Hemodialysis Impact on Motor Function beyond Aging and Diabetes—Objectively Assessing Gait and Balance by Wearable Technology

Abstract

Motor functions are deteriorated by aging. Some conditions may magnify this deterioration. This study examined whether hemodialysis (HD) process would negatively impact gait and balance beyond diabetes condition among mid-age adults (48–64 years) and older adults (65+ years). One hundred and ninety-six subjects (age = 66.2 ± 9.1 years, body-mass-index = 30.1 ± 6.4 kg/m2, female = 56%) in 5 groups were recruited: mid-age adults with diabetes undergoing HD (Mid-age HD+, n = 38) and without HD (Mid-age HD−, n = 40); older adults with diabetes undergoing HD (Older HD+, n = 36) and without HD (Older HD−, n = 37); and non-diabetic older adults (Older DM−, n = 45). Gait parameters (stride velocity, stride length, gait cycle time, and double support) and balance parameters (ankle, hip, and center of mass sways) were quantified using validated wearable platforms. Groups with diabetes had overall poorer gait and balance compared to the non-diabetic group (p < 0.050). Among people with diabetes, HD+ had significantly worsened gait and balance when comparing to HD− (Cohen’s effect size d = 0.63–2.32, p < 0.050). Between-group difference was more pronounced among older adults with the largest effect size observed for stride length (d = 2.32, p < 0.001). Results suggested that deterioration in normalized gait speed among HD+ was negatively correlated with age (r = −0.404, p < 0.001), while this correlation was diminished among HD−. Interestingly, results also suggested that poor gait among Older HD− is related to poor ankle stability, while no correlation was observed between poor ankle stability and poor gait among Older HD+. Using objective assessments, results confirmed that the presence of diabetes can deteriorate gait and balance, and this deterioration can be magnified by HD process. Among HD− people with diabetes, poor ankle stability described poor gait. However, among people with diabetes undergoing HD, age was a dominate factor describing poor gait irrespective of static balance. Results also suggested feasibility of using wearable platforms to quantify motor performance during routine dialysis clinic visit. These objective assessments may assist in identifying early deterioration in motor function, which in turn may promote timely intervention.

Daily Use of Bilateral Custom‐Made Ankle‐Foot Orthoses for Fall Prevention in Older Adults: A Randomized Controlled Trial

“…Also, our previous study revealed a significant reduction in ankle sway (an indicator of ankle stability) and center of mass sway (an indicator of postural control) compared to baseline and compared to the CG in response to daily use of AFOs . Prior studies have suggested that reduction in fear of falling and postural sway are linked to lower fall risk in older adults . Additionally, the high adherence and the high acceptability of AFOs reported in our previous study could be an important factor that contributed to converting the improvement in the balance and fear of falling to an actual reduction in falls.…”

“…23 Prior studies have suggested that reduction in fear of falling and postural sway are linked to lower fall risk in older adults. [34][35][36] Additionally, the high adherence and the high acceptability of AFOs reported in our previous study 23 could be an important factor that contributed to converting the improvement in the balance and fear of falling to an actual reduction in falls.…”

Application of Wearables to Facilitate Virtually Supervised Intradialytic Exercise for Reducing Depression Symptoms

“…Moreover, for patients with severe physical and physiological issues, it is even more difficult to bring them to out-clinic facilities on a non-dialysis day for exercise [23]. In addition, due to the deconditioning in physical function [43], the conventional exercise such as cycling, walking, jogging, and resistance training may become too difficult for hemodialysis patients and easily overtax them [21,22]. On the other hand, the intradialytic exergame enables adjustable exercise tasks depending on the motor capacity and cognitive status of the patient.…”

Application of Wearables to Improve Uptake of Exercise Therapy during Hemodialysis Treatment for Reducing Depression Symptom &ndash; A Single Blinded Randomized Controlled Trial

“…Moreover, for patients with severe physical and physiological issues, it is even more difficult to bring them to an out-clinic facility on a non-dialysis day for exercise [23]. In addition, due to the deconditioning in physical function [42], the conventional exercises such as cycling, walking, jogging, and resistance training may become too difficult for hemodialysis patients and easily overtax them [21,22]. On the other hand, the Exergame enables adjustable exercise tasks depending on the motor capacity and cognitive status of the patient.…”