Study recommends introduction of exercise programmes to haemodialysis units in Ireland

Structured, physiotherapy-led, intra-dialytic exercise can be safely and effectively introduced to Irish haemodialysis units, a study has found.

Intra-dialytic exercise was associated with many clinical benefits but it has not been widely adopted in routine practice, researchers noted in the February edition of the Irish Medical Journal (IMJ).

“Exercise training is known to be beneficial for adult patients with chronic kidney disease,” they wrote.

“There is a growing body of evidence that providing a structured exercise programme to haemodialysis patients during their routine dialysis treatment has significant benefits, including increased exercise tolerance, improved mobility and functional status, improved muscle strength and improved quality of life.”

These programmes were also associated, they said, with improvements in blood pressure control, arterial stiffness and small solute clearance.

During their study, an intra-dialytic exercise programme was piloted to investigate patient adherence and early clinical benefits in an Irish haemodialysis cohort.

The primary outcome of the 8-week exercise programme was patient adherence.

Secondary outcomes included physical functionality, quality of life and dialysis adequacy.

Physical functionality was assessed by hand-grip strength, the sit-to-stand test and the Duke Activity Status Index (DASI). Patients partook in 45-minute exercise classes twice-weekly, which included resistance training and aerobic training.

Six patients took part in the study.

The mean age of the participants was 58.2 years, with a mean dialysis vintage of 24.3 months.

Adherence was high, with five of the participants completing more than 75 per cent of the sessions.

The results showed there was a significant increase in physical functionality, as measured by the sit-to-stand test, from a mean of 21.1 (in 1 minute) to 27.3 (in 1 minute) following the programme.

There was no significant change noted in the other secondary outcomes, while no safety concerns were encountered.

Ward et al said the findings of the pilot study were consistent with international findings.

“More widespread introduction and expansion of such programmes across the national chain of dialysis units would be expected to result in significant clinical benefits for patients and potentially significant cost savings for healthcare providers,” they wrote.

IMJ; Vol 114, No. 2, P261.

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