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Nakoui N, Ilbeigi S, Ahmadi MM, Saber A. Comparison of the effect of aerobic and resistance training on fatigue, quality of life and biochemical factors in hemodialysis patients. Sci Rep 2025; 15:10052. [PMID: 40122960 PMCID: PMC11930928 DOI: 10.1038/s41598-025-94257-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Accepted: 03/12/2025] [Indexed: 03/25/2025] Open
Abstract
Although hemodialysis has been able to increase the lifespan of dialysis patients, it has also brought many problems such as fatigue, low QOL, hypertension and physical weakness to them. Therefore, the aim of this study was to compare the effect of aerobic and resistance training on fatigue, quality of life (QOL), blood Na+, hemoglobin, C-reactive protein (CRP) and urea-creatinine ratio in hemodialysis patients. This research was conducted on 51 patients in two dialysis centers in Kerman, Iran. Patients were randomly divided into resistance group (RG) (n = 17), aerobic group (AG) (n = 17) and control group (CG) (n = 17). The patients in RG and AG performed the training protocol for eight weeks. Research variables as fatigue, QOL, blood Na+, hemoglobin, CRP, and urea-creatinine ratio were measured in pre-test and post-test. Data analysis was done using one-way ANOVA and Tukey's post hoc tests in SPSS25. (p < 0.05). The mean level of fatigue in RG and AG was significantly lower than the CG (p = 0.001). The mean levels of blood Na+ in AG was significantly higher than RG and CG (p = 0.01). Also, the mean ratio of urea-creatinine in RG and AG were significantly lower than CG (p = 0.001). There was no significant difference in QOL, hemoglobin and CRP between the RG and AG compared to the CG (p > 0.05). Based on our evidence, resistance and aerobic training for 8 weeks, 3 times weekly, is likely to improve the conditions of hemodialysis patients, and might be an option to increase intradialytic exercise adherence. Future studies should determine whether the findings are generalizable and examine the long-term effects of intradialytic exercise training.
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Affiliation(s)
- Naimeh Nakoui
- Faculty of Sports Sciences, University of Birjand, Birjand, Iran
| | - Saeed Ilbeigi
- Faculty of Sports Sciences, University of Birjand, Birjand, Iran.
| | | | - Azadeh Saber
- Kerman University of Medical Sciences, Kerman, Iran
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Taşkaya C, Büyükturan B, Büyükturan Ö, Alkan H, Bingölbali Ö, Heybeli C. Comparison of the efficacy of intradialytic core stabilization and aerobic exercises for hemodialysis patients: randomized controlled single-blind study. Disabil Rehabil 2025; 47:1243-1252. [PMID: 38874310 DOI: 10.1080/09638288.2024.2366438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE This study was performed to investigate and compare the effects of intradialytic core stabilization and aerobic exercises on physical performance, fatigue, quality of life and dialysis adequacy. MATERIALS AND METHODS The study involved 39 individuals on hemodialysis randomized into two groups: aerobic exercise (AE, n = 20) and core stabilization (CSE, n = 19). Over 8 weeks, the AE group performed pedal ergometer exercises, while the CSE group performed 4-phase core stabilization exercises. Physical performance (five times sit to stand test, 2-min step test), quality of life (Kidney Disease Quality of Life-36; KDQOL-36), fatigue levels (Piper Fatigue Scale), and dialysis adequacy (Kt/V and URR) were assessed. RESULTS After training, a significant improvement was observed in the physical performance, fatigue levels, and some parameters of KDQOL-36 of the patients (p < 0.05). However, no significant changes were observed in dialysis adequacy indicators (Kt/V and URR) (p > 0.05). When the amount of development obtained in both treatment groups is compared, kidney disease burden only in the subparameter of KDQOL-36 was statistically significantly improved in the CSE group compared to the AE group (p < 0.05). CONCLUSIONS According to the results of the study, intradialytic core stabilization exercises appear to have similar effects to aerobic exercises and can be performed by HD patients.
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Affiliation(s)
- Cengiz Taşkaya
- Department of Health Care Services, Vocational School of Health Services, Muş Alparslan University, Muş, Turkey
| | - Buket Büyükturan
- School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Öznur Büyükturan
- School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Halil Alkan
- Faculty of Health Sciences, Muş Alparslan University, Muş, Turkey
| | - Ömer Bingölbali
- Department of Health Care Services, Vocational School of Health Services, Muş Alparslan University, Muş, Turkey
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Fang Y, Xiaoling B, Huan L, Yaping G, Binying Z, Man W, Juan W, Xinyu L. Effects of exercise dose based on the ACSM recommendations on depression in hemodialysis patients: a systematic review and meta-analysis of randomized controlled trials. Front Physiol 2025; 15:1513746. [PMID: 39959813 PMCID: PMC11825786 DOI: 10.3389/fphys.2024.1513746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Accepted: 12/23/2024] [Indexed: 02/18/2025] Open
Abstract
Objective To explore the impact of various exercise doses on depressive symptoms among hemodialysis patients and offer valuable guidance for the selection of optimal exercise doses in clinical practice settings. Methods A comprehensive systematic review was conducted across four major databases, namely, PubMed, Embase, Web of Science, and Cochrane Library, covering the period from their inception until August 2024. Exercise interventions were classified based on adherence to American College of Sports Medicine (ACSM) recommendations, dividing studies into groups with high and low/uncertain ACSM adherence. A meta-analysis was performed utilising Review Manager5.4.1 to assess the effects of ACSM adherence on depression in hemodialysis patients. Results This meta-analysis incorporated a total of 19 randomized controlled trials, involving 1,285 patients. The mean age of the patients ranged from 33.2 to 70 years, and the average body mass index (BMI) fluctuated between 23.3 and 28.81 kg/m2. Males accounted for a relatively larger proportion of the participants. Among these trials, 14 were classified as having high ACSM adherence, while 5 were categorized as having low or uncertain adherence. Overall, exercise markedly improved depression in hemodialysis patients (SMD: -0.63, 95% CI: -0.87, -0.39; p < 0.05). The high ACSM adherence group showed greater improvement relative to the low/uncertain adherence group (SMD: -0.66 vs. -0.56). No notable disparities were noted in the effects of exercise duration or patient age on depression outcomes between the subgroups (p = 0.86, p = 0.48). Conclusion Exercise interventions that exhibit high adherence to the ACSM guidelines prove to be more efficacious in alleviating depression among hemodialysis patients as compared to those with low or uncertain adherence levels. Systematic Review Registration https://www.crd.york.ac.uk/prospero/#myprospero.
