Twelve weeks of combined physical and cognitive intradialytic training preserves alertness and improves gait speed: a randomized controlled trial

Abstract

Background Hemodialysis (HD) patients often experience cognitive deficits and reduced mobility. While studies have shown promising results of physical and/or cognitive training in older adults, their effects in HD patients remain understudied. Aims This study aimed to evaluate the impact of a 12-week intradialytic training program combining cognitive training with physical exercise on attention domains and spontaneous gait speed (SGS) in HD patients. Methods Forty-four HD patients were randomly assigned to either intradialytic cognitive and physical exercise training (EXP group; n = 22) or a standard care control group (CON group; n = 22). The EXP group performed intradialytic cycling and tablet-based cognitive training three days per week for 12 weeks. The primary outcome of the study was performance on the computerized test battery ‘Test of Attentional Performance.’ Secondary study outcome was patient mobility assessed by the four-meter SGS. Outcomes were assessed pre- and post-intervention. Results Significant group x time interaction was observed in alertness (F(1,41) = 6.15, p = 0.017) and SGS (F(1,41) = 18.33, p < 0.001) in favor of the EXP group. Within-group analysis revealed a significant pre–post decline in the CON group in alertness test (−26.7 s; p = 0.04) and an improvement of SGS in EXP group (+ 0.07 s; p < 0.001). Discussion This original study demonstrated that a combined physical and cognitive intradialytic training intervention led to improvements in SGS and preservation in alertness compared to a deterioration in the CON group. Conclusion Findings suggest that the intervention may serve as an effective tool to prevent the physical and cognitive decline in this patient population.

Intradialytic exercise in haemodialysis patients: applicability and effects on muscle function

“…After the IDE intervention, absolute and relative changes in muscle function significantly differed by treatment status in patients aged from 60 to 70 years but did not differ in patients aged below 60 and over 70 years. Our findings regarding age heterogeneities partially align with previous reports on the effectiveness of IDE on lower extremity muscle function and physical functioning in age-diversified groups of HP, favouring patients age 60 and older Matsuzawa et al, 2017;Sánchez-Tocino et al, 2022;Bogataj et al, 2023). However, other studies reported no age-related differences in functional adaptation following IDE Uchiyama et al, 2021;Yabe et al, 2021).…”

Randomized Controlled Trial of Intradialytic Cognitive and Physical Training to Enhance Functional Capacity

“…The results of the primary outcome measure, the Alertness score of the Test of Attentional Performance, were published in Bogataj et al. 22 In the current paper, focus is on the following outcome measures: TMT A and B (TMTA and TMTB), TUG test, and the TUG-dual. Other secondary outcome measures of the whole protocol were reported earlier 22 , 23 , 24 : Montreal Cognitive Assessment, Symbol Digit Modalities Test, 10 repetition sit-to-stand test, stork balance test, hand grip strength test, spontaneous gait speed, frailty, bioimpedance analysis, quality-of-life, brain derived neurotrophic factor, C-reactive protein, and interleukin-6.…”

“… 22 In the current paper, focus is on the following outcome measures: TMT A and B (TMTA and TMTB), TUG test, and the TUG-dual. Other secondary outcome measures of the whole protocol were reported earlier 22 , 23 , 24 : Montreal Cognitive Assessment, Symbol Digit Modalities Test, 10 repetition sit-to-stand test, stork balance test, hand grip strength test, spontaneous gait speed, frailty, bioimpedance analysis, quality-of-life, brain derived neurotrophic factor, C-reactive protein, and interleukin-6. The safety parameters were urea, creatinine, sodium, potassium, hemoglobin, hematocrit, self reported falls, and musculoskeletal injuries.…”

The Impact of Intradialytic Cognitive and Physical Training Program on the Physical and Cognitive Abilities in End-Stage Kidney Disease Patients: A Randomized Clinical Controlled Trial

“…In addition, the pilot study on HD patients demonstrated that cognitive training and physical exercise separately prevented cognitive decline [ 29 ]. A growing number of studies on exercise training in the HD population show improvements in quality of life [ 30 , 31 ], body composition [ 32 ], inflammation [ 33 ], dialysis symptoms [ 34 , 35 ], and cognitive function [ 36 , 37 ]. Despite the previously mentioned positive impacts of physical exercise, there is a lack of randomized controlled trials that explore its effects on cognitive performance in HD patients.…”