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Phys Sportsmed. 2009 Dec;37(4):84-96.
Exercise performance by hemodialysis patients: a review of the literature.

Brenner I.

Department of Biology, Trent/Fleming School of Nursing, Trent University, Peterborough, Ontario K9J 7B8, Canada. ibrenner@trentu.ca

Hemodialysis (HD) patients exhibit poor functional capacity and reduced quality of life as a result of the complications associated with end-stage renal disease (ESRD). A review of the literature indicates that regular physical activity can reduce the complications associated with ESRD by inducing adaptations in the cardiovascular, nervous, and musculoskeletal systems. In turn, this increases functional capacity and enhances quality of life in patients on HD. Hemodialysis patients can safely participate in a variety of exercise programs with minimal adverse effects. Intradialytic exercise programs that can incorporate aerobic and resistance exercise promote exercise adherence and should be encouraged on dialysis units.

все признают физические упражнения полезными, однако большой разницы в результатах упражнений в диализном зале или дома некторыии группами исследователей не было обнаружено:
Am J Kidney Dis. 2010 Jan;55(1):88-99. Epub 2009 Nov 22.
Effect of intradialytic versus home-based aerobic exercise training on physical function and vascular parameters in hemodialysis patients: a randomized pilot study.

Koh KP, Fassett RG, Sharman JE, Coombes JS, Williams AD.

School of Human Life Sciences, University of Tasmania, Launceston, Tasmania, 7250 Australia.

BACKGROUND: Hemodialysis patients show reduced physical function and greater risk of increased arterial stiffness because of hypertension, metabolic disturbances, and vascular calcification. Exercise interventions potentially could improve their vascular risk profile. STUDY DESIGN: Randomized controlled pilot clinical study comparing the effects of 6 months of supervised intradialytic exercise training versus home-based exercise training or usual care on physical function and arterial stiffness in hemodialysis patients. SETTING & PARTICIPANTS: 70 hemodialysis patients from 3 renal units. INTERVENTION: Intradialytic-exercise patients trained 3 times/wk for 6 months on a cycle ergometer and home-based-exercise patients followed a walking program to achieve the same weekly physical activity. Usual-care patients received no specific intervention. OUTCOMES & MEASUREMENTS: Primary outcome measures were distance traveled during a 6-minute walk test and aortic pulse wave velocity. Secondary outcome measures included augmentation index (augmentation pressure as a percentage of central pulse pressure), peripheral (brachial) and central blood pressures (measured noninvasively using radial tonometry), physical activity, and self-reported physical functioning. Measurements were made at baseline and 6 months. RESULTS: At 6 months, there were no significant differences between changes in 6-minute walk test distance (intradialytic exercise, +14%; home-based exercise, +11%; usual care, +5%), pulse wave velocity (intradialytic exercise, -4%; home-based exercise, -2%; usual care, +5%), or any secondary outcome measure. LIMITATIONS: Lack of medication data limited the analysis of vascular parameters in this study. CONCLUSION: There were no differences between intradialytic or home-based exercise training and usual care for either physical function or vascular parameters. Copyright 2009 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

PMID: 19932545 [PubMed - indexed for MEDLINE]

И наконец:

Arch Phys Med Rehabil. 2006 May;87(5):680-7.
Exercise training during hemodialysis improves dialysis efficacy and physical performance.

Parsons TL, Toffelmire EB, King-VanVlack CE.

School of Rehabilitation Therapy, Queen's University, and Division of Nephrology, Kingston General Hospital, ON, Canada.

Comment in:

* Arch Phys Med Rehabil. 2007 Jan;88(1):130; author reply 130-1.

OBJECTIVE: To determine the impact of a 20-week intradialytic exercise program, consisting of 60 minutes of cumulative duration, low-intensity exercise during the first 2 hours of dialysis, on dialysis efficacy, physical performance, and quality of life in self-care hemodialysis (HD) patients. DESIGN: One-group repeated measures. SETTING: Satellite HD units affiliated with a Canadian teaching hospital. PARTICIPANTS: A convenience sample of 13 self-care HD patients who were stable on dialysis for a minimum of 6 months and were medically screened for significant cardiac, pulmonary, and/or musculoskeletal pathology that would preclude exercise. INTERVENTION: A 5-month intradialytic exercise program in which subjects exercised 3 times a week (cycle ergometer, mini-stepper) for 30 minutes in each of the first 2 hours of HD. MAIN OUTCOME MEASURES: Dialysis efficacy (in single-pool model of urea kinetics [spKt/V]) was assessed prior to and at the end of each month of the exercise program. Physical function (6-minute walk test [6MWT]), and quality of life. (Kidney Disease Quality of Life-Short Form [KDQOL]) were determined at baseline and at weeks 10 and 20 of the exercise program. RESULTS: SpKt/V increased 11% at the end of the first month of the program (P<.05) and remained elevated for the duration of the program (18%-19%). Distance walked on the 6MWT increased by 14% at both weeks 10 and 20 (P<.05). No changes were noted in KDQOL scores. CONCLUSIONS: A low-intensity intradialytic exercise program is a viable adjunctive therapy, which improves HD efficacy and physical function in HD patients.