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Affiliation(s)
- Yang Fang
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China
- School of Nursing, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Bai Xiaoling
- Department of Nursing, Guizhou Nursing Vocational College, Guiyang, Guizhou, China
| | - Li Huan
- School of Nursing, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
- Hospital infection Management Department, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China
| | - Guan Yaping
- School of Nursing, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Zhang Binying
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Wang Man
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Wu Juan
- Department of Nursing, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Liu Xinyu
- School of Nursing, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
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Agarwal M, Alexiuk J, Bohm C, Sikora L, Zimmerman D. Factors Influencing Recruitment, Retention, and Adherence Rates in Exercise Interventions in ESKD: A Scoping Review. Kidney Med 2025; 7:100933. [PMID: 39810814 PMCID: PMC11732533 DOI: 10.1016/j.xkme.2024.100933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2025] Open
Abstract
Rational & Objective Majority of people with end-stage kidney disease (ESKD) are sedentary, which increases risk for decreased quality and quantity of life. Development of exercise programs with characteristics that address individual preferences may increase interest in participating and completing exercise programs. We evaluated which exercise intervention characteristics affect exercise program recruitment, adherence, and completion in people with ESKD receiving dialysis. Study Design Scoping review of randomized controlled trials (RCTs) with searching of Medline, Embase, Cochrane, and CINAHL databases through May 12, 2023. Setting & Study Populations Adults with ESKD receiving dialysis. Selection Criteria RCTs with exercise interventions of ≥12 weeks that included more than 10 people with ESKD receiving dialysis in each study arm. Data Extraction One individual extracted data and the second author checked for accuracy. Analytical Approach Data were synthesized qualitatively. Associations between intervention characteristics and recruitment, retention and adherence rates were assessed through one-way analysis of variance tests. Risk of bias was assessed using the Cochrane Risk of Bias 1.0 tool. Results Of 7,396 studies identified, 55 studies with 3,269 trial participants were included. The majority of participants were male (63.2%) and treated with hemodialysis (89.1%). Mean age was 56 ± 11.5 years. Average recruitment, retention and adherence rates were 77.4%, 81.2%, and 76.0%, respectively. Only 27% of studies reported adherence rates. No significant associations were found between intervention characteristics (ie, exercise type, duration, frequency, setting, and supervision) and recruitment, adherence, and retention rates. Limitations Data were limited by small sample size, suboptimal risk of bias, selective recruiting methods, and variability in definitions of adherence rates. Conclusion Average recruitment, retention, and adherence rates in exercise interventions for patients receiving dialysis were high although less than 1 in 4 studies reported adherence rates. These results call for standardized reporting of recruitment, retention, and adherence rates in exercise interventions.
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Affiliation(s)
| | - Jamie Alexiuk
- Faculty of Kinesiology, University of Manitoba, Manitoba, Canada
| | - Clara Bohm
- Section of Nephrology, Department of Internal Medicine, University of Manitoba, Manitoba, Canada
| | - Lindsey Sikora
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Deborah Zimmerman
- Kidney Research Centre, The Ottawa Hospital, Ontario, Canada
- Department of Nephrology, The Ottawa Hospital, Ontario, Canada
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Zhou X, Bai Y, Zhang F, Gu M. Exercise and depression symptoms in chronic kidney disease patients: an updated systematic review and meta-analysis. Ren Fail 2024; 46:2436105. [PMID: 39627168 PMCID: PMC11616742 DOI: 10.1080/0886022x.2024.2436105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Revised: 10/31/2024] [Accepted: 11/25/2024] [Indexed: 12/06/2024] Open
Abstract
OBJECTIVES To investigate whether exercise intervention is associated with reducing depressive symptoms in chronic kidney disease (CKD) patients. METHODS Medline (PubMed), Web of Science, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to February 28, 2024. Randomized controlled trials comparing exercise intervention with usual care or stretching sessions for depression symptoms. Independent data extraction was conducted, and the quality of studies was assessed. A meta-analysis was carried out by using random effects models to calculate standardized mean difference (SMD) with a 95% confidence interval (95% CI) between groups. RESULTS 23 trials with 1561 CKD patients were identified. Exercise interventions are associated with a significant reduction in depression symptoms among CKD patients, with a moderate average SMD of -0.726 (95% CI: -1.056, -0.396; t=-4.57; p < 0.001). Significant heterogeneity was observed (tau2 = 0.408 [95%CI: 0.227, 1.179], I2 = 79.9% [95% CI: 70.5%, 86.3%]). The funnel plot shows potential publication bias. Subgroup analyses showed that the beneficial effects of exercise on depression remained constant across all subgroups. The evidence is deemed as 'very low' certainty. CONCLUSIONS Our systematic review and meta-analysis showed that exercise intervention was associated with significantly alleviating depression symptoms (certainty of evidence: very low). While the very low certainty of the evidence highlights a need for further research. PROSPERO REGISTRATION NUMBER CRD42021248450.
