IMPACT OF 12-MONTHS INTRADIALYSIS VIRTUAL REALITY EXERCISE ON LOWER LIMB MUSCLE STRENGTH: RANDOMIZED CONTROLLED TRIAL

E. Segura-Ortí¹, A. Garcia-Testal², J.A. Gil-Gómez³, N. Valtuena-Gimeno¹, M. Torquero-Correa¹, V.G. Monnier¹, F.J. Martínez-Olmos¹, V. Benavent-Caballer¹, V. Vercher-Narbona², R. García-Maset²

¹Universidad Cardenal Herrera-CEU, CEU Universities, Physiotherapy, Moncada-Valencia, Spain, ²Hospital de Manises, Nephrology, Manises-Valencia, Spain, ³Univesitat Politècnica de Valencia, Instituto Universitario de Automatica e Informatica Industrial, Valencia, Spain

Background: Patients with chronic kidney disease (CKD) stage 5 in hemodialysis (HD) have lower cross-sectional muscle area than their healthy counterparts. Improving muscle strength of lower limbs is very important to improve functional capacity and to decrease independent daily activities. Previous studies have shown that 3-months of non-immersive virtual reality (VR) intradialysis exercise improves muscle strength. But little is known about the long-term effects of this type of exercise program.

Purpose: The aim of this study is to test the impact of a long-term non-immersive VR intradialysis exercise program (12 monhts) on the strength of the lower limbs muscles. The secondary aim was to assess the impact of the timing of the exercise program (early vs. late timing).

Methods: Patients from a HD unit that were under treatment for at least 3 months were selected. A VR exercise program was implemented in two randomized groups, one group exercised during the first two hours of the HD session (Group A) and the other group during the last two hours of the HD session (Group B). The program consisted of a non-immersive VR program with the game 'Treasure Hunting'. Lower limb muscle stregth of hip flexors, hip abductors and ankle plantiflexors was measured every 3 months with a handheld dynamometer during the HD session. Data were analysed with a Mixed Model ANOVA.

Results: 36 participants (N=20 Group A, N=16 Group B) were included. The median age was 77 (minimum 44, maximum 89) years, including 15 women and 21 men. The median HD vintage was 29 (minimum 4, maximum 261) months. We found a significant positive effect over time on all measures of strength, without differences between groups (18 patients 12 months, 26 patients 9 months , 28 patients 6 months y 36 patients 3 months) for hip muscles but not for ankle muscles. For right hip flexors, after 3 months the improvement was around 8 Newtons, after 6 months 12 Newtons, after 9 months 23 Newtons and after 12 months 31 Newtons. For the right hip abductors, after 3 months the improvement was around 12 Newtons, after 6 months 10 Newtons, after 9 months 17 Newtons and after 12 months 26 Newtons. For left hip flexors, after 3 months the improvement was around 6 Newtons, after 6 months 13 Newtons, after 9 months 23 Newtons and after 12 months 34 Newtons. For the left hip abductors, after 3 months the improvement was around 7 Newtons, after 6 months 15 Newtons, after 9 months 21 Newtons and after 12 months 31 Newtons.

Conclusions: Non-immersive VR exercise intradyalisis has a positive impact on the strenght of hip flexors and abductors, with no difference regarding the moment when exercise is performed.

Implications: Non-immersive intradialysis exercise is safe and results in increased hip flexors and abductors strength. Ankle plantiflexors need other types of exercise, probably out of the HD session, to increase strenght. Physiotherapy interventions during hemodialysis have a positive impact on subjects undertaking HD treatment.

Funding acknowledgements: This research is funded by Ministerio de Ciencia e Innovación y Universidades and by the European Union, Erasmus + program.

Keywords:
Chronic Kidney Disease
Hemodialysis
Physical Activity

Topics:
Health promotion & wellbeing/healthy ageing/physical activity
Non-communicable diseases (NCDs) & risk factors
Older people

Did this work require ethics approval? Yes

Institution: Hospital Universitario y Politécnico La Fe

Committee: Comité de Ética de la Investigación con Medicamentos

Ethics number: 2018/0633