Intradialytic exercise: a controlled nationwide effectiveness-implementation study
Pedro M Martins1,2, Diogo V Leal1, Aníbal A Ferreira2,3,4
1Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, Maia, Portugal.
Background:
Efficacy studies have demonstrated the benefits of intradialytic exercise. However, real-world effectiveness trials are lacking. This study evaluated a nationwide clinical implementation of intradialytic exercise settled as a routine practice. Implementation of intradialytic exercise and its effectiveness regarding safety, physical function and body composition were investigated.
Methods:
This was a retrospective analysis of the first year of implementation using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance). For effectiveness outcomes, participants (n = 347) were compared with patients who refused the intervention (n = 394), except for physical function in which a pre-post design was performed. Physical function tests included the 8-foot up and go, 30-s sit-to-stand, 5 times sit-to-stand, single leg stance and hand dynamometer. Body composition was determined by multifrequency bioimpedance.
Results:
Adoption: 20 hemodialysis units adopted the intervention (55.6%). Reach: 1270 patients were eligible (55.8%). The main reason for non-eligibility was physical/cognitive incapacity (50.8%). Of those eligible (n = 1270), 811 (63.9%) started the intervention and 459 (36.1%) refused. Maintenance: attrition rate was 57.2%. Implementation: patients completed 86.3 ± 29.0 min/week of aerobic exercise and adherence was 75.0% ± 19.7%. Effectiveness: there was a lower incidence of cramps in the exercise group (P < .001). No significant differences were found for other adverse events. A significant improvement was observed for all physical function tests, except for handgrip strength. For body composition, significant differences favorable to the exercise group were found for lean tissue mass (P = .045), lean tissue index (P = .013) and body cell mass (P < .001).
Conclusions:
Large-scale intradialytic exercise implementation is realistic, safe and effective. Nevertheless, implementation outcomes were limited, and complementary interventions may be needed.
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