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Affiliation(s)
- Xueyi Zhou
- Department of Nursing, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Bai
- Department of Nephrology A, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fan Zhang
- Department of Nephrology A, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Gu
- Department of Nursing, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Lee CL, Wang PC, Chen YL, Chen ZY, Uen CC, Lai HY, Shiao CC. Comparisons of Intradialytic Exercise Versus Home-Based Exercise in Hemodialysis Patients: A Narrative Review. Biomedicines 2024; 12:2364. [PMID: 39457675 PMCID: PMC11504674 DOI: 10.3390/biomedicines12102364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Revised: 10/14/2024] [Accepted: 10/15/2024] [Indexed: 10/28/2024] Open
Abstract
With the increasing prevalence of end-stage kidney disease, the number of patients requiring hemodialysis (HD) continues to rise. While life-sustaining, HD is often associated with adverse effects such as muscle loss, physical deconditioning, fatigue, and compromised health-related quality of life (HRQoL). Recent research suggests that intradialytic exercise (IDE) and home-based exercise (HBE) may mitigate these adverse effects and improve patient outcomes. However, the existing literature mainly focuses on the outcomes of both exercises, whereas the comparison of types is often omitted. Hence, this review consolidates findings from studies investigating the effectiveness, implementation, safety, feasibility, and adherence of different types of IDE and HBE in HD patients. Overall, the current literature bolsters the significance of IDE and HBE for improving health in HD patients. IDE and HBE enhance physical function, cardiopulmonary capacity, HRQoL, and cognitive well-being. Some research proposed an indirect link between IDE and survival rates. Despite these benefits, challenges remain in implementing these exercise modalities, including patient adherence and the feasibility of routine exercise during HD sessions. Integrating these exercises into routine care allows healthcare providers to enhance outcomes for HD patients. Further research is suggested to optimize exercise protocols and explore long-term effects and cost-effectiveness.
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Affiliation(s)
- Chao-Lin Lee
- Division of Neurology, Department of Internal Medicine, Camillian Saint Mary’s Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong 265, Yilan, Taiwan; (C.-L.L.); (Z.-Y.C.); (C.-C.U.)
| | - Ping-Chen Wang
- Department of Medical Research and Education, Camillian Saint Mary’s Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong 265, Yilan, Taiwan;
| | - Yi-Ling Chen
- Department of Nursing, Camillian Saint Mary’s Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong 265, Yilan, Taiwan;
| | - Zen-Yong Chen
- Division of Neurology, Department of Internal Medicine, Camillian Saint Mary’s Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong 265, Yilan, Taiwan; (C.-L.L.); (Z.-Y.C.); (C.-C.U.)
| | - Ching-Cherng Uen
- Division of Neurology, Department of Internal Medicine, Camillian Saint Mary’s Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong 265, Yilan, Taiwan; (C.-L.L.); (Z.-Y.C.); (C.-C.U.)
| | - Hsien-Yung Lai
- Department of Anesthesiology, Da Chien General Hospital, No. 36 Gongjing Rd., Miaoli 360012, Miaoli, Taiwan
| | - Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary’s Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong 265, Yilan, Taiwan
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Shdaifat EA, Abu-Sneineh FT, Ibrahim AM. Quality of life and psychological distress in end-stage renal disease patients undergoing hemodialysis and transplantation. World J Nephrol 2024; 13:95739. [PMID: 39351185 PMCID: PMC11439089 DOI: 10.5527/wjn.v13.i3.95739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/15/2024] [Accepted: 07/15/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Among diverse profound impacts on patients' quality of life (QoL), end-stage renal disease (ESRD) frequently results in increased levels of depression, anxiety, and stress. Renal replacement therapies such as hemodialysis (HD) and transplantation (TX) are intended to enhance QoL, although their ability to alleviate psychological distress remains uncertain. This research posits the existence of a significant correlation between negative emotional states and QoL among ESRD patients, with varying effects observed in HD and TX patients. AIM To examine the relationship between QoL and negative emotional states (depression, anxiety, and stress) and predicted QoL in various end-stage renal replacement therapy patients with ESRD. METHODS This cross-sectional study included HD or TX patients in the Eastern Region of Saudi Arabia. The 36-item Short Form Survey and Depression Anxiety Stress Scale (DASS) was used for data collection, and correlation and regression analyses were performed. RESULTS The HD and TX transplantation groups showed statistically significant inverse relationships between QoL and DASS scores. HD patients with high anxiety levels and less education scored low on the physical component summary (PCS). In addition, the results of the mental component summary (MCS) were associated with reduced depression. Compared with older transplant patients, TX patients' PCS scores were lower, and depression, stress, and negative working conditions were highly correlated with MCS scores. CONCLUSION The findings of this study revealed notable connections between well-being and mental turmoil experienced by individuals undergoing HD and TX. The PCS of HD patients is affected by heightened levels of anxiety and lower educational attainment, while the MCS of transplant patients is influenced by advancing age and elevated stress levels. These insights will contribute to a more comprehensive understanding of patient support.
