Mo065multicentric Evaluation of a Sport Therapy Program During Dialysis

Abstract

Introduction and Aims: Various programs of physical exercise have been shown to improve outcomes in hemodialysis (HD) patients. Increasing age and comorbidity, however, are perceived to limit options for therapeutic exercise on HD. An individually structured physical exercise program (SPEP), broadly applicable also for frail and elderly patients, was introduced in five units of a large non-profit provider. We compared outcomes in SPEP patients with propensity-score (PS) matched controls. Methods: Patients ( pts) were offered a supervised SPEP consisting of 30 mins. each of strength-and endurance training twice weekly. Data were collected prospectively from the electronic health records through a quality registry. Controls were selected based on a PS including age, sex, vascular access, albumin and 16 other variables. Outcomes assessed were survival and hospitalization rate. Results: 98 pts participated in the SPEP and were matched with 490 controls (mean age: 68.6 yrs (IQR 58-78), mean vintage 56.4 mo (SD 55.0), 45.4% female, 51.4% diabetic, 33.7% with PVD). 17.9% were > 80 years old, 10.5% had a baseline albumin of < 35g/l, 45.7% had > 4 co-morbidities, 78.4% had permanent contra-indications to transplantation. After one year of training, important outcome-associated parameters improved in SPEP pts. but not in controls. Hemoglobin increased 1.3 % (0.15 g/dl, p = n.s.), and serum anorganic phosphate decreased 1.8 % (0.03 mmol/l, p = 0.04). Survival at one year was higher in SPEP-pts than in controls ( p=n.s.), and hospitalizations were lower ( p=0.03). Conclusions: These results confirmed that improving strength and endurance by exercise while dialyzing was not only associated with improved surrogate markers but decreased hospitalizations and, possibly, mortality. Individualized training was feasible also in elderly and frail HD patients. This will likely translate into improved patients' well-being, care perception, and fall prevention. This SPEP, therefore, should be considered as a non-pharmaceutical and patient-centered routine part of hemodialysis treatment.

Trainingstherapie während der Dialyse - Eine wirksame Behandlungsoption für die Patienten

“…In 4 davon konnten über ein elektronisches Register Ergebnisse nachverfolgt werden. Auch dort ergab sich bei 174 analysierten Patienten nach einem Jahr eine Adhärenz von 79 % [26]. Das mittlere Alter der Patienten war 68 Jahre, 44 % davon mit Multimorbidität (≥ 4 Komorbiditäten) und 14 % über 80 Jahre alt.…”

“…Es zeigte sich keine Erhöhung der Krankenhausaufenthalte und es wurden keine schweren Zwischenfälle berichtet. Sportpatienten hatten ein besseres Überleben als eine Kontrollgruppe, die aus Zentren gematcht wurde, in denen kein Sportprogramm angeboten wurde [26]. Dieser Erfolg in der Implementierung eines nachweislich wirksamen Trainingsprogramms ist nicht zuletzt dem Umstand zu verdanken, dass dieses Sportprogramm von einer lokalen Krankenkasse zum Teil erstattet wird.…”