Abstract
OBJECTIVE: Evaluate the feasibility of implementing a combined in-hospital and home-based exercise program in older hemodialysis (HD) patients. DESIGN: A prospective longitudinal 12-week pilot study. SETTING: A university hospital HD unit and patients' homes. PARTICIPANTS: A convenience sample of nine older (>55 years) patients undergoing HD. INTERVENTIONS: An individualized exercise program performed on HD days (3/week) and at home (2-3/week), including aerobic, flexibility, strength exercises and patient education. MAIN OUTCOME MEASURES: Feasibility measure: patient participation. Exercise performance: Duke Activity Status Index (DASI); 2-min walk test (2MWT); Timed-up-and-go (TUG). Quality of life: The Illness Intrusiveness Ratings Scale (IIRS); The Kidney Disease Quality of Life Questionnaire (KDQOL). RESULTS: The mean (SD) age of the patients was 68.1 (7.1). Participation in the in-hospital supervised exercise program was high, with patients exercising during 89% of HD sessions, but was lower for the unsupervised home-based component (56% exercised ≥ 2 times/week). Patients showed a gradual increase in the amount of exercise performed over 12 weeks. The 2MWT, TUG, IIRS and the KDQOL physical composite score demonstrated moderate responsiveness, while the DASI score exhibited only limited responsiveness. CONCLUSIONS: This exercise program and the outcome measures were feasible for older HD patients: in-hospital participation was high, and physical performance and QOL measures exhibited moderate levels of responsiveness. Future, larger studies are needed to demonstrate whether intra-dialysis exercise, with or without home exercise, can lead to improved outcomes in this population.