Can the fistula arm be used to lift heavy items? Six-pound dumbbells versus handgrip exercise in a 6-month follow-up secondary analysis of a randomized controlled trial

Abstract

Introduction: Patients with arteriovenous fistulas are advised to avoid carrying heavy objects draped over the fistula arm. Awareness gradually leads to overprotection and a reduction in the use of the fistula arm. However, restricting motion in the fistula arm leads to decreased quality of life and diminished muscle strength. The current safety recommendations regarding lifting heavy items with the fistula arm are primarily based on experience. Few studies have provided evidence clarifying the scope of safe activity and the influence of load bearing on the continued patency of arteriovenous fistulas. Methods: This prospective observation was based on a long-term follow-up study in which 86 hemodialysis recipients with arteriovenous fistulas were randomized into either a dumbbell group or a handgrip group. The dumbbell group exercised with 6-lb dumbbells, while the handgrip group squeezed rubber balls. Postintervention primary patency and adverse events at the 6-month follow-up were analyzed. Results: No significant difference in postintervention primary patency was observed between the dumbbell group and the handgrip group at 6 months (97.4% vs 95.0%). There were two participants with high-flow fistulas in the dumbbell group and three in the handgrip group, with no significant difference between the two groups (5.3% vs 7.5%). In both groups, there were no other adverse events reported regarding cardiac failure, aneurysm, puncture site hematoma, or hemorrhage. Conclusion: Hemodialysis patients can safely use their fistula arm to lift objects weighing less than 6 lb, which encourages increased motion and helps preserve the functionality of the fistula arm.

Aerobic Exercise Increases Vascular Diameter of Arteriovenous Fistula in Hemodialysis Patients

“…Some studies show that the upper limb muscle training with recent AVF increases its vessel diameter and vasodilatation, besides, contributing to adequate AVF maturation [7]. Also, Mo et al [1] investigated the upper limb muscle training of the AVF in patients undergoing maintenance HD and showed an improvement in the AVF draining vein diameter and its blood flow after a 3-month exercise period using a dumbbell. Both authors reinforce exercise’s importance also in AVF maintenance [1, 7].…”

“…Also, Mo et al [1] investigated the upper limb muscle training of the AVF in patients undergoing maintenance HD and showed an improvement in the AVF draining vein diameter and its blood flow after a 3-month exercise period using a dumbbell. Both authors reinforce exercise’s importance also in AVF maintenance [1, 7].…”

“…Arteriovenous fistula (AVF) is the safest and most preferable vascular access for maintenance hemodialysis (HD) in chronic kidney disease patients, and its health needs attention [1]. Stenosis and thrombosis are the major cardiovascular complications that compromise AVF health and cause its loss.…”

“…When these complications occur, a new invasive intervention must be performed to regain the AVF patency, such as percutaneous transluminal angioplasty, surgery, and endovascular interventions [1]. Therefore, the prevention of these complications needs to be better investigated.…”

Exercise guide to help on arteriovenous fistula maturation and maintenance

“…4,10 Previous studies have used dumbbells and elastic bands, progressive manual gripping, structured isometric, and blood flow restriction exercises. 6,11–13 These studies investigated whether exercises would improve AVF maturation and despite it seems they do, which was confirmed by previous systematic reviews, the evidence is not well-established yet. 5,14…”