Learning Objective #1: Realize the effects of forearm isometric exercise on veins

Learning Objective #2: Understand the influences of forearm isometric exercise on native arteriovenous fistulas

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Background: Native arteriovenous fistulas (AVF) are the first choice when creating vascular access among hemodialysis patients. Also, it has been claimed that an important variable in the success rate of native fistulas is to increase the size and capacitance of native veins before the formation of the vascular access. Therefore, an active strategy to support this aspect is necessary. Objectives: The purpose of this quasi-experimental study is to test the effects of forearm isometric exercise designed to affect the size and capacitance of native veins before AVF operations and to influence AVF maturation after the operations. Method: A standard intervention of forearm isometric exercise proposed by Leaf, Macrae, Grant, and Kraut (2003) will be applied in this study. A purposive sampling of patients who are diagnosed of chronic kidney disease in stage four and five will be recruited. Participants are going to be randomly assigned to the experimental and control group. With regard to outcome measurement, the investigator will invite a vascular surgeon to measure the diameter and blood flow of veins by Doppler ultrasound and invite two well-trained hemodialysis nurses to evaluate AVF maturation status by stethoscopes and physical examination. The data gathered from the study will be processed by descriptive statistics, t test, and chi-square test. Expected outcome: We anticipate that after the exercise program, the blood flow and diameter of the vein can increase, and also, can facilitate AVF maturation. Ultimately, we hope the expected results can build up some evidence-based practices when facing the problems about native arteriovenous fistulas.