Eficacia y seguridad de un programa de ejercicio físico intradiálisis / Impact and safety outcomes of an intradialytic physical exercise program

Introducción: Los pacientes en hemodiálisis (HD) suelen tener una condición física mermada y elevado sedentarismo. La consolidación de programas de ejercicio físico en las unidades de diálisis está limitada por barreras como la seguridad inherente a estos programas y la falta de recursos. Objetivos: Evaluar la eficacia y seguridad en la implantación de un programa de ejercicio físico intradiálisis (EFI) sobre la condición física de los pacientes con un equipo multidisciplinar (fisioterapeuta y auxiliares de enfermería). Material y métodos: Estudio cuasiexperimental pre-post unicéntrico prospectivo de 6 meses en 34 pacientes. Intervención con EFI combinado 2 días a la semana, evaluándose de forma basal y final la capacidad cardiorrespiratoria (6MWT), fuerza muscular (HG, dinamometría de cuádriceps y 10STS), la composición corporal (bioimpedanciometría) y la capacidad coordinativa (Timed Up and Go test). La seguridad se valoró registrando las incidencias relacionadas con el acceso vascular, la estabilidad hemodinámica y el perfil de rellenado vascular (RBV) durante las sesiones. También se registró la adherencia al programa así como parámetros analíticos habituales. Resultados: La adherencia al programa de EFI fue elevada (70,8%). Se constató una mejora significativa de 47m (p<0,001) en el 6MWT; un incremento medio de 1,6kg (p=0,007) en el HG para la fuerza de extremidades superiores y en las extremidades inferiores (10STS p=0,003; dinamometría p<0,05). Respecto a la seguridad, no se detectaron incidencias ni diferencias significativas en el RBV. Conclusiones: Un programa de EFI combinado favorece la mejora de la condición física de los pacientes en HD sin comprometer la seguridad del tratamiento. Es aconsejable un equipo multidisciplinar para implantar y dar continuidad eficazmente a un programa de EFI. (AU)

Introduction: Patients undergoing hemodialysis (HD) are characterized by a poor physical condition and a substantial sedentary profile. The implementation of physical exercise programs in the hemodialysis units is usually limited by the inherent safeness and the lack of appropriate resources. Objectives: We aimed to evaluate the impact and safety outcomes of the implementation of an intradialytic physical exercise program (IPE) by a multidisciplinary team (physiotherapist and nursing assistant) in the physical condition of the patients. Material and methods: This six months single-centre and experimental pre-post prospective study was carried out in 34 patients. A two day-week combined IPE intervention was implemented. The cardiopulmonary capacity (6MWT), muscular strength (HG, leg dynamometry and 10STS), body composition (bioimpedance) and coordination capacity (Timed Up and Go test) was assessed at the beginning and at the end of the study. Safety was evaluated by means of the number of issues regarding the vascular access, the hemodynamic stability as well as the vascular refilling profile (RBV) in each session. The adhesion to the program was also registered. Additionally, analytical parameters were recorded. Results: The adhesion to an IPE program was high (70.8%). A significant improvement of the cardiopulmonary capacity (6MWT average increase 47m; p<0.001), superior limbs (HG average increase of 1.6kg; p=0.007) as well as the lower extremities (10STS; p=0.003; dynamometry p<0.05). Regarding safeness, there were no incidences neither significant difference in the RBV. Conclusions: A combined IPE may contribute to the improvement of the physical condition of the patients as well as ensures a safe development of the HD treatment. We suggest a multidisciplinary team in order to efficiently establish an IPE program. (AU)

Impact and safety outcomes of an intradialytic physical exercise program.

INTRODUCTION: Patients undergoing hemodialysis (HD) are characterized by a poor physical condition and a substantial sedentary profile. The implementation of physical exercise programs in the hemodialysis units is usually limited by the inherent safeness and the lack of appropriate resources. OBJECTIVES: We aimed to evaluate the impact and safety outcomes of the implementation of an intradialytic physical exercise program (IPE) by a multidisciplinary team (physiotherapist and nursing assistant) in the physical condition of the patients. MATERIAL AND METHODS: This six months single-centre and experimental pre-post prospective study was carried out in 34 patients. A two day-week combined IPE intervention was implemented. The cardiopulmonary capacity (6MWT), muscular strength (HG, leg dynamometry and 10STS), body composition (bioimpedance) and coordination capacity (Timed Up and Go test) was assessed at the beginning and at the end of the study. Safety was evaluated by means of the number of issues regarding the vascular access, the hemodynamic stability as well as the vascular refilling profile (RBV) in each session. The adhesion to the program was also registered. Additionally, analytical parameters were recorded. RESULTS: The adhesion to an IPE program was high (70.8%). A significant improvement of the cardiopulmonary capacity (6MWT average increase 47 m; p < 0.001), superior limbs (HG average increase of 1.6 kg; p = 0.007) as well as the lower extremities (10STS; p = 0.003; dynamometry p < 0.05). Regarding safeness, there were no incidences neither significant difference in the RBV. CONCLUSIONS: A combined IPE may contribute to the improvement of the physical condition of the patients as well as ensures a safe development of the HD treatment. We suggest a multidisciplinary team in order to efficiently establish an IPE program.