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Affiliation(s)
- Emad A Shdaifat
- Community Nursing Department, Imam Abdulrahman Bin Faisal University, Dammam 1982, Saudi Arabia
| | - Firas T Abu-Sneineh
- Department of Fundamental Nursing, Imam Abdulrahman Bin Faisal University, Dammam 1982, Saudi Arabia
| | - Abdallah M Ibrahim
- Department of Fundamental Nursing, Imam Abdulrahman Bin Faisal University, Dammam 1982, Saudi Arabia
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Battaglia Y, Baciga F, Bulighin F, Amicone M, Mosconi G, Storari A, Brugnano R, Pozzato M, Motta D, D'alessandro C, Torino C, Mallamaci F, Cupisti A, Aucella F, Capitanini A. Physical activity and exercise in chronic kidney disease: consensus statements from the Physical Exercise Working Group of the Italian Society of Nephrology. J Nephrol 2024; 37:1735-1765. [PMID: 39269600 PMCID: PMC11519309 DOI: 10.1007/s40620-024-02049-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 07/21/2024] [Indexed: 09/15/2024]
Abstract
The Italian Society of Nephrology has tasked its Working Group on Physical Exercise with developing a consensus statement document on physical activity and exercise in patients with chronic kidney disease (CKD). This paper consists of 16 points that were discussed, and approved using the mini-Delphi method by 15 members of the working group. Each statement is based on a comprehensive review of the literature, clinical experience, and expert opinions. Overall, the statements affirm that regular physical activity and exercise training offer numerous benefits to CKD patients, including improved physical function, enhanced cardiometabolic and neuromuscular function, cognitive benefits, and an overall improvement in quality of life. Furthermore, exercise may provide nephroprotection and reduce mortality. These advantages are observed across all CKD stages, whether on conservative therapy or kidney replacement therapy (hemodialysis or peritoneal dialysis), and in kidney transplant recipients. Moreover, when physical activity and exercise training are implemented with appropriate precautions, they are safe in CKD patients. Gradual physical activity and customized exercise programs should be tailored to the patient's exercise tolerance, potentially enhancing compliance. Clinicians are encouraged to use a series of questionnaires and tests to assess the patient's level of physical activity and performance. However, exercise and physical activity are poorly implemented in clinical practice due to many barriers related to patients and healthcare staff. Overcoming these barriers requires the proactive role of the nephrologists, who should actively incorporate exercise training and promote physical activity within routine care plans. Adopting a multidisciplinary team approach, which includes nephrologists, nurses, exercise professionals, and dietitians, is crucial for providing comprehensive rehabilitation for CKD patients. Integrating new technologies and remote check ups could further enhance the effectiveness of these interventions.
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Affiliation(s)
- Yuri Battaglia
- Department of Medicine, University of Verona, Verona, Italy.
- Nephrology and Dialysis Unit, Pederzoli Hospital, Via Monte Baldo, 24, Peschiera del Garda, 37019, Verona, Italy.
| | - Federica Baciga
- Department of Medicine, University of Verona, Verona, Italy
- Nephrology and Dialysis Unit, Pederzoli Hospital, Via Monte Baldo, 24, Peschiera del Garda, 37019, Verona, Italy
| | | | - Maria Amicone
- Department of Public Health, Chair of Nephrology, University of Naples Federico II, Naples, Italy
| | - Giovanni Mosconi
- Nephrology and Dialysis Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Alda Storari
- Nephrology and Dialysis Unit, University of Ferrara, Ferrara, Italy
| | - Rachele Brugnano
- Nephrology and Dialysis Unit, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Marco Pozzato
- Nephrology and Dialysis Unit, S. Giovanni Bosco Hospital, University of Turin, Turin, Italy
| | - Daria Motta
- Nephrology and Dialysis Unit, Martini Hospital, ASL Città Di Torino, Turin, Italy
| | - Claudia D'alessandro
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudia Torino
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | - Francesca Mallamaci
- Nephrology and Dialysis Unit, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Filippo Aucella
- Nephrology and Dialysis Unit, Casa Solievo Della Sofferenza, San Giovanni Rotondo Foggia, Italy
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Gupta B, Goel R, Goel A, Mittal A. Effect of Physical Activity on Health-Related Quality of Life among Cancer Patients and Survivors: A Systematic Review and Meta-Analysis. Asian Pac J Cancer Prev 2024; 25:2247-2255. [PMID: 39068555 PMCID: PMC11480597 DOI: 10.31557/apjcp.2024.25.7.2247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVES To manage chronic illnesses and enhance health-related quality of life (HRQOL), exercise is essential. This research attempts to determine how different forms of exercise affect cancer patients' and survivors' HRQOL and its physical, mental, emotional and social components separately. METHODOLOGY This study was prepared following PRISMA guidelines for systematic review and meta-analysis. Databases like PubMed, Scopus, Embase, and Google Scholar were searched. Only randomized control trials in the English language were included in the review. The authors obtained the standardized mean difference (SMD) and 95% confidence interval (CI) of the aggregated intervention effect estimate by pooling every study for a random-effects meta-analysis. Risk of Bias was assessed using Cochrane's Risk of Bias tool 2.0 for randomized control trials. Publication bias was expressed using funnel plots. RESULTS AND CONCLUSION The pooled standardized mean difference of physical, mental, emotional and social components of the health-related quality of life index, as determined by the meta-analysis, was 0.61 [0.13;1.09] (p<0.01), 0.27 [-0.17; 0.7] (p<0.01), 0.54 [-0.30;1.38] (p<0.01) and, 0.38 [-0.27; 1.02] (p<0.01) respectively. There was an overall low risk of bias in the included RCTs. The publication bias showed overall symmetry in funnel plots. The review's conclusions show that exercise therapies improve HRQOL significantly overall as well as a few specific HRQOL dimensions, such as social, mental, emotional, and physical functioning. However, not all types of cancers have been included in the study therefore more research can be done for all other cancer types separately.
