MO597: An Intradialytic Virtual Reality Exercise Intervention to Reduce Frailty in a Hemodialysis Population: Revid Study
Authors: Benavent Caballer Vicente , Garcia-Testal Alicia , José Martínez-Olmos Francisco , Valtueña-Gimeno Noemi , Toquero Correa Marina , Garcia-Maset Rafael , Royo-Maicas Pilar , Rico-Salvador Inmaculada , Vercher Narbona Verónica , Antonio Gil-Gómez José , Segura Eva 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Hemodialysis (HD) induces changes not just to the kidney but in other organs or systems so that patients usually report fatigue, weakness, weight loss, exhaustion, or low levels of physical activity, all present in the frail phenotype criteria. Because its association with negative health-related outcomes, frailty is considered an important issue to mitigate and manage in the hemodialysis population. However, very few studies analyzing the frail phenotype have focused on hemodialysis populations, despite the knowledge that frailty can be reversible after an early detection and treatment. On the other hand, our group has shown that nonimmersive virtual reality exercise during hemodialysis is a safe modality to improve physical function and health-related quality of life. Therefore, the aim of this study was to analyze the impact of an intradialysis nonimmersive virtual reality exercise program on the frail phenotype in a hemodialysis population.

METHOD
An ongoing randomized trial (ReVID study) enrolls subjects undertaking hemodialysis from June 2021 onward. All participants were assessed using the five Fried frail phenotype criteria as follow; Unintended weight loss in the past year greater than 4.5 kg, self-reported exhaustion was measured using two questions from the Center for Epidemiologic Studies Depression (CES-D) scale, weakness (hand-grip strength) was measured using a hand-grip dynamometer, slow walking speed was measured based on time to needed to cover 4.6 m at usual speed, and low physical activity was measured by using the short version of the Minnesota Leisure Time Activity questionnaire. Each of the five criteria scored as 0 (no frail-related) or 1 (frail-related). Finally, participants were stratified as follows: 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 frail phenotype assessment, all participants performed an intradialytic exercise program consisting of a nonimmersive virtual reality video game adapted to the dialysis session, in which the patient must catch treasures while avoiding bombs by moving the lower extremities, with a progressive duration of 25–45 min. Adherence to the exercise program was measured as a percentage (number of sessions attended/number of sessions offered). All assessments and interventions were conducted between June and September 2021 at Hospital de Manises (Valencia, Spain).

RESULTS
23 subjects were included in the study (median age 70, 5 years; 11 males, 0/23 robust, 8/23 pre-frail and 15/23 frail). A chi-square value of 4329 (P = 0.05) showed a significant change in the frail phenotype of the participants after completing the exercise intervention. 17/23 of the participants ended the exercise program as pre-frail (9 participants changed from frail to pre-frail), and non-worsening in the frail phenotype of the participants was reported. The mean adherence to the exercise program throughout the study was 40%.

CONCLUSION
This study shows that an intradialytic exercise program consisting of a nonimmersive virtual reality video game adapted to the dialysis session can be useful to mitigate and manage frailty in the hemodialysis population.