Randomised factorial mixed method pilot study of aerobic and resistance exercise in haemodialysis patients: DIALY-SIZE!

Abstract

ObjectivesFor people with end-stage renal disease requiring haemodialysis, exercise can improve aspects of quality of life (QoL). However, the relative benefits and risks of different types of exercise in this population are unknown. Therefore, this pilot study aimed to evaluate the feasibility of a main study evaluating the efficacy of cycling and resistance exercise each performed during the haemodialysis treatment on QoL.MethodsIn this factorial (2×2) pilot trial, 31 haemodialysis patients were randomised to cycling, resistance, cycling and resistance, or an attention control. Feasibility was defined a priori by criteria on recruitment, fidelity to the protocol and patient response to the intervention. To better understand feasibility, we conducted interviews with dialysis unit staff and trial participants. As secondary outcomes, we estimated the main effect of cycling and weights each compared with control on QoL, physical function and strength.FindingsWe exceeded the target accrual of 28 participants over 12 weeks. Irrespective of exercise group allocation, adherence was high; of the 1038 training sessions offered, 87% were initiated and over 80% of exercise sessions were performed as per protocol. Progression based on perceived exertion, individual instruction and interactions with the kinesiologist facilitated acceptability across exercise groups. Using an attention control, measures of contamination and attrition were low. Important barriers to unit staff readiness for the intervention were initial safety and workflow concerns, unit workload and onerous data collection. Secondary outcomes were not statistically significant. Adverse events were low and did not increase with a higher volume of exercise.ConclusionsThe main study is feasible with minor modifications. In addition to practical assistance, involvement from unit staff could increase patient participation and improve trial implementation. Strategies to increase acceptability of the intervention for staff include improving workflow integration and using a prestudy demonstration phase to introduce the intervention.Trial registration numberNCT02234232. Results

Pneumatic Compression, But Not Exercise, Can Avoid Intradialytic Hypotension: A Randomized Trial

“…It was postulated that exercise during HD would increase the flow of solutes from tissues to the vascular compartment and that these solutes would have greater access to the membrane of the dialyzer, thereby increasing the dialysis efficiency [16,17]. Most studies involving exercise in patients on dialysis were limited to assess the long-term effects on aerobic capacity of individuals [18,19,20]. A few studies have addressed the acute effects of intradialytic exercise, with focus on increasing dialysis efficacy and solute removal [16,17,21].…”

The role of exercise in improving patient‐reported outcomes in individuals on dialysis: A scoping review

“…Applying the inclusion/exclusion criteria to titles/abstracts resulted in 44 articles for full‐text screening. Once the full text of those articles was screened, 25 RCTs (1.8% of those identified by the search process) met all inclusion criteria . We also included five systematic reviews for our review of generic HRQOL …”

“…Study and participant characteristics are summarized in Table . Of the 25 RCTs included in this review, 13 studies investigated the effect of aerobic exercise (11 intradialytic and 3 home‐based interventions) . Seven studies looked at the effect of intradialytic resistance exercise .…”

“…Of the 25 RCTs included in this review, 13 studies investigated the effect of aerobic exercise (11 intradialytic and 3 home‐based interventions) . Seven studies looked at the effect of intradialytic resistance exercise . Seven studies implemented an intervention combining both aerobic and resistance exercise (six intradialytic; one facility based) and two of these studies had a total of four arms.…”

“…Seven studies implemented an intervention combining both aerobic and resistance exercise (six intradialytic; one facility based) and two of these studies had a total of four arms. One of these was a factorial design and one compared the effects of aerobic exercise alone, resistance exercise alone, and combined resistance and aerobic exercise to a control group . Finally, two studies investigated exercise and rehabilitation counseling programs which incorporated counseling regarding home‐based physical activity programming …”