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Affiliation(s)
- Bhupesh Gupta
- Department of Community Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana (Ambala), Haryana, India.
| | - Ramita Goel
- Department of Psychiatry, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana (Ambala), Haryana, India.
| | - Ashank Goel
- Department of Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana (Ambala), Haryana, India.
| | - Anshu Mittal
- Department of Community Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana (Ambala), Haryana, India.
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Kanbay M, Copur S, Yildiz AB, Tanriover C, Mallamaci F, Zoccali C. Physical exercise in kidney disease: A commonly undervalued treatment modality. Eur J Clin Invest 2024; 54:e14105. [PMID: 37814427 DOI: 10.1111/eci.14105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Physical inactivity has been identified as a risk factor for multiple disorders and a strong association exists between chronic kidney disease (CKD) and a sedentary lifestyle. Even though physical activity is crucial in the development and progression of disease, the general focus of the current medical practice is the pharmacological perspective of diseases with inadequate emphasis on lifestyle intervention. METHODS In this narrative review we explain the pathophysiological mechanisms underlying the beneficial effects of physical exercise on CKD in addition to discussing the clinical studies and trials centred on physical exercise in patients with CKD. RESULTS Physical activity influences several pathophysiological mechanisms including inflammation, oxidative stress, vascular function, immune response and macromolecular metabolism. While exercise can initially induce stress responses like inflammation and oxidative stress, long-term physical activity leads to protective countermeasures and overall improved health. Trials in pre-dialysis CKD patients show that exercise can lead to reductions in body weight, inflammation markers and fasting plasma glucose. Furthermore, it improves patients' functional capacity, cardiorespiratory fitness and quality of life. The effects of exercise on kidney function have been inconsistent in these trials. In haemodialysis, peritoneal dialysis and kidney transplant patients exercise interventions improve cardiorespiratory fitness, walking capacity and quality of life. Combined training shows the best performance to increase peak oxygen uptake in haemodialysis patients. In kidney transplant recipients, exercise improves walking performance, quality of life and potentially arterial stiffness. However, exercise does not affect glucose metabolism, serum cholesterol and inflammation biomarkers. Long-term, adequately powered trials are needed to determine the long-term feasibility, and effects on quality of life and major clinical outcomes, including mortality and cardiovascular risk, in all CKD stages and particularly in kidney transplant patients, a scarcely investigated population. CONCLUSION Physical exercise plays a crucial role in ameliorating inflammation, oxidative stress, vascular function, immune response and macromolecular metabolism, and contributes significantly to the quality of life for patients with CKD, irrespective of the treatment and stage. Its direct impact on kidney function remains uncertain. Further extensive, long-term trials to conclusively determine the effect of exercise on major clinical outcomes such as mortality and cardiovascular risk remain a research priority.
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Affiliation(s)
- Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Abdullah B Yildiz
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Cem Tanriover
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Francesca Mallamaci
- Nephrology, Dialysis and Transplantation Unit Azienda Ospedaliera "Bianchi-Melacrino-Morelli" & CNR-IFC, Institute of Clinical Physiology, Research Unit of Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, Reggio Calabria, Italy
| | - Carmine Zoccali
- Renal Research Institute, New York, New York, USA
- Institute of Molecular Biology and Genetics (Biogem), Ariano Irpino, Italy
- Associazione Ipertensione Nefrologia Trapianto Renal (IPNET), c/o Nefrologia, Grande Ospedale Metropolitano, Reggio Calabria, Italy
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Yu H, Huang M, Tao Y, Li S, Wang J, Li P, Lv H, Ni C. The effects of exercise training interventions on depression in hemodialysis patients. Front Psychiatry 2024; 14:1321413. [PMID: 38260806 PMCID: PMC10800967 DOI: 10.3389/fpsyt.2023.1321413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose Depression considerably influences the clinical outcomes, treatment compliance, quality of life, and mortality of hemodialysis patients. Exercise plays a beneficial role in depressive patients, but its quantitative effects remain elusive. This study aimed to summarize the effects of exercise training on depression in patients with end-stage renal disease undergoing hemodialysis. Methods The PUBMED, EMBASE, and Cochrane Library databases were systematically searched from inception to April 2023 to identify published articles reporting the effect of exercise training on the depression level of patients with End-Stage Renal Disease undergoing hemodialysis. Data were extracted from the included studies using predefined data fields by two independent researchers. The Cochrane Handbook for Systematic Reviews of Interventions and Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies were employed for quality evaluation. Results A total of 22 studies enrolling 1,059 patients who participated in exercise interventions were included. Hemodialysis patients exhibited superior outcomes with intradialytic exercise (SMD = -0.80, 95% CI: -1.10 to -0.49) and lower levels of depression following aerobic exercise (SMD = -0.93, 95%CI: -1.32 to -0.55) compared to combined exercise (c - 0.85, 95% CI: -1.29 to -0.41) and resistance exercise (SMD = -0.40, 95%CI: -0.96 to 0.17). Regarding exercise duration, patients manifested lower depression levels when engaging in exercise activities for a duration exceeding 6 months (SMD = -0.92, 95% CI: -1.67 to -0.17). Concerning the duration of a single exercise session, the most significant improvement was noted when the exercise duration exceeded 60 min (SMD = -1.47, 95% CI: -1.87 to -1.06). Conclusion Our study determined that exercise can alleviate depression symptoms in hemodialysis patients. This study established the varying impacts of different exercise parameters on the reduction of depression levels in hemodialysis patients and is anticipated to lay a theoretical reference for clinicians and nurses to devise tailored exercise strategies for interventions in patients with depression. Systematic review registration https://www.crd.york.ac.uk/prospero/, This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database, with registration number CRD42023434181.
