Učinki vadbe in vadbenega svetovanja pri dializnih bolnikih : doktorska disertacija

Bogataj, Špela (author), Pajek, Maja (mentor), Buturović Ponikvar, Jadranka (comentor)

Dializni bolniki so v povprečju manj gibalno dejavni in zmogljivi kot splošna populacija. Dializno kolesarjenje je široko uporabljen način vadbe hemodializnih bolnikov, medtem ko so učinki drugih vadbenih metod slabo raziskani. Cilj doktorskega dela je bil ugotoviti učinek dodatka funkcionalne vadbe in vadbenega svetovanja k osnovnemu programu kolesarjenja med dializo. 40 hemodializnih bolnikov je bilo naključno razporejenih v eksperimentalno skupino (n = 20) in v kontrolno skupino (n = 20). V 1. fazi (8 tednov) je eksperimentalna skupina pred dializo izvajala funkcionalno vadbo in nadaljevala s kolesarjenjem med dializo. V 2. fazi (8 tednov) je eksperimentalna skupina samostojno izvajala vadbo v domačem okolju z ohranjenim dializnim kolesarjenjem. Kontrolna skupina je sodelovala v programu dializnega kolesarjenja vseh 16 tednov. Po 8 tednih je eksperimentalna skupina izboljšala svoj rezultat pri testu 10 ponovitev vstajanja s stola (p = 0,021) in ga ohranila do 16. tedna (p = 0,037). Eksperimentalna skupina je dosegla bistveno boljše rezultate v primerjavi s kontrolno skupino v moči stiska pesti (p = 0,004), predklonu sede (p < 0,001), testu ravnotežja (p < 0,001) in v gibljivosti ramenskega obroča v zunanjem in notranjem zasuku (p = 0,003). V 16. tednu je eksperimentalna skupina ohranila pridobljeno zmogljivost iz prve faze. Obe skupini sta prikazali statistično značilno izboljšanje v učinkovitosti opravljenega dializnega zdravljenja (kazalnik Kt/V) v primerjavi z njunimi začetnimi vrednostmi (p < 0,05). Med skupinama ni bilo značilnih razlik v spremembi Kt/V v obeh fazah raziskave. Bolniki z rezultatom na vprašalniku Pričakovanja o rezultatih vadbe (OEE) in na vprašalniku Ravnotežje odločitev (DB) nad mediano (> 3,15 oziroma > 1,3) so pokazali bistveno boljše sodelovanje pri dializnemu kolesarjenju (opravljenih 89% v primerjavi s 76%, vadbenih enot in 89% v primerjavi z 77%, p < 0,05 za obe primerjavi). Bolniki v eksperimentalni skupini z rezultatom OEE (vendar ne DB) nad mediano, so izkazali značilno večjo udeležbo na vodeni in domači funkcionalni vadbi (93% v primerjavi z 81% in 85% v primerjavi s 60%, p < 0,05 za obe primerjavi). Rezultat vprašalnika DB je napovedal končni rezultat pri testu moč stiska pesti in 6-minutnem testu hoje. Nižji rezultat na OEE in v manjši meri tudi nižji rezultat na DB vprašalniku sta povezana s slabšo prisotnostjo na vodenih programih vadbe v dializnem centru, kot tudi pri vadbi v domačem okolju in nam lahko pomagata določiti tiste bolnike, ki potrebujejo večje motiviranje s strani izvajalcev vadbe in dializnega osebja. Funkcionalna vadba se je izkazala kot praktičen, izvedljiv in učinkovit vadbeni način pri izboljšanju telesne zmogljivosti hemodializnih bolnikov, katere lahko uspešno pripravimo na samostojno vadbo v domačem okolju. Naša raziskava je potrdila predpostavko, da je kombinirana oblika vadbe učinkovitejša od zgolj aerobne med-dializne vadbe.

• Language: Slovenian
• Keywords: hemodializa, funkcionalna vadba, dializno kolesarjenje, gibalne sposobnosti, kronična ledvična bolezen
• Work type: Doctoral dissertation
• Typology: 2.08 - Doctoral Dissertation
• Organization: FŠ - Faculty of Sport
• Year: 2020
• PID: 20.500.12556/RUL-121424
• COBISS.SI-ID: 34626563
• Publication date in RUL: 09.10.2020

Secondary language

• Language: English
• Title: Effects of exercise and exercise counseling in hemodialysis patients

Abstract

Dialysis patients are less physically active and have lower physical function compared to the general population. In the literature, the most widely used exercise program for hemodialysis patients is cycling during dialysis, whereas added benefit of other exercise modalities remains unknown. This study aimed to determine the effect of adding functional exercise and exercise counseling to the basic exercise program of cycling during dialysis. Forty hemodialysis patients were randomized into an experimental group (n = 20) and an intradialytic cycling control group (n = 20). In the first phase (8 weeks), the experimental group attended a guided functional exercise before the dialysis and continued with a cycling session during dialysis. In the second phase (8 weeks) the experimental group was instructed to exercise at home and continued with the program of intradialytic cycling as did the control group. After 8 weeks, the experimental group showed a significant advancement in 10-repetition-sit-to-stand test (p = 0,021), and maintained it until week 16 (p = 0,037). The experimental group demonstrated significantly better outcomes compared to control group at handgrip strength test (p = 0,004), sit-and-reach test (p < 0,001), Stork balance test (p < 0,001), and at back scratch test (p = 0,003). In week 16, the experimental group retained the performance gains from the first phase. Both groups demonstrated a significant increase in dialysis adequacy (Kt/V) compared to their baseline values (p < 0,05) with no significant between-group differences. Patients with above-median Outcome Expectations for Exercise (OEE) and Decisional Balance (DB) scores (> 3.15 and > 1.3, respectively) expressed significantly better adherence to intradialytic cycling (89% vs. 76%, 89% vs. 77%, respectively, p < 0.05). Experimental group patients with above-median OEE (but not DB) score had significantly better adherence to supervised and home-based functional exercise (93% vs. 81% and 85% vs. 60%, respectively, p < 0.05). Baseline DB score predicted the final result in the hand-grip test and 6-minute walk test. Low OEE and, to a lesser degree, low DB questionnaire scores associate with inferior adherence to dialysis bundled and home-based exercise programs and may help define patient subsets in need of intensified motivational input by exercise caregivers. Our research showed that functional training is practical, feasible, and effective in improving the physical function of HD patients and can successfully prepare patients for independent exercise in the home environment. This study supports the assumption that combined training is more effective compared to solely aerobic intradialytic exercise.

• Keywords: hemodialysis, functional exercise, intradialytic cycling, motor skills, chronic kidney disease