Intradialytic exercise preconditioning: an exploratory study on the effect on myocardial stunning

Penny, Jarrin D; Salerno, Fabio; Brar, Ranveer; García, Eric; Rossum, Krista; McIntyre, Christopher W.; Bohm, Clara

doi:10.1093/ndt/gfy376

Cited by 33 publications

(37 citation statements)

References 21 publications

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“…We intentionally chose to supplement intra-dialytic cycling with pre-dialysis functional training to verify this strategy as a possible improvement in content and volume of contemporary well-established intradialytic cycling programs. An additional argument for the retention of cycling in the experimental group is its putative effects in the prevention of HD related myocardial stunning 18 . In the extension phase of this trial, we sought to determine the achievable level of transfer of mastered functional exercise routines to a home environment on non-dialysis days in order to evaluate the sustainability of this approach.…”

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confidence: 99%

Kinesiologist-guided functional exercise in addition to intradialytic cycling program in end-stage kidney disease patients: a randomised controlled trial

Bogataj

Pajek

Ponikvar

et al. 2020

Sci Rep

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Intradialytic cycling is a widely used workout mode, whereas added benefit of other exercise modalities remains unknown. This is the first randomised controlled trial on the effects and sustainability of functional training and counselling in addition to intradialytic cycling. patients were randomly assigned to a kinesiologist-guided functional training in addition to intradialytic cycling (n = 20, experimental group) or intradialytic cycling only (n = 20, control group) over 16 weeks. The experimental group attended predialysis functional exercise in the first eight weeks and afterward performed functional training at home for the next eight weeks. The primary study endpoint was 10-repetition-sit-to-stand test time at eight weeks: at this test, the experimental group improved significantly better than controls (−4.5 ± 1.9 s, 95%CI −8.4 to −0.7; P = 0.021), which was maintained at week 16 (−4.7 ± 2.1 s, 95%CI −9.0 to −0.3; P = 0.037). At week 8, the experimental group significantly outperformed controls also at handgrip strength (P = 0.004), lower body flexibility test (P < 0.001), balance test (P < 0.001), and upper body flexibility test (P = 0.003). At week 16, superior results of the experimental group in secondary end-points remained preserved for handgrip strength, balance, and upper body flexibility tests. Functional training with exercise counselling meaningfully improves physical performance and successfully prepares patients for sustainable home exercise. Intradialytic exercise on a customized ergometer (cycling) is currently the most common mode of in-centre exercise among haemodialysis (HD) patients 1,2. This exercise mode is well feasible, time-efficient, can be easily supervised 1 and has shown numerous improvements in aerobic capacity 3-6 , functional performance 7-9 , HD efficiency (improved Kt/V) 1 , and quality of life 1,5,7. It could be perceived as the current standard of physical training in the HD population. However, the comparative data on the efficiency and sustainability of various types of exercise modes are lacking. With the previous studies showing a minimal efficacy of intradialytic cycling on the functional performance of HD patients 7,9-12 , we need innovative strategies to improve the outcome and sustainability of dialysis exercise programs. Functional training simulates activities of daily living 13 and targets the neuromuscular system to train movements that activate both the nervous system and the muscle groups 14. Functional training is performed as a combination of lower and upper body movements including various multi-joint activities 15. A systematic review among older adults, including 13 trials with 1139 participants, demonstrated positive effects of functional training on muscle strength, physical functioning, and activities of daily living 16. The authors stated that functional training, which imitates specific performance, confers the best performance gains. HD patients have largest functional deficits in flexibility, balance, and lower extremity functions 17. These are...

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confidence: 99%

Kinesiologist-guided functional exercise in addition to intradialytic cycling program in end-stage kidney disease patients: a randomised controlled trial

Bogataj

Pajek

Ponikvar

et al. 2020

Sci Rep

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“…From this, SBP (Table 2) was similar in the control session (132.60 mm Hg ± 5.13) to the exercise session (136.76 mm Hg ± 6.44). Recent studies examining blood pressure in subjects receiving intradialytic exercise reported similar findings with no differences in either control or exercise sessions (21,22). Other researchers observed no changes in SBP between control (140.90 mm Hg ± 22.30) and exercise sessions (131.30 mm Hg ± 20.00) (21).…”

Section: Discussionmentioning

confidence: 79%

“…Recent studies examining blood pressure in subjects receiving intradialytic exercise reported similar findings with no differences in either control or exercise sessions (21,22). Other researchers observed no changes in SBP between control (140.90 mm Hg ± 22.30) and exercise sessions (131.30 mm Hg ± 20.00) (21). However, other researchers have demonstrated significant increases in SBP with the introduction of intradialytic exercise (6,9,23).…”

