Current status of exercise rehabilitation in maintenance hemodialysis patients_West China Medical Journal

Authors：

LIU Jing ¹ , YU Shaobin ¹ , YUAN Huaihong ^1,2 ,  FU Ping ¹

1. Department of Nephrology/Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

FU Ping, Email: fupinghx@scu.edu.cn

Keywords：

End-stage renal disease; Maintenance hemodialysis; Exercise rehabilitation

DOI：

10.7507/1001-5515.202006109

Video：

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Patients undergoing maintenance hemodialysis are characterized with lower cardiorespiratory capacity and muscle atrophy, thus easily leading to a sedentary lifestyle. These patients are usually associated with lower quality of life and worse prognosis. Evidence indicates appropriate exercise rehabilitation plan could help maintenance hemodialysis patients achieve better health outcomes. However, there is still a lack of evidence data to precisely recommend exercise type, intensity, frequency and timing specially designed for maintenance hemodialysis patients. This article aims to summarize the existing expert consensus on exercise rehabilitation for maintenance hemodialysis patients, important considerations in the implementation process, factors that affect exercise rehabilitation, with a view to encouraging maintenance hemodialysis patients to participate in the development of appropriate exercise rehabilitation plan and maximize health benefits.

Citation： LIU Jing, YU Shaobin, YUAN Huaihong, FU Ping. Current status of exercise rehabilitation in maintenance hemodialysis patients. West China Medical Journal, 2020, 35(7): 757-761. doi: 10.7507/1001-5515.202006109 Copy

