title: Implementation of exercise training programs in a hemodialysis unit: effects on physical performance.
abstract: BACKGROUND
  Exercise training is beneficial for hemodialysis patients, but it should be tailored to individual abilities and willingness to participate. This study evaluated the effects of different 6-month programs of physical activity in 18 patients of a single hemodialysis unit.
  
  
  METHODS
  Before and after a 12-month control period (T0), and following 3 (T3) and 6 (T6) months of training, the patients underwent the 6-minute walk test (6MWT) and constant treadmill test at 3 km/hour speed and 10% grade; spontaneous physical activity was assessed by pedometers. All patients trained for coordination, flexibility and muscular strengthening for 30 minutes within the first 2 hours of hemodialysis sessions: 9 patients underwent home exercise walking training (advised walking group [AWG]); the other 9 patients underwent the advised home training program plus an additional supervised gym training session, twice weekly (supervised walking group [SWG]).
  
  
  RESULTS
  In both AWG and SWG, no changes occurred during the control period (232 ± 204 m and 248 ± 187 m at T0). In contrast, endurance performance at treadmill increased at T3 and T6 in the AWG (377 ± 272 m and 615 ± 413 m; p<0.01) and in the SWG (424 ± 272 m and 890 ± 364 m; p<0.001). No unwanted side effects occurred.
  
  
  CONCLUSIONS
  This study shows that physical exercise programs can safely increase physical performance in hemodialysis patients. The training program should be continued for at least 6 months to increase muscle strength and endurance. Intradialytic exercise and home-based, pedometer-based regimens may be a useful and easy approach, whereas supervised programs can give additional benefits in motivated, selected patients.
authors.affiliation: Rehabilitation Medicine Unit, Pescia Hospital, Pescia, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bulckaen
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capitanini
authors.forename: Sara
authors.initials: S
authors.lastname: Lange
authors.forename: Andrea
authors.initials: A
authors.lastname: Caciula
authors.forename: Franco
authors.initials: F
authors.lastname: Giuntoli
authors.forename: Adamasco
authors.initials: A
authors.lastname: Cupisti
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000453:epidemiology; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010807:Physical Endurance / Q000502:physiology*; D015995:Prevalence; D011446:Prospective Studies; D006435:Renal Dialysis; D055070:Resistance Training / Q000379:methods*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology