The effect of intradialytic foot pedal exercise on blood pressure phosphate removal effi ciency and health related quality of life in haemodialysis patients

Abstract

Introduction: Most dialysis patients have reduced aerobic power and muscle strength that often presents challenges in tolerating even the many activities required for daily living. As the American National Kidney Association recommends hemodialysis patients should be offered programs of exercise of 30 minutes per day our aim was to seek evidence for the merits of a structured exercise program for 17 patients in a small regional acute Western Australian hospital dialysis unit Method: This study examined the effects of a program of intradialytic foot pedal exercises on patients' blood pressure, phosphate levels, satisfaction and Health related quality of life. Participation was recorded and categorised according to duration and consistency of pedalling. Blood pressure and serum phosphate were measured prior to haemodialysis, on commencement of the study and then at 4 weekly intervals. SF-12 scores were collected prior to commencement and on completion of the program. Results: Participation in the exercise varied considerably, with few patients able to achieve consistent pedalling for 30 mins or more by week three. Participation decreased from 100% in week one to 61% in week 12. Repeated measures ANOVA indicated there were no significant changes in either serum phosphate, systolic blood pressure, diastolic blood pressure or satisfaction. Paired t tests undertaken for pre and post SF12 scores, and physical and mental component summaries, also showed no significant changes. Conclusions: Although there was considerable variability across the group in the degree to which patients completed the recommended program of exercise, in general, it was not well tolerated. The major outcomes of the study lie in enhanced engagement between staff and patients, resulting in increased teaching opportunities and an increased awareness of the importance of some level of exercise or other activity.