Hemodialysis patients have extremely low exercise tolerance. Most research studies have included only younger patients with few comorbidities, which are not representative of the general dialysis population. Objective: To assess the feasibility and effectiveness of two programming approaches (independent home exercise (IND) and incenter cycling during dialysis (ICC) to improve physical functioning. We aimed to include a wide range of patients and to use testing measures that can easily be administered in the dialysis clinics. Design: This was a controlled trial in which 286 patients were recruited for the intervention from 5 clinics. Fifty two control patients from a separate clinic underwent testing only with no intervention. Testing was done at baseline, after 8 weeks of IND and again after 8 weeks of ICC. Outcome Variables: Testing included 3 physical performance tests: normal and fast gait speed , sit to stand, and 6 minute walk (6MW). The SF-36 questionnaire was completed at each testing time. Self-report of physical activity was categorized into ADL only, 'some' cardiovascular exercise and recommended cardiovascular exercise (RCV). Methods: Independent home exercise was individually prescribed and adherence was assessed at the time of each dialysis session. A recumbent cycle was used during the dialysis treatment and the prescription was individually developed. Repeated measures ANOVA was used to evaluate change in the groups over time. Findings: There was significant drop out due to missed tests, mostly due to medical reasons. Physical activity increased in the intervention group from 60% reporting ADL's only and 12% RCV at baseline to 6% reporting ADL's only and 45% RCV at the end of the study. Significant time by group interactions were found in gait speed, sit to stand and all the physical scales on the SF-36 (p<.02), with the intervention group improving over time and the control group declining or showing no change over time. The baseline values for normal gait speed were 64% of age-predicted normals, and for the STS were 24 % of age-predicted normals. Conclusions: There is a well established relationship between self-reported physical function on the SF-36 questionnaire and outcomes such as hospitalizations and mortality in dialysis patients, thus, the improvements observed in the intervention patients suggest that interventions such as these may positively impact outcomes. This study demonstrates that patients on dialysis will increase physical activity when given information and encouragement to do so, and that increased physical activity increases physical functioning as measured with performance based tests and self-report both which may have a positive impact on outcomes. Implications: Challenges associated with exercise interventions in this patient group include: timing of exercise training and testing, coordination of schedules with dialysis staff, enlisting dialysis staff encouragement for patient participation, frequent changes in clinical condition often requiring hospitalization, low expectations for well-being on the part of patients, families and dialysis staff.
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