исследовались пациенты, участвовавшие в длительных программах (24 недели) физических упражнений и эти пациенты сравнивались с пациентами получавшим короткие куры физических упражнений (12 недель). Достоверных различий между этими группами не обнаружили.
Am J Kidney Dis. 2007 Oct;50(4):574-84.
Randomized controlled trial of intradialytic resistance training to target muscle wasting in ESRD: the Progressive Exercise for Anabolism in Kidney Disease (PEAK) study.

Cheema B, Abas H, Smith B, O'Sullivan A, Chan M, Patwardhan A, Kelly J, Gillin A, Pang G, Lloyd B, Fiatarone Singh M.

School of Exercise and Sport Science, University of Sydney, Sydney, Australia. b.cheema@massey.ac.nz

BACKGROUND: To determine whether prolonged (24 weeks) intradialytic progressive resistance training (PRT) could counteract muscle wasting more effectively than short-duration training (12 weeks) in patients with end-stage renal disease. STUDY DESIGN: Randomized controlled trial. SETTING & PARTICIPANTS: 49 patients (age, 62.6 +/- 14.2 years; 0.3 to 16.7 years on hemodialysis therapy) were randomly assigned to PRT plus usual care for 24 weeks (24WK group) or a crossover control group that received usual care for the first 12 weeks, then PRT plus usual care for the latter 12 weeks (12WK group). INTERVENTION: Two sets of 10 free-weight PRT exercises were performed at a high intensity during routine thrice-weekly hemodialysis treatment under direct supervision. OUTCOMES & MEASUREMENTS: Primary outcomes include thigh muscle cross-sectional area by means of computed tomography and intramuscular lipid content estimated through attenuation. Secondary outcomes include muscular strength, exercise capacity, and C-reactive protein level. RESULTS: The 24WK group increased muscle cross-sectional area (+1.82 +/- 3.25 cm(2)) compared with losses in the 12WK group (-1.37 +/- 6.87 cm(2); relative effect size, 0.59; 95% confidence interval [CI], -0.27 to 6.65; P = 0.04). However, this outcome did not achieve the level of statistical significance required (P = 0.025) after Bonferroni correction for multiple primary outcomes. There was no significant change in intramuscular lipid content between groups (+0.19 +/- 1.32 versus +0.16 +/- 1.69 Hounsfield units in the 24WK and 12WK groups, respectively; P = 0.31). Log C-reactive protein level tended to decrease in the 24WK group compared with the 12WK group (relative effect size, -0.63; 95% CI, -0.27 [-0.54 to 0.00]; P = 0.05). The 24WK group improved muscular strength measures and exercise capacity throughout the trial. LIMITATIONS: Single geographic site used; no control group without exercise exposure; unblinded assessment of some secondary outcome measures. CONCLUSIONS: Prolonged intradialytic PRT did not significantly improve muscle cross-sectional area or intramuscular lipid content compared with a shorter duration of exercise. Future trials are required to more thoroughly investigate the clinical importance and magnitude of myogenic adaptations to PRT in this cohort.

PMID: 17900457 [PubMed - indexed for MEDLINE]

Применение физических упражнений непосредственно перед диализом или во время процедуры помогало удалять фосфаты лучше

Am J Kidney Dis. 2004 Jan;43(1):85-9.
Time and exercise improve phosphate removal in hemodialysis patients.

Vaithilingam I, Polkinghorne KR, Atkins RC, Kerr PG.

Department of Nephrology, Monash Medical Centre, Clayton, Vic, Australia.

BACKGROUND: Control of serum phosphate remains a difficult clinical issue in most hemodialysis (HD) patients. This study examines 2 nonpharmacological approaches to improving phosphate control in HD patients. METHODS: First, 9 stable HD patients underwent dialysis in random fashion for either 4 hours 3 times weekly or 5 hours 3 times weekly. Adjustments were made to blood flow rates such that Kt/V was the same for all sessions, thus allowing independent assessment of the influence of time. The primary end point was weekly dialysate phosphate removal. In the second study, 12 different patients underwent an exercise program in which they pedaled a bicycle ergometer either immediately before or during dialysis. Again, weekly dialysate phosphate removal was measured. RESULTS: In the time study, urea reduction ratio (69% +/- 0.02% versus 68% +/- 0.07, 4 versus 5 hours) and weekly urea removal were no different between the 2 groups. However, weekly phosphate removal (3,007 +/- 641 versus 3,400 +/- 647 mg; P < 0.02) significantly improved with longer dialysis duration. Serum phosphate levels improved, but did not reach statistical significance in this short-term study. In the exercise study, weekly phosphate removal improved with exercise, but did not reach significance (2,741 +/- 715 [no exercise] versus 2,917 +/- 833 [exercise predialysis] versus 2,992 +/- 852 mg [exercise during dialysis]; P = 0.055), although comparing only exercise during dialysis with no exercise reached significance (P = 0.02). There was no significant difference in serum phosphate levels. CONCLUSION: Both increased dialysis time and exercise result in increased dialytic removal of phosphate and could be expected in the long term to improve phosphate control.

PMID: 14712431 [PubMed - indexed for MEDLINE]