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S. Colak1, G. Yurteri2, Z.C. Algun3
1Bandırma Onyedi Eylül University, Vocational School of Health Services, Department of Therapy and Rehabilitation, Balıkesir, Turkey, 2Rentek Dialysis Center, Internal Medicine, Istanbul, Turkey, 3Institute of Health Sciences / Istanbul Medipol University, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
Background: It is known that muscle strength and biochemistry change in patients with end-stage renal disease. Respiratory mechanics include the activation of the primary respiratory muscles as well as the activity of the paravertebral, abdominal and pelvic floor muscles. These muscles are effective in respiratory mechanics and in maintaining intra-abdominal pressure balance. In the literature, the effects of respiratory muscle training and trunk stabilization exercises applied in dialysis patients on pulmonary function tests, muscle strength and dialysis adequacy are still the subject of research.
Purpose: The aim of this study was to investigate the effect of core exercises (CORE) and inspiratory muscle training (IMT) on respiratory function and muscle strength. The secondary aim is to investigate the effect on dialysis adequacy.
Methods: Fifty six patients aged 25-45 years old who underwent hemodialysis treatment for 4 hours a day for at least 6 months were divided randomly into 3 groups. CORE group (n=17) and IMT group (n=19) participated in the intradialytic exercise program under physiotherapist supervision for 3 days a week for 10 weeks. IMT protocol was applied with load set to 40% of PImax. The CORE group exercises were composed of three progressive phases. The usual nephrological therapy was continued in the control group (n=20). The measurements were done before the start of the exercise program and at the end of the 10th week. Participants' Functionality and Physical Activity level was obtained by Six Minute Walking, Timed Up and Go, and Five Times Sit-to-Stand test, International Physical Activity Questionnaire. Pulmonary function was assessed by use of spirometry. Kt/V and urea Reduction Rate (URR), which are indicators of dialysis adequacy, were calculated by using level of blood urea nitrogen (BUN) values before and after dialysis.
Results: In both exercise groups, significant gains were obtained in terms of pulmonary function test, MIP, MEP and physical activity level when compared with the control group (p˂0.05). There was a statistically significant decrease (p˂ 0.05) in only 6MWT in the control group, but no significant difference was found in other parameters. The positive gains in the intervention groups were not superior to each other. At the end of the treatment, there was no significant difference (p>0.05) in dialysis adequacy of the groups and acute complications of hemodialysis.
Conclusions: In future works, maximum gains can be obtained with different intensity exercise programs.
In this study, with the physiotherapy applications carried out 3 days a week under the supervision of a physiotherapist, both provided ensured the compliance of the participants and positive gains were obtained in the cases.
Although positive results haven’t been obtained in dialysis adequacy, we recommend that it be investigated in patients with stage 4 and 3 chronic renal failure.
In this study, with the physiotherapy applications carried out 3 days a week under the supervision of a physiotherapist, both provided ensured the compliance of the participants and positive gains were obtained in the cases.
Although positive results haven’t been obtained in dialysis adequacy, we recommend that it be investigated in patients with stage 4 and 3 chronic renal failure.
Implications: Not only peripheral muscle training, but also core exercise and inspiratory muscle training can provide physical and functional gains in dialysis cases.
Having a physiotherapist in a multidisciplinary team will provide significant gains.
Having a physiotherapist in a multidisciplinary team will provide significant gains.
Funding acknowledgements: This research was supported by Istanbul Medipol University Scientific Research Projects Unit with project number 2016/20.
Keywords:
Chronic kidney disease
Respiratory muscle
Stabilization exercise
Chronic kidney disease
Respiratory muscle
Stabilization exercise
Topics:
Non-communicable diseases (NCDs) & risk factors
Cardiorespiratory
Musculoskeletal
Non-communicable diseases (NCDs) & risk factors
Cardiorespiratory
Musculoskeletal
Did this work require ethics approval? Yes
Institution: Istanbul Medipol University Institute of Health Sciences
Committee: Non-Interventional Clinical Studies Ethics Committee
Ethics number: 10840098-604.01.01-E.6533 dated 16.05.2016.
All authors, affiliations and abstracts have been published as submitted.