Section: Discussionmentioning

confidence: 85%

Intradialytic exercise increases cardiac power index

et al. 2019

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Introduction: Mortality rates are high in end-stage renal disease due to cardiovascular complications. Perfusion of the myocardium declines during and after hemodialysis sessions with the potential for aerobic exercise to mitigate these during hemodialysis. Objectives: The purpose of this study was to investigate acute changes in hemodynamics in subjects with end-stage renal disease (ESRD) during exercise. Patients and Methods: Subjects (n = 10) were monitored for 1.5 hours during hemodialysis treatment during a control (CON) and an exercise (EX) session. Subjects cycled using an ergometer strapped to the reclining dialysis chair at an RPE of 11-13 for 30 minutes during the EX session beginning at 30 min into dialysis and ending at 60 minutes. Data for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were collected using an automated blood pressure cuff attached to the hemodialysis machine. Data for cardiac output (Q̇ ), cardiac power index (CPI), stroke volume (SV), systemic vascular resistance (SVR), and heart rate (HR) were collected using the NICaS bioelectrical impedance device. Results: During the EX session, CPI, Q̇ , SV, and HR were significantly greater (P<0.05) than the CON session. Additionally, Q̇ was significantly (P< 0.05) greater at 45 minutes and 60 minutes compared to 15 minutes. HR was significantly (P<0.05) greater at 45 minutes compared to 90 minutes. No significant interactions were found for MAP, CPI, Q̇ , HR, SV, SBP, DBP, or SVR. Conclusion: In conclusion, exercise during dialysis may decrease the likelihood of experiencing ischemic or hypotensive events by enhancing myocardial perfusion through increasing CPI and Q̇ .

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“…Exercise during hemodialysis may also improve solute removal and stabilize cardiovascular hemodynamics (12). Exploratory studies of intradialytic cycle ergometry have recently reported improved O 2 saturation, partial pressure of O 2 (Pa O2 ), and reduced myocardial regional wall motion abnormalities, indicative of attenuated cardiac stunning (13)(14)(15). As such, this form of exercise may help to reduce the side effects and risks associated with hemodialysis.…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary and metabolic physiology during hemodialysis and inter/intradialytic exercise

McGuire

Horton

Renshaw

et al. 2021

Journal of Applied Physiology

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Background: Hemodialysis is associated with numerous symptoms and side effects which, in part, maybe due to sub-clinical hypoxia. However, acute cardio-pulmonary and metabolic physiology during hemodialysis is not well defined. Intra-dialytic and inter-dialytic exercise appear to be beneficial and may alleviate these side effects. To better understand these potential benefits, the acute physiological response to exercise should be evaluated. The aim of this study was to compare and characterise the acute physiological response during hemodialysis, intra-dialytic and inter-dialytic exercise. Methods: Cardiopulmonary physiology was evaluated during three conditions; 1) hemodialysis without exercise (HD), 2) intra-dialytic exercise (IDEx), and 3) inter-dialytic exercise (Ex). Exercise consisted of 30 minutes constant load cycle ergometry at 90% VO2AT. Central hemodynamics (via non-invasive bio-reactance) and ventilatory gas exchange were recorded during each experimental condition. Results: Twenty participants (59 ± 12 yrs, 16/20 male) completed the protocol. Cardiac output (Δ = -0.7 L/min), O2 uptake (Δ = -1.4 ml.kg-1.min-1) and arterial-venous O2 difference (Δ = -2.0 ml/O2/100ml) decreased significantly during HD. Respiratory exchange ratio exceeded 1.0 throughout HD and IDEx. Minute ventilation was lower (p = 0.001) during IDEx (16.5 ± 1.1 L/min) compared to Ex (19.8 ± 1.0 L/min). Arterial-venous O2 difference was partially restored further to IDEx (4.6 ± 1.9 ml/O2/100ml) compared to HD (3.5 ± 1.2 ml/O2/100ml). Conclusion: Hemodialysis altered cardiopulmonary and metabolic physiology, suggestive of hypoxia. This dysregulated physiology contributed to a greater physiological demand during intra-dialytic compared to inter-dialytic exercise. Despite this, intra-dialytic exercise partly normalised physiology during treatment.

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Intradialytic exercise preconditioning: an exploratory study on the effect on myocardial stunning

Cited by 33 publications

References 21 publications

Kinesiologist-guided functional exercise in addition to intradialytic cycling program in end-stage kidney disease patients: a randomised controlled trial

Kinesiologist-guided functional exercise in addition to intradialytic cycling program in end-stage kidney disease patients: a randomised controlled trial

Intradialytic exercise increases cardiac power index

Cardiopulmonary and metabolic physiology during hemodialysis and inter/intradialytic exercise

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