Utility of Regular Management of Physical Activity and Physical Function in Hemodialysis Patients

Abstract

Background/Aims: Several clinical practice guidelines recommend regular assessment of physical activity and physical function as part of routine care in hemodialysis patients. However, there is no clear evidence to support these recommendations. We investigated whether the proportion of attendance at a regular program for management of physical activity and physical function can predict all-cause mortality and cardiovascular events in hemodialysis patients. Methods: This retrospective cohort study consisted of 266 hemodialysis patients participating in the management program at least once. Participants were tracked for 3 years after their first attendance at the management program to determine their attendance proportion. The main study outcomes included all-cause mortality and a composite of fatal and nonfatal cardiovascular events. Results: Median patient age was 64.5 (interquartile range, 56.8 – 72.0) years, 45% were women, and the median time on hemodialysis was 35.5 (interquartile range, 12.0 – 114.3) months at baseline. Sixty-five patients died over a median follow-up of 79 months. The incidence of cardiovascular events was 60 over a median follow-up of 68 months. Even after adjusting for any of the prognostic models, participants who attended ≤ 75% of sessions (n = 140) had higher risks of mortality (hazard ratio (HR), 1.79; 95% confidence interval (CI): 1.00 – 3.36; P = 0.049) and cardiovascular events (HR, 1.84; 95% CI: 1.07 – 3.48; P = 0.03) than those attending > 75% of sessions (n = 126). Conclusion: Hemodialysis patients in whom physical activity and physical function could be assessed more regularly had better prognosis than those with only intermittent assessment.

Effects of exercise therapy on the persistence of physical function, exercise habits, and self‐efficacy after cessation of exercise in patients undergoing hemodialysis: A nonrandomized control trial

“…There were many dropouts in the present study. According to a study that included the participation rate of physical therapists in periodic physical function measurements of patients undergoing HD, the percentage of people who participated in all 3 years was reported to be 36.8% 41 . In the RCTs that reported the effects of exercise intervention, the dropout rate was 31.1% in the exercise group and 15.1% in the control group.…”

Factors associated with dropout from physical function assessment programs among participants receiving maintenance hemodialysis: A retrospective observational cohort study

“…Although preventing dropout from physical function assessment programs can help improve prognosis among patients with HD, only 22.4% of the patients in our study continued the program for 3 years [9]. In a previous study, 36.8% of patients assessed once or twice per year continuously participated in a similar program [9].…”

“…Despite encouragement, several patients undergoing HD drop out of the program, and the factors influencing the dropout rate remain unknown. One study investigating adherence to a regular physical functioning assessment program in patients receiving HD reported that 43.3% of patients did not participate in any program, whereas only 36.8% who participated in the program were able to continue [9]. Furthermore, the continuation ratio was significantly associated with prognosis and cardiovascular events, even after adjusting for baseline physical function, physical activity, nutritional status, dialysis history, and inflammation levels [9].…”

“…One study investigating adherence to a regular physical functioning assessment program in patients receiving HD reported that 43.3% of patients did not participate in any program, whereas only 36.8% who participated in the program were able to continue [9]. Furthermore, the continuation ratio was significantly associated with prognosis and cardiovascular events, even after adjusting for baseline physical function, physical activity, nutritional status, dialysis history, and inflammation levels [9]. Intrinsic rewards [10], exerciserelated emotions [11], and self-efficacy (SE) [12] have been identified as factors associated with exercise persistence in community-dwelling older adults.…”

Posture and physical activity in dialysis patients

“…For example, studies by Yamamoto et al demonstrated that the incidence of cardiovascular events was significantly lower in patients who regularly attended physical activity sessions during 3 years of dialysis [38]. Physical activity has a strong impact on mental health and can be used as non-pharmacological treatment, preventing depressive episodes and mood changes, which are significantly more frequent in dialysis patients [1,2,19,24,39,40].…”