Ana de Alba is a Sport and Exercise Science Professional, who coordinates the Exercise Department in Fundación Renal Iñigo Álvarez de Toledo (F.R.I.A.T.) and helps to improve the physical performance in patients with end-stage renal disease in hemodialysis treatment. Before starting in healthcare environment, Ana worked six years as a Fitness Coach, specialized in people with special needs and back pathologies and giving sports training courses as a teacher in Dirección General de Deportes (D.G.D) of Madrid Council.
Purpose: The number of patients with end-stage renal disease is rapidly growing, and hemodialysis remains the most frequent treatment for this condition. Hemodialysis patients commonly suffer from a worrying loss of physical function and mental deterioration. We aimed to determine the effects of an intradialytic exercise program on patients’ physical performance and mental status.
Methods: 27 patients (33% women; age, 68±13 years) were enrolled in a 14-week intradialytic endurance-resistance training program (‘exercise’ group), performing a total of 40 training sessions; 40 hemodialysis patients (28% women; 68±11 years) performing no exercise during the same time length were used as controls. Endpoints included physical performance (6-minute walk test [6MWT], 10-repetition sit to stand test [STS-10], handgrip strength), mental health (Beck’s depression inventory and State-Trait Anxiety Inventory), and mental and physical component scores of the short-from (SF)-12 Health Survey.
Results: There were no differences (p>0.05) between groups at baseline for sex distribution, mean age or BMI. Beneficial effects of the exercise program were observed on 6MWT distance (11 and -3% for the exercise and control groups, respectively; p<0.001), STS-10 time (-22 and 6%; p<0.001) and handgrip strength (4 and -4%; p<0.02). No significant benefits (p>0.05) were observed for mental status endpoints nor for SF-12 component scores.Despite significant benefits on physical performance, the rate of clinically meaningful responders was low (<50%). Responsiveness was dependent on baseline physical performance(p<0.05) but not on age or sex (p>0.05).
Conclusion: A 14-week intradialytic training program fields significant improvements on physical performance. However, the rate of clinically meaningful responders observed in the present study was low, being the level of responsiveness dependent on baseline physical status. Efforts to individualize exercise prescription are needed in clinical practice to enhance responsiveness, which may involve prescribing a higher training stimulus in some subjects.