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Affiliation(s)
- Huihui Yu
- School of Nursing, Air Force Medical University, Xi’an, China
- The 1th Department of Gerontology, the 960th Hospital of PLA Joint Logistics Support Force, Jinan, China
| | - Mei Huang
- School of Nursing, Air Force Medical University, Xi’an, China
| | - Yuxiu Tao
- School of Nursing, Air Force Medical University, Xi’an, China
| | - Shanshan Li
- School of Nursing, Air Force Medical University, Xi’an, China
| | - Jing Wang
- School of Nursing, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Ping Li
- School of Nursing, Air Force Medical University, Xi’an, China
| | - Honghong Lv
- Blood Purification Center, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Chunping Ni
- School of Nursing, Air Force Medical University, Xi’an, China
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12
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Battaglia Y, Amicone M, Mantovani A, Combe C, Mitra S, Basile C. Home-based exercise in patients on maintenance dialysis: a systematic review and meta-analysis of randomized clinical trials. Nephrol Dial Transplant 2023; 38:2550-2561. [PMID: 37202219 DOI: 10.1093/ndt/gfad102] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The impact of home-based exercise on physical performance and quality of life (QoL) in patients on maintenance dialysis has not yet been fully established. METHODS We searched four large electronic databases to identify randomized controlled trials (RCTs) reporting the impact of home-based exercise interventions vs. usual care or intradialytic exercise interventions, on physical performance and QoL in patients on dialysis. The meta-analysis was performed using fixed effects modeling. RESULTS We included 12 unique RCTs involving 791 patients of various ages on maintenance dialysis. Home-based exercise interventions were associated with an improvement of walking speed at the 6 Minutes Walking Test [6MWT; nine RCTs; pooled weighted mean differences (WMD): 33.7 m, 95% confidence interval (CI) 22.8-44.5; P < 0.001; I2 = 0%) and in aerobic capacity as assessed by the peak oxygen consumption (VO2 peak; 3 RCTs; pooled WMD: 2.04 ml/kg/min, 95% CI 0.25-3.83; P = 0.03; I2 = 0%). They were also associated with improved QoL, as assessed by the Short Form (36) Health (SF-36) score. Stratifying the RCTs by control groups, no significant difference was found between home-based exercise and intradialytic exercise interventions. Funnel plots did not reveal any significant publication bias. CONCLUSIONS Our systematic review and meta-analysis showed that home-based exercise interventions for 3-6 months were associated with significant improvements in physical performance in patients on maintenance dialysis. However, further RCTs with a longer follow-up should be conducted to assess the safety, adherence, feasibility, and effects on QoL of home-based exercise programs in dialysis patients.
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Affiliation(s)
- Yuri Battaglia
- University of Verona, Department of Medicine, Verona, Italy
- Pederzoli Hospital, Nephrology and Dialysis Unit, Peschiera del Garda, Italy
| | - Maria Amicone
- Department of Public Health, Chair of Nephrology, University of Naples Federico II, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Christian Combe
- Department of Nephrology, CHU de Bordeaux and INSERM U1026, University of Bordeaux, Bordeaux, France
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre (MAHSC), University Hospitals, Oxford Road, Manchester, UK
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
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13
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Ferrari F, Andrade FP, Teixeira MS, Ziegelmann PK, Carvalho G, Bittencourt ESS, Barcellos FC, Stein R. Efficacy of six exercise-based interventions for individuals undergoing hemodialysis: a network meta-analysis of randomized clinical trials. Nephrol Dial Transplant 2023; 38:2389-2406. [PMID: 37118876 DOI: 10.1093/ndt/gfad083] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Evidence comparing different exercise modalities in individuals undergoing hemodialysis remains incipient. Our aim was to conduct a systematic review and network meta-analysis of randomized clinical trials to compare and synthesize the efficacy of five different intradialytic exercise modalities and home-based training in this population. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Studies were searched in PubMed/MEDLINE, Cochrane Library, Embase, Cinahl, and Scopus from their inception to 19 September 2022. We used traditional random-effects models and Bayesian network meta-analysis models. The risk of bias was assessed using the RoB v.2.0 tool, and the assessment of confidence in the results through the Confidence in Network Meta-Analysis (CINeMA) tool. RESULTS Seventy-eight studies involving 3326 participants were included. Our network meta-analysis showed that combined training was the intervention with the best performance to increase VO2 peak [mean difference (MD) = 3.94 ml/kg/min; 95% credible interval (CrI), 2.38 to 5.76] and to reduce diastolic blood pressure (MD = -5.19 mmHg; 95%CrI, -9.35 to -0.96) compared to the usual care group. Inspiratory muscle training was the intervention that most improved the 6-minute walk test distance (MD = 70.97 m; 95%CrI, 18.09 to 129.87). C-reactive protein decreased in resistance training (MD = -2.6 mg/l; 95%CrI, -4.97 to -0.33) and aerobic training (MD = -1.4 mg/l; 95%CrI, -3.15 to -0.06). Kt/V improved in aerobic training (MD = 0.11; 95%CrI, 0.02 to 0.18), and SF-36 physical functioning outcomes improved in resistance training (MD = 10.66 points; 95%Crl, 1.91 to 20.22). No intradialytic exercise modality was superior to others or comparable with home-based training in improving the evaluated outcomes. Subgroup analysis revealed that exercise interventions >12 weeks improved functional capacity more than interventions ≤12 weeks, and that combined training reduces diastolic blood pressure only after 12 weeks of follow-up. Furthermore, our results suggest that moderate or moderate-to-vigorous intensity training leads to more pronounced improvements in functional capacity, whereas mild or mild-to-moderate intensity training does not have the same effect. In this review, most of the included studies were assessed as having some concern, which resulted in a low to very low level of confidence in the overall findings. CONCLUSIONS Both intradialytic training and home-based training can promote benefits for individuals undergoing hemodialysis, with no evidence of the superiority of either training modality over the other.
