Kinesiologist-guided functional exercise in addition to intradialytic cycling program in end-stage kidney disease patients: a randomised controlled trial

Abstract

Intradialytic cycling is a widely used workout mode, whereas added benefit of other exercise modalities remains unknown. This is the first randomised controlled trial on the effects and sustainability of functional training and counselling in addition to intradialytic cycling. Patients were randomly assigned to a kinesiologist-guided functional training in addition to intradialytic cycling (n = 20, experimental group) or intradialytic cycling only (n = 20, control group) over 16 weeks. The experimental group attended predialysis functional exercise in the first eight weeks and afterward performed functional training at home for the next eight weeks. The primary study endpoint was 10-repetition-sit-to-stand test time at eight weeks: at this test, the experimental group improved significantly better than controls (-4.5 ± 1.9 s, 95%CI -8.4 to -0.7; P = 0.021), which was maintained at week 16 (-4.7 ± 2.1 s, 95%CI -9.0 to -0.3; P = 0.037). At week 8, the experimental group significantly outperformed controls also at handgrip strength (P = 0.004), lower body flexibility test (P < 0.001), balance test (P < 0.001), and upper body flexibility test (P = 0.003). At week 16, superior results of the experimental group in secondary end-points remained preserved for handgrip strength, balance, and upper body flexibility tests. Functional training with exercise counselling meaningfully improves physical performance and successfully prepares patients for sustainable home exercise.

Figure 1

Flow diagram of the randomized controlled study design.

Figure 2

CONSORT (Consolidated Standards of Reporting Trials) diagram. *death (n = 1), sepsis (n = 1), fall and osteomuscular injury (n = 1), discontinued on patient’s demand; exacerbated symptoms of spinal stenosis (n = 1), **discontinued on patient’s demand (n = 1), coronary artery disease exacerbation with exertional dyspnea (n = 1), transplantation (n = 1).

Figure 3

Results of 10 repetition sit-to-stand test over time Note: (a) individual changes in 10 repetition sit-to-stand test for experimental group; (b) individual changes in 10 repetition sit-to-stand test for the control group; (c) changes of the mean in 10 repetition sit-to-stand test for both groups, summarized; *P < 0.05 indicates significant between-group difference. Abbreviations: EXP, experimental group; CON, control group; STS-10, 10 repetition sit-to-stand test.