EFFECTS OF INTRADIALYTIC EXERCISE ON FALLS IN OLDER PATIENTS UNDERGOING HEMODIALYSIS: A SINGLE-CENTER NON-RANDOMIZED STUDY

Abstract BACKGROUND AND AIMS Older hemodialysis patients with low physical function who sustain a fall demonstrate reduced activities of daily living and quality of life. Therefore, it is desirable to examine how improving physical function with exercise therapy affects fall prevention. Several recent studies have shown that intradialytic exercise is effective in improving physical function. However, the effect of intradialytic exercise on falls has not been thoroughly investigated. The purpose of this study was to evaluate the effect of a 3-year, intradialytic exercise program on falls in elderly dialysis patients in a non-randomized, prospective intervention. METHOD In this single-center, prospective, non-randomized, controlled trial, the patients were assigned to either the exercise or control groups. Patients were assigned to the exercise group based on their spontaneous preference for initiation of intradialytic exercise. The inclusion criteria were age ≥70 years, ability to ambulate without assistance. The exercise group was offered 3 years of intradialytic exercise training three times a week. The training program involved both resistance and aerobic training exercises. Four types of resistance exercises were performed using an elastic tube. The aerobic exercise program consisted of 20 min of ergometer cycling. The grip strength (GS), leg extremity muscle strength (LES), short physical performance battery (SPPB) score and 10-min walk speed at baseline were evaluated in both groups. These physical functions were re-evaluated each year in the exercise group only. Falls were monitored during each dialysis treatment. All subjects were followed until the first fall, or until the end of the follow-up period (31 December 2020). The ethical institution at Seirei Christopher University approved all the procedures performed in this study; informed consent was obtained from all the patients. Baseline characteristics and physical function were compared using an unpaired t-test or Mann–Whitney U test. In the exercise group, measurements of physical functioning at the initial 1-, 2- and 3-year time points were conducted using multiple comparison tests. The relationship between exercise intervention and falls was studied using the Kaplan–Meier analysis and the log-rank test. All tests were performed at a statistical significance level of P < 0.05. RESULTS Of the 85 patients, 31 were assigned to exercise groups and 40 to control groups, with the exception of 14 patients who needed walking assistance. In the control group, six patients started to exercise and were excluded from the analysis. Therefore, 65 patients (79.3 ± 6.7 years) were included in this study. There were no significant differences in age, GS, LES, 10-min walking speed, SPPB score, or other laboratory values between the exercise and control groups at baseline. In the exercise groups, 19 patients (61.2%) continued to exercise for over three years; the median duration of exercise was 3 years (interquartile range: 1.25–3 years). The median follow-up time for all subjects was 35 months (interquartile range: 22–35 months), during which 8 (9.4%, 1 of exercise, and 7 of control group) falls were observed; one of the cases had a fracture. The exercise group showed no significant differences in any physical functioning between each measurement time point. However, the exercise intervention was significantly associated with a reduction in falls in the Kaplan–Meier survival analysis and log-rank test. CONCLUSION To our knowledge, this is the first study to show the effect of intradialytic exercise on falls in older adults on HD. This study revealed that physical function did not improve significantly in 3-year intradialytic exercise intervention, contrary to previous studies. However, the effect of exercise on fall prevention in this study supports the results of a previous study in nondialysis patients. This study could provide evidence for the clinical care of older patients undergoing dialysis.