Effects of Intra-dialytic, Short-term Resistance Exercise on Physical Fitness, Depression and Dialysis Adequacy

On Lee; Myoung-Hyee Kim; Chang-Hwa Lee; Il-Hwan Oh; Yeon-Soo Kim

doi:10.5763/kjsm.2016.34.2.162

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Lee, Kim, Lee, Oh, and Kim: Effects of Intra-dialytic, Short-term Resistance Exercise on Physical Fitness, Depression and Dialysis Adequacy

Clinical Article

Korean J Sports Med 2016;34(2):162-168.

Published online: 20 January 2016

DOI: https://doi.org/10.5763/kjsm.2016.34.2.162

Effects of Intra-dialytic, Short-term Resistance Exercise on Physical Fitness, Depression and Dialysis Adequacy

On Lee¹, Myoung-Hyee Kim¹, Chang-Hwa Lee², Il-Hwan Oh², Yeon-Soo Kim^1,³

¹Department of Physical Education, College of Education, Seoul National University, Seoul, Korea

²Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea

³Institute of Sport Science, Seoul National University, Seoul, Korea

Correspondence: Yeon-Soo Kim Department of Physical Education, College of Education, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea Tel: +82-2-889-1926, Fax: +82-2-886-7804 E-mail: kys0101@snu.ac.kr

Received 24 September 2016 Revised 16 November 2016 Accepted 17 November 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This study aims to identify effects of intra-dialytic, short-term strength exercises on physical fitness, depression and dialysis adequacy. In addition, we aim to examine the minimum level of momentum that positive effect is displayed for each part. The subjects were 27 hemodialysis patients who have no disability in free living. They were allocated to a moderate amount exercise group and a low amount exercise group. Both groups joined strength exercise program during hemodialysis which was set three times a week for 4 weeks. The exercise program was progressed by warm up, main exercise, and cool down that was designed to use low limb and core muscles. Measurements were taken before and after the intervention. In physical factor, body composition, physical fitness, physical function, physical activity level and, dialysis adequacy was measured. In psychological part, depression was measured. As a results, body composition, physical function, physical activity and dialysis adequacy were not changed by exercise intervention. However, leg strength and agility was increased (p＜0.05) after 4-week moderate amount exercise program. Also, depression was significantly improved (p＜0.05) in both exercise group.

Keywords: Renal dialysis, Resistance training, Physical fitness, Depression

References

1. ESRD Registry Committee, the Korean Society of Nephrology. Current renal replacement therapy in Korea [Internet]. Seoul (KR): The Korean Society of Nephrology;c2015. [cited 2015 May 31]. Available from:. http://www.ksn.or.kr.

2. Jin DC. Current status of dialysis therapy for ESRD patients in Korea. J Korean Med Assoc. 2013; 56:562–8.

3. Arora P, Vasa P, Brenner D, et al. Prevalence estimates of chronic kidney disease in Canada: results of a nationally representative survey. CMAJ. 2013; 185:E417–23.

4. Rhee CM, Alexander EK, Bhan I, Brunelli SM. Hypothyroidism and mortality among dialysis patients. Clin J Am Soc Nephrol. 2013; 8:593–601.

5. Hedayati SS, Bosworth HB, Kuchibhatla M, Kimmel PL, Szczech LA. The predictive value of self-report scales compared with physician diagnosis of depression in hemodialysis patients. Kidney Int. 2006; 69:1662–8.

6. Deborah AK, Risucci DA, Mark WB, Fred AL. ASSET: an effective educational experience for practicing surgeons. Bull Am Coll Surg. 2012; 97:31–5.

7. Segura-Orti E. Exercise in haemodyalisis patients: a literature systematic review. Nefrologia. 2010; 30:236–46.

8. Lee JY, Ko IT, Choi SW. Review on the exercise of hemodialysis patients. Korea J Sports Sci. 2016; 25:1101–8.

9. Painter P, Ward K, Nelson RD. Self-reported physical activity in patients with end stage renal disease. Nephrol Nurs J. 2011; 38:139–47.

10. Sheng K, Zhang P, Chen L, Cheng J, Wu C, Chen J. Intradialytic exercise in hemodialysis patients: a systematic review and metaanalysis. Am J Nephrol. 2014; 40:478–90.

