Implementation of exercise training programs in a hemodialysis unit: effects on physical performance.

INTRODUCTION: Exercise training is beneficial for hemodialysis patients, but it should be tailored to individual abilities and willingness to participate. This study evaluated the effects of different 6-month programs of physical activity in 18 patients of a single hemodialysis unit. METHODS: Before and after a 12-month control period (T0), and following 3 (T3) and 6 (T6) months of training, the patients underwent the 6-minute walk test (6MWT) and constant treadmill test at 3 km/hour speed and 10% grade; spontaneous physical activity was assessed by pedometers. All patients trained for coordination, flexibility and muscular strengthening for 30 minutes within the first 2 hours of hemodialysis sessions: 9 patients underwent home exercise walking training (advised walking group [AWG]); the other 9 patients underwent the advised home training program plus an additional supervised gym training session, twice weekly (supervised walking group [SWG]). RESULTS: In both AWG and SWG, no changes occurred during the control period (232 ± 204 m and 248 ± 187 m at T0). In contrast, endurance performance at treadmill increased at T3 and T6 in the AWG (377 ± 272 m and 615 ± 413 m; p<0.01) and in the SWG (424 ± 272 m and 890 ± 364 m; p<0.001). No unwanted side effects occurred. CONCLUSION: This study shows that physical exercise programs can safely increase physical performance in hemodialysis patients. The training program should be continued for at least 6 months to increase muscle strength and endurance. Intradialytic exercise and home-based, pedometer-based regimens may be a useful and easy approach, whereas supervised programs can give additional benefits in motivated, selected patients.

[Rehabilitation program in patients with moderate-to-severe intermittent claudication: immediate results and one year follow-up]. / Riabilitazione del paziente arteriopatico allo stadio IIB: risultati immediati e follow-up a un anno.

BACKGROUND: Physical training is believed the primary treatment of claudication symptoms. Although exercise therapy is self-effective, some drugs improving functional capacity have additive effects. TASC (Trans Atlantic Society Consensus) considers Propionil-L-Carnitine (PLC) and prostaglandin-E1 (PGE1) as poorly studied drugs with potential benefits in improving claudication. This retrospective, observational study was performed to compare the efficacy of PGE1 and PLC, and to evaluate both the immediate results of an intensive, short-course rehabilitation program and the outcome at one year follow-up. METHODS: Twenty-five patients with severe-moderate claudication were selected. All patients were subjected to an intensive, supervised exercise program for 4 weeks in combination with either PGE1 (10 patients) or PLC (15 patients). Drugs were infused i.v. before every exercise session: 60 microg PGE1 within 2 hours and 600 mg PLC within 10 minutes. Patients were trained with the same supervised tread-mill walking-exercise program. At the end of the rehabilitation period, patients were instructed to keep walking (advised home exercise). Initial claudication distance (ICD) and absolute claudication distance (ACD) were evaluated during a constant treadmill test (3 km/hour speed, 10% grade) at entry, after 4 weeks and at one year follow-up. A patient was considered as no-responder if his/her improvement in ACD was <33%. RESULTS: A significant increase of both ICD and ACD was detected after both 4 weeks (+269% and +135%, respectively, in PGE1 group; +245% and +125%, respectively, in PLC group) and one year (+364% and +202%, respectively, in PGE1 group; +279% and +176%, respectively, in PLC group). No-responder patients after the intensive training period (2 in PGE1 group and 4 in PLC group) remained no-responders also at one year follow-up. Both PGE1 and PLC treatments were well tolerated. No serious drug-related side effect requiring interruption of the treatment was observed. CONCLUSIONS: A short-course of intensive exercise treatment plus PLC or PGE1 may enhance walking ability. The result was confirmed at one year follow-up.