Encompass Health - Intradialytic Exercise

Intradialytic Exercise

Kidney Disease

Chronic Kidney Disease

• Progressive, irreversible destruction of the nephrons in both kidneys leads to accumulation of toxins and fluid creating imbalances (1)

• End-Stage Renal Disease (ESRD) - loss of 90% of kidney function & the body cannot maintain normal function since the kidneys cannot clear waste (2)

• Hypertension & diabetes lead to increased prevalence of CKD (2)

Symptoms of Kidney Disease (3)

• Anemia
• Fatigue
• Nausea
• Headaches
• Edema
• Shortness of breath
• Metabolic acidosis
• Bone demineralization
• Physical function challenges

In Conclusion

• Intradialytic exercise is safe and efficient for both patient and staff

• It has physiological and psychological benefits to improve patient's quality of life

• Exercise can be tailored to therapist and/or patient preference

Exercise Guidelines

General Guidelines

• Something is better than nothing (3)

• Exercise often done at the beginning of dialysis (within first 2 hours) because the CV response is more stable (1, 2, 7)

• No established consensus on guidelines and studies inconclusive if aerobic or resistive exercise or combination is best (3, 5, 6)

References

Examples of Exercise

Intradialytic Exercise

1. Paluchamy, T., & Vaidyanathan, R. (2018). Effectiveness of intradialytic exercise on dialysis adequacy, physiological parameters, biochemical markers and quality of life - A pilot study. Saudi Journal of Kidney Diseases and Transplantation: An Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 29(4), 902–910.

2. Soltani, P., Saeedi, N., Mashaykhi, N., Rostami, A., & Tajfar, M. (2020). Evaluating the effect of intradialytic exercise on blood pressure, inflammatory markers and dialysis adequacy. Journal of Preventive Epidemiology, 5(2), e21–e21.

3. Parker, K. (2016). Intradialytic Exercise is Medicine for Hemodialysis Patients. Current Sports Medicine Reports, 15(4), 269–275.

4. Palar, R., & Lobo, D. (2022). Impact of intradialytic exercise on fatigue, biochemical and physiological parameters in patients on maintenance hemodialysis - A pilot study - Part 1. Clinical Epidemiology and Global Health, 15(101064), 101064.

5. Hu, H., Liu, X., Chau, P. H., & Choi, E. P. H. (2022). Effects of intradialytic exercise on health-related quality of life in patients undergoing maintenance haemodialysis: a systematic review and meta-analysis. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 31(7), 1915–1932.

6. Orcy RB, Dias PS, Seus TLC, Barcellos FC, Bohlke M. Combined Resistance and Aerobic Exercise is Better than Resistance Training Alone to Improve Functional Performance of Haemodialysis Patients - Results of a Randomized Controlled Trial. Physiotherapy Research International. 2012;17:235-243.

7. Chang, Y., Cheng, S.-Y., Lin, M., Gau, F.-Y., & Chao, Y.-F. C. (2010). The effectiveness of intradialytic leg ergometry exercise for improving sedentary life style and fatigue among patients with chronic kidney disease: a randomized clinical trial. International Journal of Nursing Studies, 47(11), 1383–1388.

8. Rhee, S. Y., Song, J. K., Hong, S. C., Choi, J. W., Jeon, H. J., Shin, D. H., Ji, E. H., Choi, E.-H., Lee, J., Kim, A., Choi, S. W., & Oh, J. (2019). Intradialytic exercise improves physical function and reduces intradialytic hypotension and depression in hemodialysis patients. The Korean Journal of Internal Medicine, 34(3), 588–598.

9. Huang, H.-Y., Hung, K.-S., Yeh, M.-L., Chou, H.-L., Yeh, A. L., & Liao, T.-Y. (2021). Breathing-based leg exercises during hemodialysis improve quality of life: A randomized controlled trial. Clinical Rehabilitation, 35(8), 1175–1184.

• Cycle ergometer is the most common (1, 3, 7, 8)

• Anaerobic exercise with elastic bands (8)

• Breathing-based leg exercises such as SLRs, quad sets, HS curls (9)

Why is it effective

Introduction

General Benefits

• Intradialytic exercise is well established in Australia and Europe but less common in America (3)

• 30 years of research has shown intradialytic exercise to be safe and beneficial but it uncommon in practice (2, 3, 4)

• Compliance has been shown to be higher with intradialytic exercise compared to extradialytic exercise (3)

• Can increase perfusion by opening vascular beds to working leg muscles (1, 3)

• Trapped urea and toxins move to bloodstream for removal (1, 3)

• Shift of ions such as potassium and phosphate with reduction of toxins (1)

• Opportunity to provide therapy with medical treatment that is safe, time-efficient, & monitored (1, 3)

• Distraction during dialysis that can enhance feelings of self-efficacy (3)

• Can blunt or reverse negative effects associated with ESRD (1)

Physiological & Psychological Benefits

• Improve physical activity & decrease fatigue (3, 7)

• Improve intradialytic hypotension and lower systolic and diastolic blood pressure (1, 2, 8)

• Improve depression and quality of life (1, 3, 8, 9)

• Improve dialysis adequacy via Kt/V levels (1, 3)

• Improve physical performance measures (8)

Hemodialysis

The Downside...

• Prolonged exposure to dialysis treatment has a catabolic effect on muscles (3)

• Physical inactivity is prevalent in the dialysis population and is associated with unfavorable clinical outcomes (4)

• Fatigue and elevated biochemical markers are directly linked to decreased activity (4)

What is dialysis ?

• Patients are connected to a dialyzer to filter out wastes, salt, and fluid of the blood (3)

• It is time consuming process that is done approximately 2-3x a week for 4 hours each (2)

The Most Common Treatment

• Hemodialysis is the most common treatment for kidney failure (1, 2, 3)

• Hemodialysis is the only maintenance treatment if transplant is not available (1)