11. Cheema B, Abas H, Smith B, et al. Randomized controlled trial of intradialytic resistance training to target muscle wasting in ESRD: the Progressive Exercise for Anabolism in Kidney Disease (PEAK) study. Am J Kidney Dis. 2007; 50:574–84.

12. Johansen KL, Painter PL, Sakkas GK, Gordon P, Doyle J, Shubert T. Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis: a randomized, controlled trial. J Am Soc Nephrol. 2006; 17:2307–14.

13. Ponngeon O, Chaunchaiyakul R, Vareesangthip K, Lumlertgul D, Nakum S, Jalayondeja W. Home-based walking program increases leg muscle strength in hemodialysis patients. J Phys Ther Sci. 2011; 23:345–8.

14. Cheema BS, Smith BC, Singh MA. A rationale for intradialytic exercise training as standard clinical practice in ESRD. Am J Kidney Dis. 2005; 45:912–6.

15. Miyamoto K, Takebayashi H, Takimoto K, Miyamoto S, Morioka S, Yagi F. A new simple performance test focused on agility in elderly people: the ten step test. Gerontology. 2008; 54:365–72.

16. Rhi SY, Lee O, Kim YS, Chung JS. Reliability of isometric maximal voluntary contraction test and regression equations to predict one repetition maximal strength in women. Korean J Phys Educ. 2011; 50:433–9.

17. Lee YH, Song JY. A study of the reliability and the validity of the BDI, SDS, and MMPI-D Scales. Korean J Clin Psychol. 1991; 10:98–113.

18. Hemodialysis Adequacy 2006 Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis. 2006; 48(Suppl 1):S2–90.

19. Ifudu O, Paul H, Mayers JD, et al. Pervasive failed rehabilitation in center-based maintenance hemodialysis patients. Am J Kidney Dis. 1994; 23:394–400.

20. Chen JL, Godfrey S, Ng TT, et al. Effect of intradialytic, low-intensity strength training on functional capacity in adult haemodialysis patients: a randomized pilot trial. Nephrol Dial Transplant. 2010; 25:1936–43.

21. de Lima MC, Cicotoste Cde L, Cardoso Kda S, Forgiarini LA Jr, Monteiro MB, Dias AS. Effect of exercise performed during hemodialysis: strength versus aerobic. Ren Fail. 2013; 35:697–704.

22. Latham NK, Bennett DA, Stretton CM, Anderson CS. Systematic review of progressive resistance strength training in older adults. J Gerontol A Biol Sci Med Sci. 2004; 59:48–61.

23. Smart N, Steele M. Exercise training in haemodialysis patients: a systematic review and metaanalysis. Nephrology (Carlton). 2011; 16:626–32.

24. Kang JH. The effect of levels of exercise participation on depression and anxiety in adults. Korean Soc Sports Sci. 2011; 20:645–54.

25. Kim JS. The effect of an exercise program on depression and anxiety in hemodialysis patients [dissertation]. Seoul: Korea University;1997.

26. Cha J, Yi M. Relationships between treatment belief, personal control, depressive mood and health-related quality of life in patients with hemodialysis. Korean J Adult Nurs. 2014; 26:693–702.

27. Kimmel PL, Cohen SD, Weisbord SD. Quality of life in patients with end-stage renal disease treated with hemodialysis: survival is not enough! J Nephrol. 2008; 21(Suppl 13):S54–8.

28. Załuska A, Załuska WT, Bednarek-Skublewska A, Ksiazek A. Nutrition and hydration status improve with exercise training using stationary cycling during hemodialysis (HD) in patients with end-stage renal disease (ESRD). Ann Univ Mariae Curie Sklodowska Med. 2002; 57:342–6.

29. Parsons TL, Toffelmire EB, King-VanVlack CE. The effect of an exercise program during hemodialysis on dialysis efficacy, blood pressure and quality of life in end-stage renal disease (ESRD) patients. Clin Nephrol. 2004; 61:261–74.

30. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004; 59:255–63.

Table 1.

