Facultad de Ciencias de la Salud

Background: Exercise programs in patients with kidney disease improve functional capacity and health-related quality of life, but the implementation of exercise programs in nephrology services is not an easy task. Aim: To evaluate the effectiveness of a home-based exercise program in patients with chronic kidney disease (CKD) stages 4–5 (with or without dialysis). Methods: A 12-week prospective observational cohort design study was carried out with patients with renal failure who undertook a home-based exercise program. Registered data included: (a) biochemical parameters; (b) functional capacity tests, that is, short physical performance battery, sit to stand to sit 10, and 6-min walking test; (c) handgrip strength; (d) health-related quality of life; (e) satisfaction; and (f) adherence. The quantitative variables were expressed by means and standard deviation, and qualitative variables, by percentage. The comparison of quantitative data between baseline and at 12 weeks of the same group was carried out using the Wilcoxon test for nonparametric-related variables and the chi-square test for categorical variables using contingency tables. Results: Fifty-three patients were included (mean age = 67.4 years). The functional capacity tests showed a significant improvement in the short physical performance battery (8.3 ± 2.8 vs. 9.5 ± 2.6 points), the sit to stand to sit 10 (35.8 ± 17.7 vs. 31.8 ± 15.3 s), and the 6-min walking test (355.0 ± 106.1 vs. 386.4 ± 113.6 meters), mainly in CKD stage 5. There were no significant differences in handgrip and health-related quality of life. Regarding the degree of program satisfaction, 70% of the patients were very satisfied with being able to participate in the program, and 64% considered that they had more strength after completing the home-based exercise program. Linking Evidence to Action: The implementation of a home-based exercise program results in improved functional capacity in patients with CKD stage 5. Moreover, this exercise program is safe, and patients were satisfied.

Background: Intradialysis exercise programs in renal patients result in improved functional capacity, muscle strength, symptoms of depression, and health-related quality of life. Home-based exercise programs are an alternative to overcome logistical and human resource problems. However, the implementation of these programs is not an easy task and there is a lack of knowledge regarding the benefits associated with home-based exercise programs. Aim: To determine whether home-based exercise programs improve functional capacity, health-related quality of life, muscle strength, and symptoms of depression among patients with stage III–V chronic kidney disease. Methods: A systematic review and meta-analyses following PRISMA guidelines were utilized. Relevant articles were collected and independently assessed for their inclusion eligibility. Effects of home-based exercise were summarized by the standardized mean differences and represented by forest plots (Review Manager 5.4). Results: Eight studies were included, none of which reported any adverse effects. The intervention was usually aerobic, 76% of these programs lasted 3–6 months, and exercise adherence was 60–87.5%. Four studies measured health-related quality of life and found significant improvements in several subscales. Regarding functional capacity, five studies used the six-minute walking test (44.9 meters; 95% CI [30.45, 59.30]; p ≤ .001), three studies used the sit-to-stand-to-sit test (−0.45 seconds; 95% CI [−0.46, −0.26]; p ≤ .001), and two studies used the timed up-and-go test (−0.76 seconds; 95% CI [−1.38, −0.15]; p ≤ .001) and the handgrip strength test (1.16 kg; 95% CI [−2.88, 5.20]; p ≤ .001). LINKING EVIDENCE TO ACTION: Home-based exercise programs are beneficial to renal patients. These interventions are safe and effective to improve health-related quality of life and functional capacity and reduce symptoms of depression among patients with chronic kidney disease.

Accurate evaluation of physical function in patients undergoing haemodialysis is crucial in the analysis of the impact of exercise programs in this population. The aim of this study was to evaluate the reproducibility of several physical functional tests, depending on the timing of their implementation (before the HD session vs. non-HD days). This is a prospective, non-experimental, descriptive study. Thirty patients in haemodialysis were evaluated twice, 1 week apart. The test session was performed before the haemodialysis session started and a retest was performed in non-dialysis day. The testing battery included the short physical performance battery, sit-to-stand tests, 6 min walk test, one-leg stand test, timed up and go, and handgrip strength with and without forearm support. The intrarater reproducibility was determined by the intraclass correlation coefficients and the agreement was assessed by Bland–Altman analysis. The intraclass correlation coefficients values ranged from 0.86 to 0.96, so that all tests showed good to very good relative reliability. The mean differences between trials of sit to stand 10 and 60, timed up and go and all the handgrip tests were close to zero, indicating no systematic differences between trials. Large range of values between trials was observed for the 6 min walk test, gait speed, one-leg stand test and short physical performance battery, indicating a systematic bias for these four tests. In conclusion, the sit to stand 10 and 60, timed up and go and handgrip tests had good to excellent test–retest reliability in measuring physical function in different dialysis days of patients undertaking haemodialysis. The minimal detectable change values are provided for this population. Bias were found for the 6 min walk test, gait speed, Short physical performance battery or one-leg stand test when the testing day changed.

The purpose of this study is to assess whether the functional capacity of patients with chronic kidney disease stage V (CKD- 5D) is different depending on their physical activity levels. We also compared functional capacity, quality of life, and symptoms of depression depending on treatment modalities (HD vs. PD). A Cross-sectional study included 52 patients (35HD and 17PD; males 61.5%, mean age 71 years). The main measurements were physical activity level using the Human Activity Profile questionnaire (HAP), muscle strength, functional capacity, health-related quality of life (HRQoL), and depressive symptomatology. The functional tests and physical activity levels correlated significantly. Participants on HD with low physical activity levels were older (*p ≤ .039) and had worst physical function (*p ≤ .01). The HAP is a useful tool to detect subjects with low functional capacity; there were no differences between the therapy modalities in terms of functional capacity, HRQoL, or depressive symptomatology.

Introducción: Cada vez es más frecuente la literatura que nos muestra los beneficios de los programas de ejercicio físico para mejorar la capacidad funcional y la calidad de vida relacionada con la salud de los pacientes con enfermedad renal crónica. Sin embargo, la implementación de estos programas no es una tarea fácil. Objetivo: Evaluar la efectividad de un programa de ejercicio físico domiciliario sobre la fuerza de agarre de las manos, capacidad funcional y calidad de vida en pacientes con enfermedad renal crónica avanzada en estadíos 4-5. Material y Método: Estudio prospectivo experimental. Los pacientes realizaron un programa completo de ejercicio domiciliario de 3 sesiones semanales durante 12 semanas. Principales datos analizados: dinamometría manual (HG) y la prueba Short Physical Performance Battery (SPPB) y calidad de vida mediante el Euroqol 5D. Resultados: 62 pacientes incluidos. 34 eran hombres con una edad media 67,4±14,9 años. La velocidad de la marcha en 4 metros aumentó en 0,18 m/s (IC95%: 0,08-0,28). Los resultados del SPPB aumentaron en 1,4 puntos (IC95%: 0,6-2,2 puntos). No se observan cambios significativos ni en la dinamometría manual (de 26,1Kg a 26,4Kg) ni en la calidad de vida relacionada con la salud (de 67,8 a 71,3 puntos). Conclusión: Un programa de ejercicio físico domiciliario de 12 semanas de duración fue seguro y mejoró la capacidad funcional de los pacientes en enfermedad renal crónica avanzada en estadíos 4-5. / Introduction: Scientific evidence is greater on the benefits of physical exercise programs to improve functional capacity and health-related quality of life of patients with chronic kidney disease. However, implementing these programs is not an easy task. Objective: To evaluate the effectiveness of a home physical exercise program on hand grip strength, functional capacity and quality of life in patients with advanced chronic kidney disease in stages 4-5. Material and Method: Prospective experimental study. The patients performed a complete home exercise program of 3 weekly sessions for 12 weeks. The main data analyzed were manual dynamometry, the Short Physical Performance Battery (SPPB) test, and the EuroQoL 5D questionnaire to assess quality of life. Results: Sixty-two patients were included, 34 men and with a mean age of 67.4±14.9 years. The 4-meter gait speed increased by 0.18 m/s (95%CI: 0.08-0.28). The SPPB results increased by 1.4 points (95%CI: 0.6-2.2 points). No significant changes were observed either in manual dynamometry (from 26.1 to 26.4Kg) or in health-related quality of life (from 67.8 to 71.3 points). Conclusion: A 12-week home physical exercise program was safe and improved the functional capacity of patients with advanced chronic kidney disease in stages 4-5.

Introducción. Las personas con enfermedad renal deben recibir una atención integral que incluya programas de ejercicio físico adaptado a sus necesidades. Objetivo. Evaluar la satisfacción de los pacientes con enfermedad renal crónica en estadios IV y V ante un programa de ejercicio físico domiciliario. Material y Método. Estudio descriptivo transversal en pacientes que realizaron un programa completo de entrenamiento físico domiciliario de 12 semanas de duración. Tras esta intervención, respondieron de forma anónima a un cuestionario ad-hoc validado por expertos, sobre su opinión acerca del programa. Resultados. Participaron 62 pacientes. 24 estaban en programa de hemodiálisis, 17 en diálisis peritoneal y 7 en situación de enfermedad renal crónica estadio IV. 34 eran hombres. La edad media fue de 67,4±14,9 años. 52 pacientes realizaron el programa solos en su domicilio. 33 de los pacientes les pareció muy correcto que el programa fuera domiciliario, 15 correcto y 2 poco correcto. 47 de los participantes consideraron muy correcto que la persona que dirigiera el programa fuera una enfermera conocida. 19 consideró que tras el programa habían mejorado mucho, 14 que habían mejorado, 9 que habían mejorado poco y 3 que no habían mejorado. 39 estuvieron muy satisfechos de haber podido participar en el programa, 6 satisfechos, 1 poco satisfecho y 1 de los pacientes no estuvo satisfecho. No hubo diferencias significativas en las respuestas en relación al sexo, edad, tipo de tratamiento, o realizar el programa solo o acompañado. Conclusiones. El programa de ejercicio físico domiciliario fue bien valorado por los pacientes que en su mayoría manifestaron haber mejorado y consideraron adecuado que fuera una enfermera la que dirigiera el programa. / Objective. To evaluate patient satisfaction chronic kidney disease in stages IV and V after a home physical exercise program. Material and methods. Descriptive cross-sectional study in patients who carried out a complete 12-week home physical training program. After this intervention, they responded anonymously to an ad-hoc questionnaire validated by experts, about their opinion about the program. Results. 62 patients participated. 24 were on a hemodialysis program, 17 on peritoneal dialysis and 7 on stage IV chronic kidney disease. 34 were men. The mean age was 67.4 ± 14.9 years. 52 patients carried out the program alone at home. 33 of the patients considered as very correct that the program was domiciliary, 15 correct and 2 not correct. 47 of the participants considered as very correct that the person leading the program was a well-known nurse. 19 responded that after the program the improvement was a lot, 14 a good improvement, 9 little improvement and 3 that had not improved. 39 were very satisfied to participate in the program, 6 satisfied, 1 not very satisfied and 1 of the patients was not satisfied. There were no significant differences in the answers in relation to sex, age, type of treatment, or if the program was done alone or accompanied. Conclusions. The home physical exercise program was well valued by the patients, who mostly said they had improved and considered as appropriate that a nurse leads the program.