1.	de Jager DJ, Grootendorst DC, Jager KJ, et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA, 2009, 302(16): 1782-1789.
2.	中国医械研究院. 《中国医疗器械蓝皮书 2019 版》. (2019-09-23)[2020-06-08]. https://www.vzkoo.com/doc/5207.html?a=4.
3.	Stack AG, Molony DA, Rives T, et al. Association of physical activity with mortality in the US dialysis population. Am J Kidney Dis, 2005, 45(4): 690-701.
4.	Kouidi E, Karagiannis V, Grekas D, et al. Depression, heart rate variability, and exercise training in dialysis patients. EurJ Cardiovasc Prev Rehabil, 2010, 17(2): 160-167.
5.	Heiwe S, Jacobson SH. Exercise training in adults with CKD:a systematic review and meta-analysis. Am J Kidney Dis, 2014, 64(3): 383-393.
6.	Kouidi EJ, Grekas DM, Deligiannis AP. Effects of exercise training on noninvasive cardiac measures in patients undergoing long-term hemodialysis: a randomized controlled trial. Am J Kidney Dis, 2009, 54(3): 511-521.
7.	Andrassy KM. Comments on “KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease”. Kidney Int, 2013, 84(3): 622-623.
8.	Wang CJ, Johansen KL. Are dialysis patients too frail to exercise?. Semin Dial, 2019, 32(4): 291-296.
9.	陈香美. 血液净化标准操作规程 (2020 版). (2020-01-07)[2020-06-08]. http://zk.cn-healthcare.com/doc-show-39849.html.
10.	Barcellos FC, Santos IS, Umpierre D, et al. Effects of exercise in the whole spectrum of chronic kidney disease: a systematic review. Clin Kidney J, 2015, 8(6): 753-765.
11.	Johansen KL. Exercise in the end-stage renal disease population. J Am Soc Nephrol, 2007, 18(6): 1845-1854.
12.	Chung YC, Yeh ML, Liu YM. Effects of intradialytic exercise on the physical function, depression and quality of life for haemodialysis patients: a systematic review and meta-analysis of randomised controlled trials. J Clin Nurs, 2017, 26(13/14): 1801-1813.
13.	Giannaki CD, Hadjigeorgiou GM, Karatzaferi C, et al. A single-blind randomized controlled trial to evaluate the effect of 6 months of progressive aerobic exercise training in patients with uraemic restless legs syndrome. Nephrol Dial Transplant, 2013, 28(11): 2834-2840.
14.	Matsuzawa R, Hoshi K, Yoneki K, et al. Exercise Training in elderly people undergoing hemodialysis: a systematic review and meta-analysis. Kidney Int Rep, 2017, 2(6): 1096-1110.
15.	Johansen KL, Painter PL, Sakkas GK, et al. Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis:a randomized, controlled trial. J Am Soc Nephrol, 2006, 17(8): 2307-2314.
16.	Cheema B, Abas H, Smith B, et al. Progressive exercise for anabolism in kidney disease (PEAK): a randomized, controlled trial of resistance training during hemodialysis. J Am Soc Nephrol, 2007, 18(5): 1594-1601.
17.	Dong J, Sundell MB, Pupim LB, et al. The effect of resistance exercise to augment long-term benefits of intradialytic oral nutritional supplementation in chronic hemodialysis patients. J Ren Nutr, 2011, 21(2): 149-159.
18.	Chang JH, Koo M, Wu SW, et al. Effects of a 12-week program of Tai Chi exercise on the kidney disease quality of life and physical functioning of patients with end-stage renal disease on hemodialysis. Complement Ther Med, 2017, 30: 79-83.
