Intradialytic exercise with blood flow restriction is more effective than conventional exercise in improving walking endurance in hemodialysis patients: a randomized controlled trial

Abstract

Objective: This study aims to compare the effect of intradialytic aerobic exercise with blood flow restriction, without blood flow restriction (conventional) and no exercise (control) on muscle strength and walking endurance among chronic kidney disease patients. Design: Open label and parallel group randomized controlled trial. Subjects: Adult patients with chronic kidney disease on hemodialysis. Intervention: A 12-week intradialytic training with or without blood flow restriction compared with a control group. Main measures: Strength and walking endurance were measured using thoracolumbar dynamometry and a 6-minute walk test, respectively, before and after training. Results: A total of 66 patients were randomized into three groups: blood flow restriction group ( n = 22), conventional exercise group ( n = 22) and control group ( n = 22). There were seven dropouts, and 59 patients were included in the analysis. There was a significant increase in the 6-minute walking distance in the blood flow restriction group (from 412.7 (115.9) to 483.0 (131.0) m, P = 0.007) in comparison with the conventional exercise group (from 426.79 (115.00) to 433.2 (120.42) m, not significant) and the control group (from 428.4 (108.1) to 417.3 (100.2) m, not significant). The change in the walking distance over time was significantly different among groups (intervention group/time, P = 0.02). The simple effects test found a significant time effect only in the blood flow restriction group. There was no significant difference in strength change between the groups. Conclusion: Among chronic kidney disease patients, intradialytic exercise of low/moderate intensity with blood flow restriction was more effective in improving walking endurance than conventional exercise or no exercise.

Effectiveness of blood flow‐restricted slow walking on mobility in severe multiple sclerosis: A pilot randomized trial

“…If aerobic BFR training in older adults 19 or in patients with chronic diseases 20,21 has shown to improve objective measures of physical function, in our study even a low degree of occlusion pressure was associated with significant improvements in MS subjects. The changes in gait speed were significantly higher than those observed in the conventional intensive overground walking group, and the magnitude of improvement was even greater than that reported in our previous studies in similar MS patients who underwent traditional overground walking or robot‐assisted gait training 8,9 .…”

The Systemic Effects of Blood Flow Restriction Training: A Systematic Review

“…A paramount concern regarding the application of BFR training is the effects partial vascular occlusion has on cardiovascular and pulmonary health. The search found articles investigating the effects on maximal oxygen consumption (VO2 Max), 4,[7][8][9][10][11] vascular stiffness and compliance, 3,[12][13][14][15][16][17][18][19] systolic and diastolic blood pressure (SBP and DBP, respectively) responses, 3,[16][17][18][19][20][21][22][23] heart rate (HR), 7,[16][17][18][19]24 stroke volume (SV), 17,18 cardiac output (CO), 17,18 ankle brachial pressure index (ABI), 3,19 and functional endurance in healthy adults 9 and those with renal disease 25 and heart failure. 26…”

Intradialytic exercise with blood flow restriction is more effective than conventional exercise in improving walking endurance in hemodialysis patients: comments on a randomized control trial

“…We read with interest the study by Cardoso et al 1 whereby patients with end-stage kidney disease underwent blood flow restriction exercise during haemodialysis across a 12 week training period, with only the blood flow restriction exercise training group showing improved walking endurance. 1 We commend the authors in taking a step forward by utilizing a captive period with these patients where they typically remain sedentary. We wish to further enhance future blood flow restriction exercise studies by highlighting the reporting from Cardoso et al with respect to characterization of training responses and information relevant for practitioners.…”

“…We wish to further enhance future blood flow restriction exercise studies by highlighting the reporting from Cardoso et al with respect to characterization of training responses and information relevant for practitioners. 1 This is paramount in advocating a technique such as blood flow restriction exercise, implementation among clinical populations remains a relative unknown for practitioners. We elaborate on the detail of these enhancements below.…”

“…Such responses to blood flow restriction exercise are unknown among haemodialysis patients, but are essential for practitioners to evaluate risk and advocate for implementation of blood flow restriction exercise. This information is difficult to ascertain in the original protocol and recent publication from Cardoso et al 1 Patients with end-stage kidney disease display a broad range of comorbidities that may exacerbate their acute responses to blood flow restriction exercise. 11 However, with no prior evidence detailing the acute responses of haemodialysis patients to blood flow restriction exercise, it would be beneficial to highlight comorbidities in the characterization of patients.…”