Effects of Exercise Training during Hemodialysis

Abstract

Fourteen maintenance hemodialysis patients volunteered to participate in a 6-month program of exercise training. The exercise was performed on a stationary bicycle during the hemodialysis treatment. Six maintenance hemodialysis patients served as control without exercise training. Exercising patients participated in 91% of all possible exercise sessions. The exercise group showed a significant (23%) increase in maximal oxygen consumption over the 6 months. No change in exercise capacity resulted in the control group. Five of eight hypertensive patients in the exercise group decreased or discontinued antihypertensive medications. No changes occurred in hematocrit or lipid profiles in either group. We conclude that exercise training during the hemodialysis treatment is technically feasible and safe for appropriately screened patients and will increase exercise capacity, and in some patients improve blood pressure control. Exercise during dialysis also improves compliance to regular exercise and facilitates supervised exercise sessions, which are desirable in this patient group.

Exercise in the End-Stage Renal Disease Population

“…Although the intensity and the duration of exercise in the studies varies, all have included initial moderate aerobic training progressing to vigorous training for 30 min or more three times per week for Ն8 wk up to 12 mo (most studies 3 to 6 mo). On average, aerobic exercise training for 8 wk to 6 mo improves VO 2peak by approximately 17% (Figure 3), but there is considerable variability from study to study, and many studies have been uncontrolled (16,18,30,(32)(33)(34)(35)(36)41,43). Only two of these studies included patients who were on peritoneal dialysis (35,40).…”

“…These other outcomes have included anemia, lipid levels, BP control, endothelial function, inflammation, mental health, and health-related quality of life. Although a few small studies have reported an improvement in anemia with vigorous aerobic exercise training (30,31), the majority of studies have not reported this benefit (32)(33)(34)36). Studies of the lipid effects of vigorous aerobic exercise training have also been mixed, with some showing a decrease in triglyceride (30,31) or an increase in HDL cholesterol (30,31) and others not showing any changes (34 -36).…”

“…However, these potential benefits must be balanced by the possibility of reduced exercise tolerance during dialysis as a result of fluid and electrolyte shifts and the possibility that exercise could exacerbate dialysisassociated hypotension. Nevertheless, beneficial effects of intradialytic exercise have been observed, and exercise is well tolerated within the first 1 to 2 hours of dialysis sessions (17,34,39).…”

Cardiac Rehabilitation and Survival of Dialysis Patients after Coronary Bypass

“…Improvements in HD patients' physical fitness as measured by reaction time and lower extremity muscle strength (16), left ventricular systolic function (17), and psychosocial functioning (18) have been demonstrated in randomized clinical trials. Other studies of exercise interventions in patients who were on HD have provided evidence to support improvement in arterial stiffness (19), decrease in pulse pressure (20), increase in aerobic capacity (21)(22)(23)(24)(25)(26), reduced need for antihypertensive medications (23,27,28), increase in hemoglobin concentration and hematocrit levels (28), and improved lipid metabolism (28). Started HD in hospital-based facility (%) 29.6 a CABG, coronary artery bypass grafting; HD, hemodialysis; AMI, acute myocardial infarction; COPD, chronic obstructive pulmonary disease.…”

End-Stage Renal Disease in People With Type 2 Diabetes: Systemic Manifestations and Exercise Implications

“…70 Although probably unrealistic, it has been recommended that people exercise in a controlled environment where they can be closely monitored secondary to systemic and cardiac complications. One study by Painter et al 71 showed positive results when individuals ride a stationary bike and exercise during their dialysis treatment.…”