Telesna in kognitivna vadba za ublažitev funkcionalnega upada pri hemodializnih bolnikih : magistrsko delo

Gogala, Eva (avtor), Bogataj, Špela (mentor)

Zaradi staranja populacije hemodializnih (HD) bolnikov in povečane obremenitve zaradi gibalnega in kognitivnega upada ter krhkosti je izvajanje ciljno usmerjenih intervencij za preprečevanje funkcionalnega upada nujno potrebno. Cilj te magistrske naloge je bil oceniti učinek med-dializnega kognitivnega treninga v kombinaciji s telesno vadbo (med-dializno kolesarjenje) na koncentracijo možganskega nevrotrofičnega faktorja (BDNF), zaznavanje mentalne utrujenosti, stopnjo krhkosti, kakovost življenja, kognitivne sposobnosti ter telesno zmogljivost pri HD bolnikih. V randomizirani, kontrolirani intervencijski raziskavi je sodelovalo 32 HD bolnikov, ki so bili naključno razdeljeni v eksperimentalno (n = 16) in kontrolno skupino (n = 16). Bolniki v eksperimentalni skupini so med dializo trikrat tedensko v 12-tedenski intervenciji izvajali kombinacijo 30–45-minutnega kolesarjenja na prilagojenem kolesu in kognitivnega treninga preko tabličnega računalnika, medtem ko je kontrolna skupina prejemala standardno HD oskrbo. Meritve so vključevale koncentracijo serumskega BDNF, subjektivno zaznavanje mentalne utrujenosti (vizualna analogna skala – M-VAS), krhkost (Edmontonova lestvica krhkosti – EFS), kvaliteto življenja (fizična (PCS) in mentalna komponenta (MCS)), kognitivne sposobnosti (Montrealska lestvica spoznavnih sposobnosti – MoCA) ter telesno zmogljivost (test vstani in pojdi – TUG). Statistična analiza je bila opravljena z uporabo parnih t-testov in analize variance za ponovljene meritve (ANOVA-RM) ter s Pearsonovim korelacijskim koeficientom. Rezultati so pokazali, da je eksperimentalna skupina dosegla značilen upad zaznavanja mentalne utrujenosti (p = 0,042) in značilno izboljšanje rezultata MoCA testa (p < 0,001) ter TUG testa (p < 0,001). Eksperimentalna skupina je ohranila vrednosti BDNF, medtem ko se je v kontrolni skupini koncentracija značilno znižala (0,006). Ugotovljena je bila negativna povezanost med spremembo koncentracije BDNF in spremembo mentalne utrujenosti pri celotnem vzorcu (r = -0,554; p = 0,001). Krhkost se je v eksperimentalni skupini zmanjšala (čeprav neznačilno), pri kontrolni pa značilno poslabšala (p = 0,011). Zaključki raziskave kažejo, da kombinirana intervencija med-dializnega kolesarjenja in kognitivnega treninga lahko pozitivno vpliva na zmanjšanje mentalne utrujenosti, izboljšanje kognitivnih in telesnih sposobnosti ter s tem prispeva k večji kakovosti življenja HD bolnikov. Ti rezultati podpirajo vključitev takšnih intervencij v redno klinično prakso, s čimer bi se lahko zmanjšale negativne posledice gibalnega in kognitivnega upada ter krhkosti v tej populaciji.

• Jezik: Slovenski jezik
• Ključne besede: hemodialzni bolniki, kognitivne sposobnosti, gibalne sposobnosti, med-dializna telesna vadba, kognitivni trening
• Vrsta gradiva: Magistrsko delo/naloga
• Tipologija: 2.09 - Magistrsko delo
• Organizacija: FŠ - Fakulteta za šport
• Leto izida: 2025
• PID: 20.500.12556/RUL-170214
• COBISS.SI-ID: 244209667
• Datum objave v RUL: 02.07.2025

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Physical and cognitive exercise to mitigate functional decrease in hemodialysis patients

Izvleček

Due to the aging population of hemodialysis (HD) patients and the increased burden resulting from physical and cognitive decline as well as frailty, implementing targeted interventions to prevent functional decline is urgently needed. The aim of this Master's thesis was to assess the effect of intradialytic cognitive training combined with intradialytic cycling on the concentration of brain-derived neurotrophic factor (BDNF), perception of mental fatigue, degree of frailty, quality of life, cognitive abilities, and physical performance in HD patients. In a randomized, controlled intervention study, 32 HD patients participated and were randomly assigned to an experimental group (n = 16) and a control group (n = 16). Patients in the experimental group performed a combination of 30–45-minute cycling on an adapted cycle and cognitive training via a tablet computer three times per week during dialysis over a 12-week intervention period, while the control group received standard HD care. Measurements included serum BDNF concentration, subjective perception of mental fatigue (visual analog scale – M-VAS), frailty (Edmonton Frailty Scale – EFS), quality of life (physical [PCS] and mental [MCS] components), cognitive abilities (Montreal Cognitive Assessment – MoCA), and physical performance (Timed Up and Go test – TUG). Statistical analyses were conducted using paired t-tests, repeated measures analysis of variance (ANOVA-RM), and Pearson’s correlation coefficient. The results showed that the experimental group achieved a significant reduction in the perception of mental fatigue (p = 0.042) and significant improvements in MoCA (p < 0.001) and TUG test results (p < 0.001). The experimental group maintained their BDNF values, whereas the control group experienced a significant decrease in concentration (p = 0.006). A negative correlation was found between the change in BDNF concentration and the change in mental fatigue across the entire sample (r = -0.554; p = 0.001). Frailty decreased (albeit insignificantly) in the experimental group, while it significantly worsened in the control group (p = 0.011). The study’s conclusions indicate that a combined intervention of intradialytic cycling and cognitive training can positively impact the reduction of mental fatigue, as well as improve cognitive and physical abilities, thereby contributing to a higher quality of life in HD patients. These results support the integration of such interventions into routine clinical practice to help mitigate the negative consequences of physical and cognitive decline and frailty in this population.

• Ključne besede: hemodialysis patients, cognitive abilities, motor abilities, intradialytic physical exercise, cognitive training