#2072 Impact of the GoodRENal platform on lower-limbs muscle strength in a Spanish sample
Authors: Segura-Ortí Eva , Martínez-Olmos Francisco José , Garcia-Testal Alicia , Cana-Poyatos Alicia , Avesani Carla Maria , Mesa-Gresa Patricia , Lozano-Quilis José Antonio , Reboredo Maycon Moura , Moscoso Paula , Garcia-Maset Rafael , Valtueña-Gimeno Noemi , Toquero Marina 
Published: May 2024

Abstract

Background and Aims
People with chronic kidney disease on hemodialysis have low levels of physical activity and low lower-limbs muscle strength, partly due to the sedentary lifestyle, and a big number of hours sitting or in a recumbent position.
The GoodRENal project aimed at creating an intradialysis health platform to improve health-related quality of life. The present study focused on the impact of the GoodRENal intradialysis platform on lower-limbs muscle strength.

Method
People in hemodialysis treatment from Spain were included. Participants were randomized into two groups, the GoodRENal or the usual care group. The participants used the GoodRENal platform for 12 weeks, 3 times a week. Games using non-immersive virtual reality were created aiming at educating on nutritional habits, increasing physical activity during the HD session, improving cognitive skills and increasing psychological well-being. All of them included dual tasks, so that the movement of the legs was used in every game. An Azure Kinect camera was used to capture the movement and all activities were dual, so that movement of lower limbs was promoted in every game. A handheld dynamometer was used to assess hip flexors and abductors muscle strength during the hemodialysis session. This procedure has proven to be reliable and save. An ANOVA mixed model (group and time factors) was used to analyze the results.

Results
19 participants were included (Control n = 9; GoodRENal n = 10). Participants’ mean age was 73.4 years for the control and 68.3 years for the GoodRENal group, with a hemodialysis vintage, median 34 months (minimum 3- maximum 277) and 25 months (minimum 5- maximum 48) for the control and GoodRENal groups. Right hip flexor muscles changed in the control group over time: Baseline 124.7 (23.2) N; 4 weeks 121.3 (20.3) N; 12 weeks 119.0 (21.1) N. In the GoodRENal group, the data were: Baseline 116.7 (34.7) N; 4 weeks 124.7 (36.7) N; 12 weeks 142.7 (44.7) N. The ANOVA showed a significant time × group interaction (F = 11.347 p &lt; 0.001) with a significant improvement in the GoodRENal group. Left hip abductor muscles changed in the control group over time: Baseline 124.5 (24.0) N; 4 weeks 123.0 (26.1) N; 12 weeks 122.0 (24.7) N. In the GoodRENal group, the data were: Baseline 111.1 (30.4) N; 4 weeks 119.2 (33.0) N; 12 weeks 138.5 (36.3) N. The ANOVA showed a significant time × group interaction (F = 15.218 p &lt; 0.001) with a significant improvement in the GoodRENal group. Both left hip flexors (F = 19.055 p &lt; 0.001) and abductors (F = 15.036 p &lt; 0.001) showed a significant time per group interaction, with an improvement in the GoodRENal group.

Conclusion
The GoodRENal platform is a feasible strategy to increase the muscle strength of the hip flexors and abductors muscles. Future studies with bigger samples should confirm these results.