#4303 REDUCING FRAILTY IN HEMODIALYSIS PATIENTS THROUGH INTRADIALYTIC VIRTUAL REALITY EXERCISE INTERVENTION: THE REVID STUDY
Authors: Caballer Vicente Benavent , Martínez-Olmos Francisco José , Valtueña-Gimeno Noemi , Toquero Marina , Garcia-Testal Alicia , Cana-Poyatos Alicia , Garcia-Maset Rafael , Royo-Maicas Pilar , Gil-Gómez José Antonio , Segura Eva 
Published: June 2023

Abstract

Background and Aims
People in hemodialysis experience fatigue, weakness, weight loss, exhaustion, and low physical activity - all criteria of the frail phenotype. Frailty is a critical issue in the hemodialysis population due to its link to negative health outcomes, but few studies have focused on frailty in this population, despite the knowledge that frailty can be reversed with early detection and treatment. Our group has previously shown that non-immersive virtual reality exercise during hemodialysis is a safe method to improve physical function and health-related quality of life. The aim of this study is to analyze the impact of an intradialysis non-immersive virtual reality exercise program on frailty in the hemodialysis population.

Method
A randomized trial (the REVID study) included two groups of patients, exercising at different times during the dialysis session. The present study includes participants from REVID study who, once the study finished, continued exercising at their preferred time during the hemodialysis treatment. All participants were evaluated using the five Fried frailty phenotype criteria: unintentional weight loss of more than 4.5 kg in the past year, exhaustion was assessed using two questions from the Center for Epidemiological Studies Depression (CES-D) scale, weakness was measured using a handgrip dynamometer, walking speed was assessed by timing the 4.6m distance covered at the participant's normal pace, and physical activity was measured using the short version of the Minnesota Leisure Time Physical Activity questionnaire. Each of the five criteria was scored as 0 (not frail-related) or 1 (frail-related). Participants were then stratified into three groups: a score of 0/5 for robust or not frail, a score of 1-2/5 for pre-frail, and a score of 3-5/5 for frail. After the frailty phenotype assessment, all participants performed an intradialytic exercise program consisting of a non-immersive virtual reality game (Treasure Hunting) adapted to the dialysis session. The game consists of catching treasures and avoiding bombs by moving the lower extremities, with a progressive duration of 15 to 45 minutes. Adherence to the exercise program was measured as a percentage (number of sessions attended divided by the number of sessions offered). All assessments and interventions were conducted at Hospital de Manises in Valencia, Spain from September to December 2022.

Results
The study included 12 subjects with a mean age of 71.8 (13.9) years, 9 of whom were male, median time in Hemodialysis 20 (11.3 - 56 interquartile range) months. Out of the 12 participants, 2 were classified as robust, 5 as pre-frail, and 5 as frail. A chi-square test showed a significant change in the frailty phenotype of the participants after the exercise intervention (15.400; P = 0.003). At the end of the program, 3 participants were classified as frail, 7 as pre-frail, and 2 as robust. 2 participants improved from being frail to pre-frail. Furthermore, five participants (four frail and one pre-frail) reduced the number of criteria associated with the frail phenotype. No worsening in the frailty phenotype was reported among the participants. The average adherence to the exercise program throughout the study was 54.4 (11.2) %.

Conclusion
This study suggests that an intradialytic exercise program consisting of a non-immersive virtual reality can be useful in mitigating and managing frailty in the hemodialysis population.