-dialytic exercise program that is easily delivered in clinical setting, engaging and scalable, we developed a novel comprehensive exercise program based on input from patients receiving [hemodialysis] HD, dialysis staff members and nephrologists,” Manisha Jhamb, MD MPH, associate professor of medicine in the renal-electrolyte division at the university, and colleagues wrote. The study objective was to determine the feasibility and safety of a comprehensive exercise (COMEX) program for patients undergoing HD.
The single-arm prospective pilot feasibility study included 13 patients undergoing in-center HD. Participants engaged in the COMEX program, which featured aerobic and resistance training video-based dialysis chair exercises, integrated with educational and motivational components, and taught during the course of 3 months.
Researchers collected recruitment, adherence, safety and acceptability data to assess physical function, patient-reported symptoms, sleep and physical activity. They also examined the feasibility of obtaining skeletal muscle biopsies and blood samples to examine molecular muscle atrophy and platelet mitochondrial function.
Overall, 76% of participants completed the intervention. Exercise adherence was high, and patients completed 88% of sessions without reported adverse effects.
The exercise video was used in 91% of completed exercise sessions, according to the results, and led to positive overall outcomes. A total of 53% of participants increased their dumbbell-arm weight, and 69% increased their ankle-leg weight. For example, the initial average arm and leg weights were 1.7 pounds and 1.4 pounds, respectively. By the end of intervention, those numbers reached an average of 3.2 pounds each.
Fatigue improved in 62% of patients, findings showed; pain reduced or remained unchanged in 62% of patients; and 62% of patients had a decrease in depressive symptoms. Objective measures of physical function obtained from standardized tests also showed improvement. There was no meaningful change in sleep quality.
Satisfaction was considerable, as 100% of participants said they would recommend COMEX to patients on dialysis.
The study highlights “important issues related to barriers to recruitment, inability to achieve targeted intensity of exercise and less than optimal dialysis staff satisfaction with the program,” according to Jhamb and colleagues.
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