Effectiveness of intradialytic exercise on dynamic balance performance and lower limb muscle strength in end-stage renal disease patients undergoing regular hemodialysis, Chumpuang Hospital
Article Sidebar
Main Article Content
Abstract
Background: Currently, the number of end-stage chronic kidney disease patients undergoing renal replacement therapy with hemodialysis has been increasing. This condition is commonly associated with fatigue and decreased physical performance.
Objective: To study the effect of intradialytic exercise on dynamic balance performance and lower limb muscle strength of end-stage renal disease patients undergoing hemodialysis.
Methods: The sample consisted of 22 patients with end-stage chronic renal disease undergoing hemodialysis at Chumphuang Hospital. They were divided into a control group of 11 patients who did not receive the intradialytic exercise program and an experimental group of 11 patients who received the intradialytic exercise program. The intervention involved resistance knee exercises using sandbags during the first two hours of hemodialysis, performed three times per week for four consecutive weeks. Dynamic balance performance while walking was evaluated using the Timed Up and Go Test (TUG), and lower limb muscle strength was assessed using the Five Times Sit to Stand Test (FTSTS). Data were analyzed using the independent t-test and Paired t-test.
Results: The experimental group who received the exercise program during dialysis had significantly greater reductions in TUG and FTSTS times than the control group (p=0.001).
Conclusion: Intradialytic exercise can improve dynamic balance performance and lower limb muscle strength in patients with end-stage chronic kidney disease.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Jacob S, Raveendran R, Kannan S. Causes, comorbidities and current status of chronic kidney disease: a community perspective from North Kerala. J Fam Med Prim Care, 2019; 8(9): 2859-63.
Luyckx VA, Tonelli M, Stanifer JW. The global burden of kidney disease and the sustainable development goals. Bull World Health Organ. 2018; 96(6): 414-22.
The Nephrology Society of Thailand. Thailand renal replacement therapy registry report 2020 [Internet]. Bangkok: The Nephrology Society of Thailand; 2020 [cited 2024 Feb 21]. Available from: https://www.nephrothai.org/wp-content/ uploads/2022/06/Final-TRT-report-2020.pdf
Flythe JE, Hilliard T, Castillo G, Ikeler K, Orazi J, Abdel-Rahman E, et al. Symptom prioritization among adults receiving in-center hemodialysis: a mixed methods study. Clin J Am Soc Nephrol. 2018; 13(5): 735-45.
Bikbov B, Purcell CA, Levey AS, Smith M, Abdoli A, Abebe M, et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020; 395(10225): 709-33.
Katayıfçı N, Hüzmeli İ, İriş D. Impairments of functional exercise capacity, muscle strength, balance and kinesiophobia in patients with chronic kidney disease: a cross-sectional study. BMC Nephrol. 2024; 25(1): 1-10.
Bennett PN, Fraser S, Barnard R, Haines T, Ockerby C, Street M, et al. Effects of an intradialytic resistance training program on physical function: a prospective stepped-wedge randomized controlled trial. Nephrol Dial Transplant. 2016; 31(8): 1302-9.
Kim J, Shapiro B, Zhang M, Li Y, Porszasz J, Bross R. Daily physical activity and physical function in adult maintenance hemodialysis patients. J Cachexia Sarcopenia Muscle. 2014; 5(3): 209-20.
Bossola M, Sanguinetti E, Antonelli M. Functional impairment is associated with an increased risk of mortality in patients on chronic hemodialysis. BMC Nephrol. 2016; 17(1): 72.
Parker K. Intradialytic exercise is medicine for hemodialysis patients. Curr Sports Med Rep. 2016; 15(4): 269-75.
American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 11th ed. Philadelphia: Wolters Kluwer; 2022.
National Kidney Foundation. Staying fit with kidney disease [Internet]. New York: National Kidney Foundation; 2025 [cited 2025 Jan]. Available from: https://www. Kidney.org/sites/default/files/staying_fit_
wih_kidney_disease_1.pdf
Aucella F, Battaglia Y, Bellizzi V, Bolignano D, Capitanini A, Cupisti A. Physical exercise programs in CKD: lights, shades and perspectives. J Nephrol. 2015; 28(2): 143-50.
Borm GF, Fransen J, Lemmens WA. A simple sample size formula for analysis of covariance in randomized clinical trials. J Clin Epidemiol. 2007; 60(12): 1234-8.
Chen SM, Shen FC, Chen JF, Chang WD, Chang NJ. Effects of resistance exercise on glycated hemoglobin and functional performance in older patients with comorbid diabetes mellitus and knee osteoarthritis: a randomized trial. Int J Environ Res Public Health. 2019; 17(1): 224-36.
Podsiadlo D, Richardson S. The timed “Up and Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991; 39(1): 142-8.
Whitney SL, Wrisley DM, Marchetti GF, Gee MA, Redfern MS, Furman JM. Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the Five-Times-Sit-to-Stand Test. Phys Ther.2005; 85 (10):1034-45.
Wilkinson TJ, Watson EL, Xenophontos S, Gould DW, Smith AC. The minimum clinically important difference in frequently reported objective physical function tests after a 12-week renal rehabilitation exercise intervention in non-dialysis chronic kidney disease. Am J Phys Med Rehabil. 2019; 98(6): 431-7.
Anding-Rost K, Von Gersdorff G, Von Korn P, Ihorst G, Josef A, Kaufmann M, et al. Exercise during hemodialysis in patients with chronic kidney failure. NEJM Evid. 2023; 2(9): 1-11.
Suza DE, Hijriana I, Ariani Y, Hariati H. Effects of lower extremity exercises on ankle-brachial index values among type 2 diabetes mellitus patients. J Med Sci. 2020; 5(8): 1-6.
Saleefeen H, Wongkiratimethawi T, Tiwawatpakorn J, Sukubol S, Areeudomwong P. Effectiveness of alphabets foot exercise program and general foot exercise in type 2 diabetes mellitus. Mahidol R2R e-Journal. 2021; 8(2): 76-89. (In Thai)
Misra A, Alappan NK, Vikram NK, Goel K, Gupta N, Mittal K, et al. Effect of supervised progressive resistance-exercise training protocol on insulin sensitivity, glycemia, lipids, and body composition in Asian Indians with type 2 diabetes. Diabetes Care. 2008; 31(7): 1282-7.
Toda N, Imamura T, Okamura T. Alteration of nitric oxide-mediated blood flow regulation in diabetes mellitus. Pharmacol Ther. 2010; 127 (3): 189-209.
Wang SY, Zang XY, Fu SH, Bai JB, Liu JD, Tian L, et al. Factors related to fatigue in Chinese patients with end-stage renal disease receiving maintenance hemodialysis: a multicenter cross-sectional study. Ren Fail. 2016; 38(3): 442-50.
