Kronik Böbrek Yetmezliği Olan Hemodiyaliz Hastalarında İntradiyalitik Kombine Egzersiz Programının Fonksiyonel Kapasite ve Fiziksel Fonksiyon Üzerine Etkisi

Abstract

The aim of our study was to determine the efficacy of an intradialytic combined exercise program applied individually by a physiotherapist in patients receiving hemodialysis (HD) treatment. Our study included 26 individuals who were randomized stratified by age and gender and divided into two groups: Intervention group (IG=13, 51.5 ± 12.2 years) and control group (CG=13, 52.75 ± 12.59 years). Individuals in the IG were given aerobic exercise training with a bed bike placed at the end of the bed for 12 weeks and strengthening training for the fistula-free side shoulder flexors, elbow flexors, hip flexors of both lower extremities, and knee extensors.The exercise program was made and progressed according to the clinical status of the individuals on that day. Individuals in the CG were encouraged to continue their routine activities and were asked to walk for at least 20 minutes three times a week. The exercise intensity of the two groups was applied between 4 and 6 points according to the Modified Borg Scale. All participants were evaluated twice before and after the intradialytic combined exercise program. Functional capacity was assessed with the 6-minute walk test, physical activity levels with the International Physical Activity Short Form, upper extremity functional levels with the Shoulder-Arm and Hand Problems Questionnaire (DASH), fatigue levels with the Fatigue Impact Scale, and quality of life with the Kidney Disease Quality of Life Scale, functional mobility and balance were evaluated with a timed up go test, lower extremity strength and endurance with a 30 second sit to stand test, peripheral muscle strength with a digital hand dynamometer, grip strength with a Jamar hand dynamometer and laboratory parameters were recorded from the patient file. After 12 weeks of combined intradialytic aerobic and resistance exercise, physical activity level, quality of life, functional capacity, physical function, peripheral muscle strength and grip strength were higher in the IG compared to the CG, while DASH symptom score and all fatigue subscale values were lower (p<0.05). Laboratory tests such as CRP, total cholesterol, LDL and HDL showed a positive improvement in the IG (p<0.05). In addition, the rate of participation in the treatment was quite high (96.75%) in the intervention group. In conclusion, intradialytic combined exercise program applied to HD patients individually and under the supervision of a physiotherapist was found to be effective and safe in improving functional capacity and physical function. Physiotherapists should act as a member of the multidisciplinary team in the management of HD patients and should create exercise training programs specific to the individual, considering the clinical findings specific to the disease and the complications that may arise during dialysis.