Feasibility and Safety of Intradialysis Yoga and Education in Maintenance Hemodialysis Patients

Abstract

Objective Patients with end-stage renal disease on maintenance hemodialysis are much more sedentary than healthy individuals. The purpose of this study was to assess the feasibility and safety of a 12-week intra-dialysis yoga intervention versus a kidney education intervention on the promotion of physical activity. Design and Methods We randomized participants by dialysis shift to either 12-week intra-dialysis yoga or an educational intervention. Intra-dialysis yoga was provided by yoga teachers to participants while receiving hemodialysis. Participants receiving the 12-week educational intervention received a modification of a previously developed comprehensive educational program for patients with kidney disease (“Kidney School”). The primary outcome for this study was feasibility based on recruitment and adherence to the interventions, and safety of intra-dialysis yoga. Secondary outcomes were to determine the feasibility of administering questionnaires at baseline and 12-weeks including the Kidney Disease-Related Quality of Life-36. Results Among 56 eligible patients approached for the study, 55% (n=31) were interested and consented to participation with 18 assigned to intra-dialysis yoga and 13 to the educational program. A total of 5 participants withdrew from the pilot study, all from the intra-dialysis yoga group. Two of these participants reported no further interest in participation. Three withdrawn participants switched dialysis times and therefore could no longer receive intra-dialysis yoga. As a result, 72% (13 of 18) and 100% (13 of 13) of participants completed 12-week intra-dialysis yoga and educational programs, respectively. There were no adverse events related to intra-dialysis yoga. Intervention participants practiced yoga a median of 21 sessions (70% participation frequency), with 60% of participants practicing at least 2 times a week. Participants in the educational program completed a median of 30 sessions (83% participation frequency). Of participants who completed the study (n=26), baseline and 12-week questionnaires were obtained from 85%. Conclusions Our pilot study of a 12-week intra-dialysis yoga and 12-week educational intervention reached recruitment goals, but less than targeted completion and adherence to intervention rates. This study provided valuable feasibility data to increase follow-up and adherence for future clinical trials to compare efficacy.

Improving wellbeing in patients undergoing dialysis: Can meditation help?

“…Meditation, as part of more rigorous and physically active programs, has been shown to be useful in dialysis contexts. Although beyond the scope of this review, meditation as part of yoga sessions and hypnosis programs have shown promising effects on pain, anxiety and depression. Furthermore, meditation alone may even benefit cognitive impairment in end‐stage kidney disease patients …”

Educational or behavioural interventions for symptoms and health‐related quality of life in adults receiving haemodialysis: A systematic review

“…In some studies, active interventions compared with the control group significantly improved fatigue ( p = 0.002), sleep ( p < 0.001), pain ( p < 0.001), multiple symptoms ( p = 0.014; Pellizzaro et al 2013); RLS ( p = 0.012; Giannaki et al 2013); anorexia ( p < 0.05; Moraes et al 2015) and depression ( p = 0.003; Giannaki et al 2013) although significant ES were not found. However, other studies did not show any changes in fatigue, depression (Henson et al 2010; Chan et al 2016) and overall symptoms (Birdee et al 2015) between groups. For HRQoL, active interventions employed in the studies significantly improved the physical health of HRQoL, although the ES was not significant ( p = 0.003; Giannaki et al 2013).…”

“…All of the included studies had recruited participants who had received HD for more than three months. The mean duration of HD ranged from 12.1 months (Lerma et al 2017) to 76.7 months (Frih et al 2017b); however, three studies did not report this characteristic (Henson et al 2010; Birdee et al 2015; Arab et al 2016). The earliest study included was published in 2009 (Duarte et al 2009) and the latest in 2019 (Burrai et al 2019).…”

“…passive intervention; see Table 2). Active interventions were exercise (aerobic or resistance training), muscle training and yoga (Henson et al 2010; Giannaki et al 2013; Pellizzaro et al 2013; Birdee et al 2015; Moraes et al 2015; Chan et al 2016; Frih et al 2017a) while passive interventions were acupressure (Arab et al 2016; Shen et al 2017), CBT/cognitive behavioural intervention (CBT/CBI), psychological intervention (Duarte et al 2009; Cukor et al 2014; Hudson et al 2017; Lerma et al 2017; Hernandez et al 2018), listening to music or the Holy Qur'an (Frih et al 2017b; Burrai et al 2019), relaxation techniques (Rambod et al 2014) and breathing programs (Tsai et al 2015). Only one study was guided by a theoretical framework (psycho‐neuro‐endocrine‐immunological framework (McCain & Zeller 1996) to provide a rationale for the intervention (Burrai et al 2019).…”

Hubungan Kadar Ureum terhadap Restless Legs Syndrome pada Pasien Chronic Kidney Disease

“…Intradialytic exercise merupakan latihan yang dilakukan pada saat sedang menjalani hemodialisa yang dapat meningkatkan aliran darah otot dan peningkatan jumlah area kapiler pada otot yang sedang bekerja sehingga menghasilkan aliran urea dan racun-racun lainnya dari jaringan ke area vaskuler yang dipindahkan ke dialiser (Chung, Yeh, & Liu, 2017;Silva, Pereira, Silva, Simôes, & Barros Neto, 2013). Metode intradialytic exercise yang popular adalah latihan bersepeda dengan terpasang ergometer (Greenwood et al, 2014), zumba (Bennett, Corradini, Ockerby, & Cossich, 2012), meditasi terpandu dengan peregangan atau yoga (Birdee et al, 2015;Motedayen, Nehrir, Tayebi, Ebadi, & Einollahi, 2014) dan alternatif latihan lainnya yang mudah untuk diterapkan dan tidak menyulitkan pasien adalah strenght training (latihan kekuatan) (Bennett, 2015).…”