19.	Dziubek W, Bulińska K, Kusztal M, et al. Evaluation of exercise tolerance in dialysis patients performing tai chi training: preliminary study. Evid Based Complement Alternat Med, 2016, 2016: 5672580.
20.	Shahgholian N, Eshghinezhad A, Mortazavi M. The effect of tai chi exercise on quality of life in hemodialysis patients. Iran J Nurs Midwifery Res, 2014, 19(2): 152-158.
21.	Gordon L, McGrowder DA, Pena YT, et al. Effect of yoga exercise therapy on oxidative stress indicators with end-stage renal disease on hemodialysis. Int J Yoga, 2013, 6(1): 31-38.
22.	Yurtkuran M, Alp A, Yurtkuran M, et al. A modified yoga-based exercise program in hemodialysis patients: a randomized controlled study. Complement Ther Med, 2007, 15(3): 164-171.
23.	Smart NA, Williams AD, Levinger I, et al. Exercise & Sports Science Australia (ESSA) position statement on exercise and chronic kidney disease. J Sci Med Sport, 2013, 16(5): 406-411.
24.	Moore GE, Painter PL, Brinker KR, et al. Cardiovascular response to submaximal stationary cycling during hemodialysis. AmJ Kidney Dis, 1998, 31(4): 631-637.
25.	Jeong JH, Biruete A, Fernhall B, et al. Effects of acute intradialytic exercise on cardiovascular responses in hemodialysis patients. Hemodial Int, 2018, 22(4): 524-533.
26.	Williams B, Poulter NR, Brown MJ, et al. British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary. BMJ, 2004, 328(7440): 634-640.
27.	Robinson BM, Tong L, Zhang J, et al. Blood pressure levels and mortality risk among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Kidney Int, 2012, 82(5): 570-580.
28.	Greenwood SA, Naish P, Clark R, et al. Intra-dialytic exercise training: a pragmatic approach. J Ren Care, 2014, 40(3): 219-226.
29.	Wilund KR, Jeong JH, Greenwood SA. Addressing myths about exercise in hemodialysis patients. Semin Dial, 2019, 32(4): 297-302.
30.	Kong S, Lee KS, Kim J, et al. The effect of two different hand exercises on grip strength, forearm circumference, and vascular maturation in patients who underwent arteriovenous fistula surgery. Ann Rehabil Med, 2014, 38(5): 648-657.
31.	Oder TF, Teodorescu V, Uribarri J. Effect of exercise on the diameter of arteriovenous fistulae in hemodialysis patients. ASAIO J, 2003, 49(5): 554-555.
32.	吕忠美, 朱亚梅, 顾艳红, 等. 动静脉内瘘围手术期患者功能锻炼开始时间的研究. 中华护理杂志, 2019, 54(8): 1224-1228.
33.	Molfino A, Amabile MI, Ammann T, et al. The metabolite beta-aminoisobutyric acid and physical inactivity among hemodialysis patients. Nutrition, 2017, 34: 101-107.
34.	Johansen KL, Kaysen GA, Dalrymple LS, et al. Association of physical activity with survival among ambulatory patients on dialysis: the Comprehensive Dialysis Study. Clin J Am Soc Nephrol, 2013, 8(2): 248-253.
35.	Wang XX, Lin ZH, Wang Y, et al. Motivators for and barriers to exercise rehabilitation in hemodialysis centers: a multicenter cross-sectional survey. Am J Phys Med Rehabil, 2020, 99(5): 424-429.