Homogeneity test for demographic and clinical characteristics among exercise group

Characteristics	Moderate EG (n=13)	Low EG (n=14)	t/z/x²	p-value
Age (yr)	61.84±7.29	55.36±9.87	−2.261	0.024∗
Sex			0.03	0.863
Male	6	6
Female	7	8
Marriage status			0.054	0.816
Yes	5	6
No	8	8
Job			0.016	0.615
Yes	4	4
No	9	10
Economic status			0.304	0.581
Upper	6	5
Lower	7	9
Duration of hemodialysis (yr)	3.86±2.74	9.20±9.57	−1.261	0.207∗
Height (cm)	160.88±8.15	163.06±9.91	0.622	0.540^†
Weight (kg)	63.94±11.86	58.59±12.41	−1.143	0.264^†
Muscle mass (kg)	25.02±5.71	25.51±7.61	0.186	0.854^†
Fat mass (kg)	20.06±9.88	14.14±4.82	−2.002	0.056^†

Values are presented as mean±standard deviation. EG: exercise group. ∗By independent t-test;

^† Mann-Whitney test.

Table 2.

Exercise program in hemodialysis

Exercise	Moderate EG	Light EG
Warm-up	Wrist circle 20 rep (without arteriovenous-fistula hand)
	Ankle plantar/dorsi-flexion 20 rep (both side)
	Ankle circle 20 rep (both side)
Main exercise	1. One leg knee up, 8−12 rep 2 set (both side)	1. One leg circle, 8−12 rep (both side)
(each week)	2. Leg raise, 12−15 rep, 2 set	2. Trunk twist, 12−15 rep
	3. One leg extension, 15−18 rep, 2 set (both side)	3. Straight one leg raise, 15−18 rep
	4. Bridge, 18−22 rep, 2 set	(both side)
		4. Crunch, 18−22 rep
Stretching	Up & down side wrist, 20 sec (without arteriovenous-fistula hand)
	Up & down side ankle, 20 sec
	Pull knee towards up-side with supine tailor sitting, 20 sec (both side)
	Pull knee towards chest, 20 sec (without arteriovenous-fistula hand)

EG: exercise group, rep: repetition.

Table 3.

Changes of the body composition and physical fitness among exercise groups

Variable	Light EG (n=14)		p-value	Moderate EG (n=13)		p-value
Variable	Pre-test	Post-test	p-value	Pre-test	Post-test	p-value
Body composition (kg)
Muscle mass	25.51±7.61	24.91±7.07	0.180∗	25.02±5.71	25.70±7.21	0.354∗
Fat mass	14.14±4.82	14.51±4.42	0.533∗	20.06±9.88	18.88±8.79	0.296∗
Physical fitness
Flexibility (cm)	1.05±9.21	−0.83±9.23	0.270∗	7.47±10.11	10.26±8.96	0.065∗
Physical function (score)	11.21±1.42	11.43±1.40	0.180^†	10.69±1.80	11.15±1.07	0.098^†
Agility (sec)	16.43±2.69	16.50±4.50	0.964∗	16.18±3.46	12.39±1.85	0.004∗
Balance (sec)	49.08±56.62	72.31±23.02	0.270^†	56.00±37.13	74.56±40.86	0.110^†
Leg strength (kg)	40.18±15.06	40.79±13.21	0.793	47.50±14.32	54.05±14.62	0.000∗
Physical activity	n=7			n=7
Mod-vigorous activity (min)	135.83±126.80	96.50±79.38	0.091∗	232.52±119.69	188.76±113.10	0.236^#

Values are presented as mean±standard deviation. EG: exercise group. ∗By paired t-test;

^† By Wilcoxon's signed-rank test.

Table 4.

Changes of the depression and dialysis efficacy among exercise groups

Variable	Light EG (n=14)		p-value	Moderate EG (n=13)		p-value
Variable	Pre-test	Post-test	p-value	Pre-test	Post-test	p-value
Depression	41.69±9.59	36.54±9.53	0.041∗	38.17±10.79	34.42±11.13	0.021∗
Dialysis efficacy (Kt/v)	1.624±0.418	1.629±0.097	0.937∗	1.460±0.418	1.476±0.361	0.703∗

Values are presented as mean±standard deviation. EG: exercise group, K: dialyzer clearance of urea, t: dialysis time, v: volume of distribution of urea. ∗By paired t-test.

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