Chronic Intradialytic Exercise : a Cardioprotective Role
Condition: Chronic Renal Failure
MeSH terms: Kidney Failure, Chronic
Study type: Interventional

Summary: 
      The main objective is to assess the effects of chronic intradialytic physical exercise on
      myocardial remodelling and regional function.
    

Detailed description: 
      Background: Hemodialysis patients have a mortality rate 50 times higher than in the general
      population, and the cause remains cardiovascular in more than half of the cases. A
      deleterious morphological and functional cardiac remodelling is well established in these
      patients, the causes of which are both the presence of factors specific to renal disease
      (hemodynamic and non-hemodynamic) and co-morbidities (diabetes, hypertension, etc. .) but
      also to the hemodialysis (HD) procedure itself, due to the sudden hemodynamic changes it
      imposes, leading to repeated episodes of intradialytic hypotension (HID) and myocardial
      stunning. The latter are now documented as direct contributors to the increased mortality
      observed in HD patients compared to the general population. The introduction of intradialytic
      physical exercise in the therapeutic program of HD patient is now recommended and practised
      routinely in many countries, in Scandinavia in particular. Several meta-analyses have clearly
      established its safety. The beneficial role of chronic intradialytic exercise in improving
      dialysis efficiency, mental health and quality of life, as well as the inflammatory status of
      HD patients is also clearly demonstrated. Chronic intradialytic exercise is also associated
      with improvements in overall fitness level, a parameter closely linked to cardiovascular
      mortality. Applied acutely during dialysis, it could play a cardioprotective role (e.g;
      limiting myocardial stunning), allowing haemodynamic and cardiac functional stabilization
      during HD. However, to our knowledge, no study to date has investigated the long-term effects
      of intradialytic exercise on remodelling and overall and regional heart function.

      Aims: The main objective is to assess the effects of chronic intradialytic physical exercise
      on myocardial remodelling and regional function. The secondary objectives are to evaluate the
      effect of acute intradialytic exercise on myocardial stunning as well as the effect of
      chronic physical exercise on macro and microcirculatory vascular function, inflammation,
      physical fitness and health-related quality of life.
    

Intervention name(s): chronic phase; acute phase
Intervention type(s): Other; Other
Intervention description(s): 1h of intradialytic execise, starting 30 min after hemodialysis beginning : 30 min of low-intensity (Borg Scale 11-14) aerobic exercise + 30 min of resistance training, frequency : 3 times a week for 16 weeks.; 30 min of low-intensity (Borg Scale 11-14) aerobic exercise, starting 30 min after hemodialysis beginning
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Acute phase : standard HD versus HD with acute intradialytic exercise (in HD-EX group only);
Chronic phase : before and after an exercise training program of 16 weeks (HD-EX group) as well as before and after 16 weeks of standard HD (HD group)
Masking: Single (Investigator)
Primary purpose: Prevention
Keywords: exercise; hemodialysis