None listed
Conditions
Brief summary
This study aims to determine if participation in a progressive combined (resistance and aerobic) exercise program facilitated by Accredited Exercise Physiologists (AEPs) at dialysis is sufficient to show improvements in time to dialysis efficiency, nutritional adequacy, body composition, physical function, and quality of life (QOL). The primary outcome is the time on dialysis to achieve dialysis adequacy with the intervention. This will be shown by improvements in SpKt/V and URR. The secondary outcome measures include: 1) change in nutrition adequacy assessed by a 2 day food recall including one dialysis day and one non dialysis day, Food Frequency Questionnaire (FFQ) (Australian Eating Survey), and Patient Generated Subjective Global Assessment (PG-SGA); 2) change in body composition assessed using Dual-energy X-ray absorptiometry (DEXA); 3) change in physical function assessed by the short physical performance battery, box and block test, 6 minute walk test and 2 minute step test; 5) change in QOL assessed using the Kidney Disease Quality of Life Short Form (KDQOL-SF) and EuroQol five dimensions (EQ5D) questionnaire Research design: Prospective cohort study (pre / post study design). This research project is designed for people on dialysis with low functional fitness. Participants must have a medical clearance prior to entering the program but once accepted will be encouraged to undertake an individualised exercise program during haemodialysis therapy. Conducting the exercise program during dialysis provides an opportunity for this population to be physically active at a time they are usually sedentary. Participants will perform a progressive exercise program at dialysis for 17 weeks (i.e. 3 days / week for 17 exercise sessions or until at least 180 minutes of physical activity per week has been achieved). The exercise will be led by an AEP with support from exercise physiology students. All outcome parameters for dialysis patients will be monitored as per usual care during the 17-week program. At completion, participants will be reassessed on the same tests as conducted at the beginning of the study so that pre-post comparisons can be made.
Interventions
The aim of this study is to determine the impact of a progressive Accredited Exercise Physiologists (AEP) led resistance and aerobic training program on time to dialysis efficiency in haemodialysis patients as well as assess the impact of the intervention on nutritional status, body composition, physical function and quality of life.
Participants will perform a progressive exercise program at the satellite haemodialysis unit (pre dialysis and intra-dialysis exercises) for 17 weeks (i.e. 3 day
The aim of this study is to determine the impact of a progressive Accredited Exercise Physiologists (AEP) led resistance and aerobic training program on time to dialysis efficiency in haemodialysis patients as well as assess the impact of the intervention on nutritional status, body composition, physical function and quality of life. Participants will perform a progressive exercise program at the satellite haemodialysis unit (pre dialysis and intra-dialysis exercises) for 17 weeks (i.e. 3 days / week for 17 weeks or until at least 180 minutes of physical activity per week has been achieved). The exercise will be led (in person) by an Accredited Exercise Physiologist with support from exercise physiology students. The pre dialysis exercise will be small group exercise sessions facilitated in person by an exercise physiologist. Tailored pre dialysis resistance training exercises will be prescribed for each patient to last 30 minutes including warm up and cool down. The program will target the major upper and lower body muscle groups, intensity will be progressively increased to ensure program progression and promote physiological adaptation. Intensity will be manipulated from the participant’s predicted Repetition Maximum (RM) or 60-75% of predicted RM, using 1-2 sets per exercise. The intra-dialysis aerobic exercise sessions will include warm up, aerobic conditioning and cool down components using cycling on an arm/leg ergometer, as well as integrating basic body movements while seated to promote continuous aerobic exercise for a minimum of 30 minutes. The aerobic component of the intervention will commence within 1½ hours of starting HD treatment at an intensity of 55-70% of Heart Rate Maximum (HRmax), preferably above 60% HRmax, or a rating of 11-13 using the Borg Rating of Perceived exertion (RPE) scale. Participants will work towards achieving 180 minutes of exercise / week. The pre dialysis exercise will be small group exercise session led by an exercise physiologist. The on dialysis exercise will be individualised to each patients own capacity and facilitated in person by the exercise physiologist. Patients will follow procedures, activities, and/or processes in accordance with their perceived capacity as directed by the exercise physiologist.
Sponsors
The Townsville Hospital Health Service
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All patients attending dialysis at NWHC (n=44) will be invited to participate. Inclusion criteria: (i) 18 years of age or older; (ii) on HD for >2 months; (iii) without acute or chronic medical conditions precluding participation assessed according to the relative and absolute contraindications to exercise developed by the American College of Sports Medicine (ACSM); (iv) adequately dialysed (Kt/v > 1.2); (v) stable during dialysis; (vi) cognition and English language adequate to understand the research and exercise protocols and provide written-informed consent; (vii) willingness to adhere to study protocols; and (vii) Nephrologist or GP medical clearance.
Exclusion criteria
Participants not medically cleared to undertake the exercise program, relative and absolute contraindications to exercise based on the American College of Sports Medicine (ACSM), refusal to participate, pregnant women and the human fetus, children and/ or young people (ie. <18 years) or people with severe cognitive impairment which would make participation potentially hazardous.
Outcome results
None listed