Effect of Intradialytic Versus Home-Based Aerobic Exercise Training on Physical Function and Vascular Parameters in Hemodialysis Patients: A Randomized Pilot Study

Background: Hemodialysis patients show reduced physical function and greater risk of increased arterial stiffness because of hypertension, metabolic disturbances, and vascular calcification. Exercise interventions potentially could improve their vascular risk profile. Study Design: Randomized controlled pilot clinical study comparing the effects of 6 months of supervised intradialytic exercise training versus home-based exercise training or usual care on physical function and arterial stiffness in hemodialysis patients. Setting & Participants: 70 hemodialysis patients from 3 renal units. Intervention: Intradialytic-exercise patients trained 3 times/wk for 6 months on a cycle ergometer and home-based-exercise patients followed a walking program to achieve the same weekly physical activity. Usual-care patients received no specific intervention. Outcomes & Measurements: Primary outcome measures were distance traveled during a 6-minute walk test and aortic pulse wave velocity. Secondary outcome measures included augmentation index (augmentation pressure as a percentage of central pulse pressure), peripheral (brachial) and central blood pressures (measured noninvasively using radial tonometry), physical activity, and self-reported physical functioning. Measurements were made at baseline and 6 months. Results: At 6 months, there were no significant differences between changes in 6-minute walk test distance (intradialytic exercise, +14%; home-based exercise, +11%; usual care, +/- 5%), pulse wave velocity (intradialytic exercise, -4%; home-based exercise, -2%; usual care, +5%), or any secondary outcome measure. Limitations: Lack of medication data limited the analysis of vascular parameters in this study. Conclusion: There were no differences between intradialytic or home-based exercise training and usual care for either physical function or vascular parameters. Am J Kidney Dis 55: 88-99. (C) 2009 by the National Kidney Foundation, Inc.