Introduction:
Fatigue and reduced physical activity are usual and debilitating among patients undergoing dialysis, significantly impairing their quality of life. While exercise has been shown to mitigate these challenges, the optimal setting and modality for exercise intervention remain unclear. Intra-dialysis exercise is a common practice, yet it is often limited by time constraints and patient adherence. Alternatively, home-based training offers greater flexibility and accessibility, particularly when supported by online supervision. