2. Universidad Cardenal Herrera-CEU

Background: Exercise improves the physical function of people suffering from chronic kidney disease on hemodialysis (HD). Virtual reality is a new type of intradialysis exercise that has a positive impact on physical function. Intradialysis exercise is recommended during the first 2 h, but its safety in the last part of the dialysis session is unknown. Methods: This was a pilot sub-study of a clinical trial. Several hemodynamic control variables were recorded, including blood pressure, heart rate, and intradialytic hypotensive events. These variables were recorded during three different HD sessions, one HD session at rest, another HD session with exercise during the first two hours, and one HD session with exercise during the last 30 min of dialysis. The intradialysis virtual reality exercise was performed for a maximum of 30 min. Results: During exercise sessions, there was a significant increase in heart rate (6.65 (4.92, 8.39) bpm; p < 0.001) and systolic blood pressure (6.25 (0.04,12.47) mmHg; p < 0.05). There was no difference in hemodynamic control between the sessions with exercise during the first two hours and the sessions with exercise during the last 30 min. There was no association between intra-dialytic hypotensive events at rest (five events) or exercise at any point (two vs. one event(s), respectively). Conclusion: performing exercise with virtual reality at the end of a hemodialysis session is not associated with hemodynamic instability.

Objective: The main objective of this investigation was to assess feasibility of conducting a future RCT with an intradialysis non-immersive virtual reality exercise intervention. The secondary aim was to explore the impact of either conventional or VR exercise on physical function. Design: Feasibility randomized trial Participants: 18 subjects who participated in a 16 weeks intradialysis combined exercise program. Interventions: The program lasted 4 additional weeks of either combined exercise or virtual reality exercise. Main outcome measures: Physical function was measured through several reliable tests (sit to stand to sit tests 10 and 60, gait speed, one-leg heel rise tests and 6-minute walk test) at baseline, after 16 weeks of intradialysis combined exercise and by the end of 4 additional weeks of exercise. Adherence to the exercise programs was registered. Results: There was a significant time effect, so that physical function improved in both groups. By the end of the 20 weeks, function improved as measured through the sit to stand to sit test 10 and 60, gait speed, one-leg heel rise left leg and the 6-minute walk test. Changes that did not occur due to error in the test were seen after 20 weeks were achieved in the sit to stand to sit test 60, gait speed, one-leg heel rise test for the left leg and 6-minute walking test. Conclusion: Virtual reality was a feasible intervention. Both interventions improved physical function. Adherence was not significantly different between groups.