1. de Jager DJ, Grootendorst DC, Jager KJ, et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA, 2009, 302(16): 1782-1789.
2. 中国医械研究院. 《中国医疗器械蓝皮书 2019 版》. (2019-09-23)[2020-06-08]. https://www.vzkoo.com/doc/5207.html?a=4.
3. Stack AG, Molony DA, Rives T, et al. Association of physical activity with mortality in the US dialysis population. Am J Kidney Dis, 2005, 45(4): 690-701.
4. Kouidi E, Karagiannis V, Grekas D, et al. Depression, heart rate variability, and exercise training in dialysis patients. EurJ Cardiovasc Prev Rehabil, 2010, 17(2): 160-167.
5. Heiwe S, Jacobson SH. Exercise training in adults with CKD:a systematic review and meta-analysis. Am J Kidney Dis, 2014, 64(3): 383-393.
6. Kouidi EJ, Grekas DM, Deligiannis AP. Effects of exercise training on noninvasive cardiac measures in patients undergoing long-term hemodialysis: a randomized controlled trial. Am J Kidney Dis, 2009, 54(3): 511-521.
7. Andrassy KM. Comments on “KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease”. Kidney Int, 2013, 84(3): 622-623.
8. Wang CJ, Johansen KL. Are dialysis patients too frail to exercise?. Semin Dial, 2019, 32(4): 291-296.
9. 陈香美. 血液净化标准操作规程 (2020 版). (2020-01-07)[2020-06-08]. http://zk.cn-healthcare.com/doc-show-39849.html.
10. Barcellos FC, Santos IS, Umpierre D, et al. Effects of exercise in the whole spectrum of chronic kidney disease: a systematic review. Clin Kidney J, 2015, 8(6): 753-765.
11. Johansen KL. Exercise in the end-stage renal disease population. J Am Soc Nephrol, 2007, 18(6): 1845-1854.
12. Chung YC, Yeh ML, Liu YM. Effects of intradialytic exercise on the physical function, depression and quality of life for haemodialysis patients: a systematic review and meta-analysis of randomised controlled trials. J Clin Nurs, 2017, 26(13/14): 1801-1813.
13. Giannaki CD, Hadjigeorgiou GM, Karatzaferi C, et al. A single-blind randomized controlled trial to evaluate the effect of 6 months of progressive aerobic exercise training in patients with uraemic restless legs syndrome. Nephrol Dial Transplant, 2013, 28(11): 2834-2840.
14. Matsuzawa R, Hoshi K, Yoneki K, et al. Exercise Training in elderly people undergoing hemodialysis: a systematic review and meta-analysis. Kidney Int Rep, 2017, 2(6): 1096-1110.
15. Johansen KL, Painter PL, Sakkas GK, et al. Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis:a randomized, controlled trial. J Am Soc Nephrol, 2006, 17(8): 2307-2314.
16. Cheema B, Abas H, Smith B, et al. Progressive exercise for anabolism in kidney disease (PEAK): a randomized, controlled trial of resistance training during hemodialysis. J Am Soc Nephrol, 2007, 18(5): 1594-1601.
17. Dong J, Sundell MB, Pupim LB, et al. The effect of resistance exercise to augment long-term benefits of intradialytic oral nutritional supplementation in chronic hemodialysis patients. J Ren Nutr, 2011, 21(2): 149-159.
18. Chang JH, Koo M, Wu SW, et al. Effects of a 12-week program of Tai Chi exercise on the kidney disease quality of life and physical functioning of patients with end-stage renal disease on hemodialysis. Complement Ther Med, 2017, 30: 79-83.
19. Dziubek W, Bulińska K, Kusztal M, et al. Evaluation of exercise tolerance in dialysis patients performing tai chi training: preliminary study. Evid Based Complement Alternat Med, 2016, 2016: 5672580.
20. Shahgholian N, Eshghinezhad A, Mortazavi M. The effect of tai chi exercise on quality of life in hemodialysis patients. Iran J Nurs Midwifery Res, 2014, 19(2): 152-158.
21. Gordon L, McGrowder DA, Pena YT, et al. Effect of yoga exercise therapy on oxidative stress indicators with end-stage renal disease on hemodialysis. Int J Yoga, 2013, 6(1): 31-38.
22. Yurtkuran M, Alp A, Yurtkuran M, et al. A modified yoga-based exercise program in hemodialysis patients: a randomized controlled study. Complement Ther Med, 2007, 15(3): 164-171.
23. Smart NA, Williams AD, Levinger I, et al. Exercise & Sports Science Australia (ESSA) position statement on exercise and chronic kidney disease. J Sci Med Sport, 2013, 16(5): 406-411.
24. Moore GE, Painter PL, Brinker KR, et al. Cardiovascular response to submaximal stationary cycling during hemodialysis. AmJ Kidney Dis, 1998, 31(4): 631-637.
25. Jeong JH, Biruete A, Fernhall B, et al. Effects of acute intradialytic exercise on cardiovascular responses in hemodialysis patients. Hemodial Int, 2018, 22(4): 524-533.
26. Williams B, Poulter NR, Brown MJ, et al. British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary. BMJ, 2004, 328(7440): 634-640.
27. Robinson BM, Tong L, Zhang J, et al. Blood pressure levels and mortality risk among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Kidney Int, 2012, 82(5): 570-580.
28. Greenwood SA, Naish P, Clark R, et al. Intra-dialytic exercise training: a pragmatic approach. J Ren Care, 2014, 40(3): 219-226.
29. Wilund KR, Jeong JH, Greenwood SA. Addressing myths about exercise in hemodialysis patients. Semin Dial, 2019, 32(4): 297-302.
30. Kong S, Lee KS, Kim J, et al. The effect of two different hand exercises on grip strength, forearm circumference, and vascular maturation in patients who underwent arteriovenous fistula surgery. Ann Rehabil Med, 2014, 38(5): 648-657.
31. Oder TF, Teodorescu V, Uribarri J. Effect of exercise on the diameter of arteriovenous fistulae in hemodialysis patients. ASAIO J, 2003, 49(5): 554-555.
32. 吕忠美, 朱亚梅, 顾艳红, 等. 动静脉内瘘围手术期患者功能锻炼开始时间的研究. 中华护理杂志, 2019, 54(8): 1224-1228.
33. Molfino A, Amabile MI, Ammann T, et al. The metabolite beta-aminoisobutyric acid and physical inactivity among hemodialysis patients. Nutrition, 2017, 34: 101-107.
34. Johansen KL, Kaysen GA, Dalrymple LS, et al. Association of physical activity with survival among ambulatory patients on dialysis: the Comprehensive Dialysis Study. Clin J Am Soc Nephrol, 2013, 8(2): 248-253.
35. Wang XX, Lin ZH, Wang Y, et al. Motivators for and barriers to exercise rehabilitation in hemodialysis centers: a multicenter cross-sectional survey. Am J Phys Med Rehabil, 2020, 99(5): 424-429.

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