Clinical Investigation

Kidney International (1984) 25, 958–963; doi:10.1038/ki.1984.117

Feasibility and benefits of exercise training in patients on maintenance dialysis

Rose Shalom, James A Blumenthal, R Sanders Williams, Robert G McMurray and Vincent W Dennis

Divisions of Nephrology, Psychology and Cardiology, Duke University Medical Center, Durham, and the Human Performance Laboratory, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

Correspondence: Dr V W Dennis, Box 3014, Duke University Medical Center, Durham North Carolina 27710, USA

Received 20 September 1983; Revised 20 December 1983.

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Abstract

Feasibility and benefits of exercise training in patients on maintenance dialysis. Fourteen of 174 patients receiving maintenance dialysis volunteered to participate in a 12-week exercise conditioning program. Seven patients attended more than 50% (range, 55 to 75%) of the sessions held three times each week. These seven patients achieved a 42% (P < 0.05) improvement in work capacity as assessed by maximal oxygen consumption during treadmill testing. No changes occurred in psychologic functioning, blood pressure control, hematocrit, or left ventricular ejection fraction. Seven patients attended fewer than half of the sessions (range, 1 to 38%) and did not demonstrate improved exercise capacity. Psychologic testing at entry revealed that those who did not attend regularly had higher scores for hostility, anxiety, and depression as compared to those patients who completed the program. No other clinical variables distinguished those who had good attendance records from those who did not. We conclude that exercise conditioning can improve physical work capacity in patients with chronic renal failure who are receiving maintenance dialysis treatment. Despite this potential benefit, the impact of exercise conditioning programs such as this may be limited because only a small portion of patients on maintenance dialysis are able or willing to participate to an extent sufficient to induce physiological changes.

La possibilité et les avantages du entraînement à l'exercice chez les malades en dialyse chronique. Quatorze parmi 174 malades en dialyse chronique ont été volontaires pour participer à un programme de conditionnement à l'exercice durant 12 semaines. Sept malades ont assisté à plus de 50% (de 55 à 75 %) des séances tri-hebdomadaires. Ces sept malades sont parvenus à une amélioration de 42% (P < 0.05) de la capacité de travail, mesurée par la consommation maximale en oxygène lors d'un test par un exercice pénible. Aucune modification ne s'est produite dans les fonctions psychologiques, le contrôle tensionnel, l'hématocrite, ni la fraction d'éjection ventriculaire gauche. Sept malades ont assisté à moins de la moitié des séances (de 1 à 38%) et n'ont pas montré d'amélioration de leur capacité d'exercice. Les tests psychologiques faits à l'entrée ont révélé que ceux qui n'avaient pas régulièrement participé avaient des scores d'hostilité, d'anxiété, et de dépression plus élevés que ceux des malades ayant achevé le programme. Aucune autre variable clinique ne distinguait ceux qui avaient une bonne assiduité de ceux qui n'en avaient pas. Nous concluons que le conditionnement à l'exercice peut améliorer la capacité de travail physique chez les malades en insuffisance rénale chronique traités par hémodialyse périodique. Malgré ce bénéfice potentiel, l'impact des programmes de conditionnement à l'exercice tels que celui-ci pourrait être limité car seule une faible partie des malades en hémodialyse chronique peut ou veut participer de façon suffisante pour induire des modifications physiologiques.

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