Exercise Training Reduces Depression and Increases the Performance of Pleasant Activities in Hemodialysis Patients

Carney, Robert M.; Templeton, Bonnie; Hong, Barry A.; Harter, Herschel R.; Hagbèrg, James M.; Schechtman, Kenneth B.; Goldberg, Andrew P.

doi:10.1159/000184490

Cited by 65 publications

(51 citation statements)

References 12 publications

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“…Despite the inconsistent association between aerobic physical activity levels and mortality in patients with CHF, we consistently observed higher HRQOL and lower depression symptom scores in patients with CHF who reported greater aerobic physical activity levels. Previous studies suggest that implementation of exercise programs in hemodialysis units improves HRQOL, reduces depression symptoms, and improves control of cardiovascular risk factors in patients on hemodialysis (12,(31)(32)(33)(34). Our findings provide additional support to the promotion of physical activity programs in hemodialysis units.…”

Section: Discussionsupporting

confidence: 69%

“…Because the analyses were cross-sectional, it is not possible to conclude on the direction of the associations of physical activity with depression symptoms and HRQOL. Results from randomized clinical trials, however, have shown that exercise training is associated with subsequent improvement in HRQOL and reduction in depression symptoms in patients on chronic dialysis (12,32).…”

Section: Discussionmentioning

confidence: 99%

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Associations of Self-Reported Physical Activity Types and Levels with Quality of Life, Depression Symptoms, and Mortality in Hemodialysis Patients

Lopes

Lantz

Morgenstern

et al. 2014

Clinical Journal of the American Society of Nephrology

128

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Background and objectives Physical activity has been associated with better health status in diverse populations, but the association in patients on maintenance hemodialysis is less established. Patient-reported physical activities and associations with mortality, health-related quality of life, and depression symptoms in patients on maintenance hemodialysis in 12 countries were examined.Design, setting, participants, & measurements In total, 5763 patients enrolled in phase 4 of the Dialysis Outcomes and Practice Patterns Study (2009)(2010)(2011) were classified into five aerobic physical activity categories (never/ rarely active to very active) and by muscle strength/flexibility activity using the Rapid Assessment of Physical Activity questionnaire. The Kidney Disease Quality of Life scale was used for health-related quality of life. The Center for Epidemiologic Studies Depression scale was used for depression symptoms. Linear regression was used for associations of physical activity with health-related quality of life and depression symptoms scores. Cox regression was used for association of physical activity with mortality.Results The median (interquartile range) of follow-up was 1.6 (0.9-2.5) years; 29% of patients were classified as never/rarely active, 20% of patients were classified as very active, and 20.5% of patients reported strength/ flexibility activities. Percentages of very active patients were greater in clinics offering exercise programs. Aerobic activity, but not strength/flexibility activity, was associated positively with health-related quality of life and inversely with depression symptoms and mortality (adjusted hazard ratio of death for very active versus never/ rarely active, 0.60; 95% confidence interval, 0.47 to 0.77). Similar associations with aerobic activity were observed in strata of age, sex, time on dialysis, and diabetes status. ConclusionsThe findings are consistent with the health benefits of aerobic physical activity for patients on maintenance hemodialysis. Greater physical activity was observed in facilities providing exercise programs, suggesting a possible opportunity for improving patient outcomes.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Associations of Self-Reported Physical Activity Types and Levels with Quality of Life, Depression Symptoms, and Mortality in Hemodialysis Patients

Lopes

Lantz

Morgenstern

et al. 2014

Clinical Journal of the American Society of Nephrology

128

View full text Add to dashboard Cite

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“…To the best of our knowledge, however, the present study is the first to examine determinants of ADL difficulty related to lower extremities after adjusting for confounders in HD patients. Walking speed and depressive symptoms, both predictors of ADL difficulty, have been reported to improve with adequate exercise training in HD patients [38,39]. Thus, exercise This study has some limitations worth noting.…”

