Effects of Exercise Program on Physical Functioning of Hemodialysis Patients.
Condition: Hemodialysis Patients
Study type: Interventional

Summary: 
      This study is designed to provide a simple, home-based, low-moderate intensity exercise
      program in chronic renal disease patients who are undergoing hemodialysis in order to improve
      physical performance, decrease the level of fatigue and eventually increase quality of life
      in patients. A randomized control trial will be conducted including patients on hemodialysis,
      who will be randomly allocated to interventional and control groups. Both the groups will
      receive six weeks of treatment, 3 times per week. Data will be collected at baseline, 3rd
      week and 6th week. Outcome measures include assessment of physical functioning including
      six-minute walk test, standing balance, 4-metre gait speed, chair stand, fatigue assessment
      scale and quality of life in kidney disease patients on hemodialysis.
    

Detailed description: 
      Chronic Kidney Disease (CKD) is defined as the structural and functional abnormalities of
      kidney along with decreased Glomerular Filtration Rate (GFR) < 60 ml/min/1.73 m2 for 3
      months. It also refers to an irreversible deterioration in renal function that usually
      develops over a period of years it represents not only as a biochemical abnormality but,
      eventually, loss of the excretory, metabolic and hormonal functions of the kidney which leads
      to the clinical symptoms and signs of renal failure. The alarmingly high prevalence of
      reduced GFR in adult men and women in Pakistan is not unexpected as the prevalence of risk
      factors of CKD including hypertension and diabetes is one of the highest reported worldwide.
      The prevalence rate of CKD is found to be 70% in Pakistan. Clinical sign of raised urea and
      creatinine should be found during routine blood tests. An early symptom is nocturia,
      tiredness or breathlessness, renal anemia or fluid overload, pruritus, anorexia, weight loss,
      nausea, vomiting and hiccups. In very advanced (chronic stage) renal failure, respiration may
      be particularly deep (Kussmaul breathing), metabolic acidosis, and patients may develop
      muscular twitching, fits, drowsiness and coma. Chronic kidney disease can be managed by
      lifestyle modifications (dietary management, weight management, physical activity) are the
      initial components of treatment. Blockade of the renin angiotensin aldosterone system, blood
      pressure control, optimally managed comorbid diabetes and avoidance of nephrotoxic
      medications to prevent worsening renal function are also part of management. Hemodialysis is
      a medical procedure to remove the waste products in the form of fluid from the blood and to
      correct electrolyte imbalances. This is accomplished using a machine and a dialyzer, also
      referred to as an artificial kidney. As dialysis requires patients to be seated for extended
      periods of time, the risk of developing obesity, high blood pressure, decreased quality of
      life, musculoskeletal problems, such as low back pain and muscle tightness is higher than
      normal.

      The physiotherapeutic exercise program during hemodialysis improves the quality of life (QOL)
      of chronic renal patients in physical, social, environmental and psychological. On regular
      basis physiotherapy intervention is to a lower frequency of edema and muscle cramps and to
      reduce the intensity of pain. It also influences the improvement of the respiratory function,
      showed by the evolution of the values maximal inspiratory pressure (IPmax), maximal
      expiratory pressure (EPmax) and peak expiratory flow.

      Studies reported that aerobic as well as strength training proved to have favorable short and
      long-term effects on the physical performance and the functional balance in patients on
      maintenance renal hemodialysis.

      All patients undertaking hemodialysis (HD) are recommended to exercise to some extent.
      Intra-dialytic resistance training program is also feasible and effective, causing
      improvement in physical functioning by improving the strength, exercise capacity and
      performance in physical tests. Patients with chronic renal failure on hemodialysis,
      inspiratory muscle training induces improvement in respiratory muscle strength, functional
      capacity, lung function and quality of life. Inspiratory muscle training can improve maximal
      respiratory pressures, lung function, functional capacity and quality of life in patients
      with chronic renal failure who are receiving hemodialysis.
    

Intervention name(s): Exercise program
Intervention type(s): Other
Intervention description(s): Home based exercise program including aerobic and resistance training will be carried out for a period of 6 weeks. Duration of aerobic exercise will be starting at 20 min/session, and progress to 30 ruin/session, with an increased pace according to the patient's capabilities. Resistance training with thera-band for 1 set of 10 repetitions twice a week. One RM will be reassessed weekly, and the program will be adjusted accordingly.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Chronic kidney disease; Hemodialysis; Home-based exercise plan