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Affiliation(s)
- Filipe Ferrari
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Exercise Cardiology Research Group (CardioEx), Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Francini P Andrade
- Graduate Program in Pneumological Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, Maia, Portugal
| | - Marcelo S Teixeira
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Exercise Cardiology Research Group (CardioEx), Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Patrícia K Ziegelmann
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Gabriel Carvalho
- Exercise Cardiology Research Group (CardioEx), Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Eduarda S S Bittencourt
- Exercise Cardiology Research Group (CardioEx), Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Ricardo Stein
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Exercise Cardiology Research Group (CardioEx), Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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14
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Li Y, Zhu B, Shen J, Miao L. Depression in maintenance hemodialysis patients: What do we need to know? Heliyon 2023; 9:e19383. [PMID: 37662812 PMCID: PMC10472011 DOI: 10.1016/j.heliyon.2023.e19383] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
Chronic kidney disease (CKD) is now recognized as a major public health problem in the world. The global prevalence of CKD is estimated at 13.4% (11.7-15.1%), with an estimated 490.2 to 7.083 million patients with End stage renal disease requiring renal replacement therapy. Hemodialysis is the main treatment for End stage renal disease patients because of its high safety and efficiency. The survival time of these patients was significantly prolonged, but many psychological problems followed. Depression is a type of mood disorder caused by a variety of causes, often manifested as disproportionate depression and loss of interest, sometimes accompanied by anxiety, agitation, even hallucinations, delusions and other psychotic symptoms. Depression has become the most common mental disorder in maintenance hemodialysis (MHD) patients according to the meta-analysis. In recent years, depression has seriously affected the quality of life and prognosis of MHD patients from dietary, sleep, treatment adherence, energy and other dimensions. This article reviews the epidemiology, etiology, diagnosis and treatment of depression in MHD patients.
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Affiliation(s)
- Yulu Li
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Bin Zhu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jianqin Shen
- Blood Purification Centre, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Liying Miao
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
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15
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Song Y, Chen L, Wang M, He Q, Xue J, Jiang H. The optimal exercise modality and intensity for hemodialysis patients incorporating Bayesian network meta-analysis and systematic review. Front Physiol 2022; 13:945465. [PMID: 36200055 PMCID: PMC9527310 DOI: 10.3389/fphys.2022.945465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Physical inactivity is highly prevalent in patients with hemodialysis, and a large body of evidence reported the positive effect of different exercise modalities on their health outcomes. However, the effective dosage of exercise for hemodialysis patients still requires verification. Objective: We aimed to determine the most effective exercise intensity and modality for improvements in physical function, blood pressure control, dialysis adequacy, and health-related quality of life for hemodialysis patients. Design: Systematic review with network meta-analysis of randomized trials. Data sources: Five electronic databases (PubMed, EMBASE, Web of Science, Cochrane CENTRAL, and Scopus) were searched for randomized controlled trials. Data extraction and quality appraisal were conducted by two authors independently. Data were analyzed by the R (version.3.6.2) and the Stata (version.15.0). Result: We included 1893 patients involving four exercise modalities and six exercise intensities. Combined training (aerobic exercise plus resistance exercise) has been the top-ranking exercise modality for improving the 6-min walk test (6MWT) (surface under the cumulative ranking curve analysis (SUCRA) score, 90.63), systolic blood pressure control (SUCRA score, 77.35), and diastolic pressure control (SUCRA score, 90.56). Moreover, the top-ranking exercise intensity was moderate–vigorous for 6MWT (SUCRA score, 82.36), systolic blood pressure (SUCRA score, 77.43), and diastolic blood pressure (SUCRA score, 83.75). Regarding dialysis adequacy and health-related quality of life, we found no exercise modality or intensity superior to the placebo. Conclusion: This network meta-analysis indicated that combined training and moderate–vigorous intensity might be the most effective interventions to improve 6MWT and blood pressure control. This finding helps further guide clinical exercise prescriptions for hemodialysis patients. Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021268535].
