Effect of a Breathing Exercise in Patients Under Hemodialysis

Purpose: To examine the effects of breathing exercises on respiratory functions and 6 Minute Walk Test (6 WT) distance in patients receiving hemodialysis treatment.

Method: This is a quasi-experimental study with a single group pretest-posttest design. It was conducted with 30 individuals in the hemodialysis unit of a public hospital between July 2022 and October 2022. Data were also collected before starting the intervention (week 1) and after completing the intervention (week 8). Socio-Demographic Data Survey, 6 Minute Walk Test and Respiratory Function Test were used as data collection tools and data were collected face to face. In the analysis of the data, mean, standard deviation, percentage, t test in dependent groups, and Wilcoxon analysis were used.

KeyWords: Individuals receiving hemodialysis treatment, respiratory exercise program, nursing care

Creating and Implementing an Exercise Program Data were collected before starting the intervention (1st week) and after the intervention was completed (8th week). 6 Minute Walking Test and Respiratory Function Test were applied to the patients before the implementation of the exercise program and after 8 weeks of application. According to the results of the Pulmonary Function Test evaluated by the pulmonologist, COPD is in Grades 3 and 4. Stage 1 patients were not included in the study. A practical explanation was given about how to use the flow-oriented Intensive Spirometry Device (ICC) (Triflow) after the 3rd hour of the treatment in the HD unit. Each of the patients was given the same brand and model flow-focused intensive spirometer (Triflow) device for breathing exercise. The Triflow device has three compartments with a capacity of 1200 ml, with a ball of different colors in each compartment. The Triflow device is based on the patient taking a maximal inspiration, then holding the breath for as long as he can (at least 5 seconds), and then exhaling slowly. The patient watches the movement of the balls for visual feedback.

During Triflow use, patients were placed in a sitting position. They were told to hold the device in an upright position, put the mouthpiece of the Triflow in their mouth, completely cover the mouthpiece with their lips to prevent air from escaping, take a deep and slow breath after a quiet exhalation, increase the duration of holding their breath as much as the patient can tolerate, and then release the balls by exhaling. Patients were instructed to bring their devices with them to each session. Since some patients forgot their hemodialysis unit and exercise device and stated that they had difficulty in bringing them back and forth due to the long distance between the dialysis unit and home, each patient was given a special triflo device to be kept in the hemodialysis unit, separate from the ones they use at home.

The exercise program was performed 3 times a week for 8 weeks, under the supervision of the researcher, with 10 repetitions at the 3rd and 4th hours of the dialysis treatment. It was recommended that they do 10 repetitions every hour after waking up on days when there was no dialysis session. In the study, patients adhered to the breathing exercise program, and no problems were reported regarding device use during the session or at home.

Eligibility Criteria:
Inclusion Criteria:

* Being ≥18 years old;
* Receiving HD treatment three times a week for at least 3 months;
* Not having a condition that prevents walking;

Exclusion Criteria:

* Having a history of Myocardial Infarction or Anginapectoris within the last month,
* Uncontrolled arrhythmia and heart rate \>120/min,
* Having uncontrolled hypertension (BP\>180/100 mm-Hg),
* Having a history of cerebrovascular accident
* Having advanced stage COPD (Stage 3, Stage 4) and advanced Stage Heart Failure (Stage 3/Stage 4),
* Having profound anemia (Hb\<7 g/dl),
* Having a history of blood transfusion in the last month,
* Having an active and chronic infection (Tuberculosis, osteomyelitis, rheumatoid arthritis),
* Needing additional oxygen therapy,
* Hospitalization in the last 1 month,
* Patients with physical or mental health problems that would prevent communication were not included in the study.