Section: Discussionmentioning

confidence: 91%

Determinants of difficulty in activities of daily living in ambulatory patients undergoing hemodialysis

et al. 2018

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Background: Patients undergoing hemodialysis (HD) have difficulty performing activities of daily living (ADL) compared to healthy people. ADL difficulty is an early predictor of loss of independence and mortality in older community-living people. However, determinants of ADL difficulty in HD patients have not been clarified. This study aimed to identify factors associated with ADL difficulty in ambulatory HD patients. Methods: Subjects were 216 Japanese outpatients (130 men, 86 women; mean age, 67 years) undergoing maintenance HD three times a week. Clinical characteristics, depressive symptoms, motor function (leg strength, balance, and walking speed), and ADL difficulty related to lower-limb function such as mobility issues were compared across three difficulty levels (higher, middle, and lower) as classified according to the percentages of patients with perceived difficulty. Multivariate logistic regression analysis was performed to examine whether clinical characteristics, depressive symptoms, and motor function could discriminate ADL difficulty at each level. Receiver operating characteristic curve analysis was performed to determine cut-off values of motor function for predicting ADL difficulty at each level. Results: ADL difficulty was independently associated with age (odds ratio (OR) = 1.05, 95% confidence interval (CI) 1. 00-1.10; P = 0.039), presence of depressive symptoms (OR = 4.24, 95%CI 1.13-15.95; P = 0.033), and usual walking speed (OR = 0.94, 95%CI 0.90-0.97; P < 0.001) for higher level difficulty; age (OR = 1.06, 95%CI 1.02-1.10; P = 0.006), maximum leg strength (OR = 0.97, 95%CI 0.94-1.00; P = 0.043), and usual walking speed (OR = 0.96, 95%CI 0.93-0.98; P = 0.001) for middle level difficulty; and age (OR = 1.06, 95%CI 1.02-1.10; P = 0.006) and usual walking speed (OR = 0.93, 95%CI 0.90-0. 6; P < 0.001) for lower level difficulty. Cut-off values of usual walking speed for predicting ADL difficulty for higher, middle, and lower level difficulty were 83.7, 75.5, and 75.1 m/min, respectively. Conclusions: A slow walking speed and old age were significantly and independently associated with ADL difficulty in ambulatory HD patients. Presence of depressive symptoms was significantly and independently associated with ADL difficulty at the higher level of difficulty in ambulatory HD patients. These findings provide useful data for planning effective therapeutic regimens to prevent ADL difficulty in ambulatory HD patients.

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“…The search resulted in 34 articles presenting the findings of 29 trials, including 9 uncontrolled trials (9/29, 31%) [5,6,7,8,9,10,11,12,13,14,15], 7 controlled trials (7/29, 24%) [16,17,18,19,20,21,22,23], and 13 RCTs (13/29, 45%) [24,25,26,27,28,29,30,31,32,33,34,35,36,37,38]. …”

Section: Results Of Searchmentioning

confidence: 99%

Exercise Training in Patients Receiving Maintenance Hemodialysis: A Systematic Review of Clinical Trials

2005

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Background: Exercise is not routinely advocated in patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis (HD), compared to best practice in other chronically diseased cohorts. Lack of widespread awareness of the exercise in HD literature may be contributing to these shortcomings of clinical practice. Therefore, our objectives are: (1) to systematically review trials of exercise training involving adult HD patients; (2) to provide empirical evidence that exercise can elicit health-related adaptations in this cohort, and (3) to provide recommendations for future investigations. Method: A systematic review of the literature using computerized databases was performed. Results: According to the 29 trials reviewed, HD patients can safely derive a myriad of health-related adaptations from engaging in appropriately structured exercise regimens involving aerobic and/or resistance training. However, methodological limitations within this body of literature may be partially responsible for minimal advocacy for exercise in this cohort. Conclusions: Robustly designed RCTs with thorough, standardized reporting are required if clinical practice and quality of life of this cohort is to be enhanced through the integration of exercise training and mainstream medical practice. Future trials should demonstrate the clinical importance, and long-term feasibility and applicability of exercise training for this vulnerable patient population.

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Exercise Training Reduces Depression and Increases the Performance of Pleasant Activities in Hemodialysis Patients

Cited by 65 publications

References 12 publications

Associations of Self-Reported Physical Activity Types and Levels with Quality of Life, Depression Symptoms, and Mortality in Hemodialysis Patients

Associations of Self-Reported Physical Activity Types and Levels with Quality of Life, Depression Symptoms, and Mortality in Hemodialysis Patients

Determinants of difficulty in activities of daily living in ambulatory patients undergoing hemodialysis

Exercise Training in Patients Receiving Maintenance Hemodialysis: A Systematic Review of Clinical Trials

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