The Effect of Exercise on Blood Parameters Related to Dialysis Patients' Survival
Condition: Chronic Kidney Diseases; End Stage Renal Disease; Hemodialysis
MeSH terms: Kidney Diseases; Renal Insufficiency, Chronic; Kidney Failure, Chronic
Study type: Interventional

Summary: 
      The purpose of this study is to check if patients' exercise during their dialysis sessions
      can improve the blood parameters which affect the heart disease and osteoporosis, so that we
      can help patients live longer.
    

Detailed description: 
      Dialysis patients suffer from a number of problems, one of which is reduced ability,
      decreased functional capacity, and consequently reduced physical capability. Forced
      inactivity due to immobility in dialysis sessions and the need to rest and relieve fatigue
      for a few hours after each session cause patients to become more inactive day by day, and
      according to various studies, inactivity in these patients along with reduced physical
      capabilities increase the risk of cardiovascular disease (CVD), which is a risk factor for
      mortality in these patients.

      On the other hand, inactivity is an independent predictor of hospitalization and mortality in
      these patients.

      The mortality rate of dialysis patients is much higher than that of healthy people, to the
      extent that it is reported to be about 10 to 30 times higher. The life expectancy of these
      patients is between 30 and 50 percent lower than that of people without the same age and sex.
      Dialysis patients suffer from many CVDs such as high blood pressure, vascular disease,
      congestive heart failure and arrhythmias. CVDs in patients are related to traditional risk
      factors such as diabetes, hypertension, sedentary lifestyle and non-traditional risk factors
      such as anemia, inflammation, abnormal calcium metabolism and phosphorus and oxidative
      stress. Studies have shown that high levels of calcium, phosphorus , calcium- phosphorus
      product and parathyroid hormone are associated with fatal and non-fatal cardiovascular events
      and all-cause mortality in dialysis patients.

      One of the most common complications of chronic kidney disease is hypophosphatemia. Phosphate
      metabolism is regulated by the interaction of the kidneys, bones and intestines. This balance
      is impaired in kidney patients and the calcification process occurs through disturbances in
      the regulation of calcium, phosphate, and hyperparathyroidism. Hyperparathyroidism is
      considered as one of the aggravating causes of anemia as well as resistance to erythropoietin
      treatment in hemodialysis patients. Due to the effect of parathyroid hormone in the
      regulation of calcium and the anabolic and catabolic role of the bones, the regulation of
      this hormone is essential for all people, especially dialysis patients.

      Human studies have shown that the regulation of parathyroid hormone and calcium and
      phosphorus metabolism are dependent on physical activity, and they have introduced exercise
      as an effective way to regulate this hormone. Considering the various effects of exercise on
      dialysis patients, a study has been designed to investigate the effect of concurrent exercise
      during dialysis on changes in calcium levels, phosphorus, calcium-phosphorus product, and
      parathyroid hormone.
    

Intervention name(s): Intradialytic exercise group
Intervention type(s): Other
Intervention description(s): Participants will do concurrent exercise (a combination of aerobic exercise and resistance training) for 30-60 minutes during the second hour of their routine hemodialysis sessions. To determine the intensity of the prescribed exercise, maximum heart rate is used for aerobic workout and 5 Repetitions Maximum (5RM) for resistance protocols. Exercises will be performed at a moderate exercise intensity (12-14 on the Borg RPE Scale). All protocols are tailor-made based on each individual's needs and physical abilities.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants will be randomly allocate to intervention group or control group and will be examined in the same way.
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Mortality; Mortality Rate; Survival; Cardiovascular Disease; Osteoporosis; Bone Mineral Disorders; Exercise during dialysis