Interdialytic Exercise Can Help Retain Physical Function in Kidney Failure

Martin Halle, MD, PhD
Credit: LinkedIn

Data from a multicenter, randomized controlled trial suggests patients with kidney failure undergoing hemodialysis experienced greater retention of their physical functional ability if they were engaged in physical activity.

A study from the Dialysis Training Therapy (DiaTT) consortium, results indicate patients who were randomized to an exercise intervention had greater retention of physical functioning without increasing the rate of adverse events during dialysis sessions and while reducing the annual median days spent in hospital for these patients.¹

“The limitations imposed by these diseases, and the time required for dialysis, often mean that those affected engage in little physical exercise. We wanted to change that,” said lead investigator Martin Halle, MD, PhD, professor of Preventive and Rehabilitative Sports Medicine at the Technical University of Munich.²

As technology has advanced diagnostic and management practices have led to improved care, a renewed emphasis has emerged in medicine on the role of physical activity and nutrition in disease management. As kidney function declines, many patients undergoing hemodialysis experience declines in their physical, and often times mental health, domains.

With this in mind, Halle and a team of colleagues formed the DiaTT consortium and launched the DiaTT trial to further understand the effects of exercise interventions on physical deconditioning among this patient population. To do so, the DiaTT trial was designed as a multicenter, cluster randomized controlled trial comparing 12-month intradialytic exercises combining endurance and resistance exercise training against usual care among a cohort of patients from 21 dialysis centers in Germany.¹

Overall, the trials randomized 1211 patients. Of these, 917 were included in the full analysis, with 446 representing the exercise cohort and 471 receiving usual care. The cohort included in the full analysis had a mean age of 65.9 (Standard deviation [SD], 14.4) years and 38.9% were female, with diastolic blood pressure values, BMI, and causes of kidney failure similar between the study groups.¹

Of note, those randomized to the exercise intervention received training 3 times per week, which consisted of supervised endurance and resistance exercise during the first 2 hours of hemodialysis and lasting for 60minutes, with 30 minutes dedicated to each mode of exercise.¹

The primary outcome of interest for the trial was change in the 60-second sit-to-stand test (STS60) from baseline to 12 months. Secondary outcomes of interest for the study included the timed up-and-go test, 6-minute walk test, and summary scores on the 46-item Short Form Health survey.¹

Upon analysis, results indicated STS60 repetitions improved from 16.2 (SD, 7.6) at baseline to 19.2 (SD, 9.1) at 12 months among the exercise group compared to a regression from 16.2 (SD, 7.1) at baseline to 14.7 (SD, 7.9) 12 months among the usual care group (Group difference, 3.85; 95% Confidence interval [CI], 2.22 to 5.48; P < .0001). Analysis of secondary endpoints revealed differences favoring the exercise group relative to usual care for the timed up-and-go test (-1.1 seconds; 95% CI, -1.9 to-0.3) and the 6-minute walk test (37.5 meters; 95% CI, 14.7 to 60.4).¹

Further analysis suggested there were physical summary score and vitality subscale of the quality of life questionnaire differences between the groups in favor of the exercise group, but no change was observed for the other subscales. Additionally, investigators out adverse events during dialysis sessions were similar between groups, but the exercise groups had lower median days spent in the hospital annually (2 vs 5 days). Investigators also highlighted mortality and dialysis-specific adverse events were not affected by randomization.¹

“Our study shows how important it is to adopt a holistic view of health, especially when it comes to elderly and infirm patients”, Halle added.² “While high-tech medicine is important, it can only achieve its full potential in combination with other fields, such as preventive medicine.”

References:

1. Anding-Rost K, von Gersdoff G, von Korn P, et al. Exercise during Hemodialysis in Patients with Chronic Kidney Failure. NEJM Evidence. Published online June 17, 2023. doi:10.1056/EVIDoa2300057
2. Technical University of Munich. Dialysis exercise improves health, study says. July 14, 2023. Accessed July 17, 2023. https://www.newswise.com/articles/dialysis-exercise-improves-health-study-says.