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16
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Chang HC, Chen CH, Cheng YY. Therapeutic Effects of Intradialytic Exercise on Life Quality of Patients with End-Stage Renal Disease: Study Protocol for a Randomized Control Trial. Healthcare (Basel) 2022; 10:healthcare10061103. [PMID: 35742154 PMCID: PMC9222984 DOI: 10.3390/healthcare10061103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/05/2022] [Accepted: 06/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Exercise training has positive effects on physical functions and could reduce a sedentary lifestyle for hemodialysis (HD) patients. Given that low-level physical activity increases morbidity and mortality, here, we aimed to determine the effects of an intradialytic exercise program delivered at different frequencies on HD patients in Taiwan. Methods: This study is a prospective, randomized control trial. An intradialytic exercise program will be arranged for patients after receiving their informed consent. Patients will be segregated at random into three groups as follows: (a) three times/week of intradialytic exercise training plus standard care maintenance of HD, (b) two times/week of intradialytic exercise training plus standard care maintenance of HD, or (c) standard care maintenance of HD. Subjects will be followed for 24 weeks. At three time points, 0, 12, and 24 weeks, the primary outcome, the Short-Form 36 score, will be measured. Additional secondary outcomes to be measured are the Beck depression inventory, 6 min walking test, sit-to-stand test, and anthropometric measures such as the body mass index, thigh circumference, and the proportion of fat in the body composition. Conclusions: There is emerging evidence in support of intradialytic exercise improving health-related quality of life for patients on HD. However, the difference in the therapeutic effects between three times per week and twice per week has never been determined. With this study, we anticipate to fill the knowledge gap in the exercise prescription among HD patients.
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Affiliation(s)
- Hsiang-Chi Chang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
| | - Cheng-Hsu Chen
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402010, Taiwan;
- Department of Nephrology, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Department of Life Science, Tunghai University, Taichung 407224, Taiwan
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402010, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Correspondence: ; Tel.: +886-4-23592525 (ext. 3500)
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17
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Wu YH, Hsu YJ, Tzeng WC. Correlation between Physical Activity and Psychological Distress in Patients Receiving Hemodialysis with Comorbidities: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073972. [PMID: 35409654 PMCID: PMC8997862 DOI: 10.3390/ijerph19073972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 11/16/2022]
Abstract
Comorbidities cause psychological distress to patients on hemodialysis and cause their physical function to deteriorate. This study aims to examine whether physical patterns are associated with anxiety, depression and fatigue among patients with and without comorbidities who are on hemodialysis. To this end, a cross-sectional survey was administered to 120 patients on hemodialysis. Data were collected using the International Physical Activity Questionnaire—Short Form, Beck Depression Inventory—Second Edition, Beck Anxiety Inventory, and Brief Fatigue Inventory—Taiwan Version. An independent sample t test and generalized linear model analyses were conducted. The results revealed that patients with comorbidities exhibited more severe levels of depression (p < 0.001), anxiety (p < 0.001), and fatigue (p = 0.010) than patients without comorbidities. Additionally, patients on hemodialysis with a high physical activity level (≥600 metabolic equivalent of task per min/week) exhibited less depression (B = −4.03; p < 0.001; 95% confidence interval [CI] = −6.04, −2.03) and anxiety (B = −2.64; p = 0.002; 95% CI = −4.27, −1.00) severity than those with a low physical activity level; those who engaged in weekly physical activities exhibited less fatigue severity (B = −1.17; p = 0.001; 95% CI = −1.84, −0.49) and fatigue interference (B = −0.61; p = 0.015; 95% CI = −1.10, −0.12). For patients on hemodialysis, having comorbidities was correlated with more severe levels of depression, anxiety, and fatigue. Weekly moderate-intensity physical activities were revealed to be correlated with less severity levels of depression, anxiety, and fatigue. The study findings aid the development of interventions for promoting physical activity among patients on hemodialysis to prevent the exacerbation of complications caused by comorbidities and psychological distress.
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Affiliation(s)
- Yu-Hui Wu
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan;
- Nursing Department, Tri-Service General Hospital, Taipei 11490, Taiwan
| | - Yu-Juei Hsu
- Nephrology Division, Tri-Service General Hospital, Taipei 11490, Taiwan;
- School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Wen-Chii Tzeng
- School of Nursing, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence:
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Wu YH, Hsu YJ, Tzeng WC. Physical Activity and Health-Related Quality of Life of Patients on Hemodialysis with Comorbidities: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020811. [PMID: 35055633 PMCID: PMC8775483 DOI: 10.3390/ijerph19020811] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/08/2022] [Accepted: 01/09/2022] [Indexed: 01/27/2023]
Abstract
Patients on hemodialysis with multiple comorbidities have limited physical activity, resulting in poor health, low activity participation, and low quality of life. Accordingly, the nursing care provided to such patients should include regular physical activity training programs. Therefore, this cross-sectional descriptive study investigated whether patients on hemodialysis with and without comorbidities have different levels of physical activity and health-related quality of life (HRQoL); the correlations among the comorbidities, physical activity, and HRQoL of the two cohorts were also assessed. The 36-Item Short-Form Health Survey version 2 and International Physical Activity Questionnaire were employed to collect data from 120 patients on hemodialysis. An independent samples t-test and univariate and multivariate linear regression analyses were conducted. The overall HRQoL of patients with comorbidities was lower than that of patients without comorbidities (p = 0.008). Compared with patients who participated in low-intensity physical activity, the overall HRQoL of patients who participated in moderate-intensity physical activity was higher (p < 0.001). The overall HRQoL of patients with comorbidities who participated in low-intensity physical activity was lower than that of those who participated in moderate-intensity physical activity (p < 0.001). Moderate-intensity physical activity was correlated with higher HRQoL for patients with comorbidities. This finding supports the implementation of effective physical activity intervention measures. Furthermore, it supports the promotion of patient self-management and the implementation of regular exercise programs and lifestyle changes, and patients on hemodialysis can benefit from the future management of physical activities.
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Affiliation(s)
- Yu-Hui Wu
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan;
- Nursing Department, Tri-Service General Hospital, Taipei 11490, Taiwan
| | - Yu-Juei Hsu
- Nephrology Division, Tri-Service General Hospital, Taipei 11490, Taiwan;
- School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Wen-Chii Tzeng
- School of Nursing, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence:
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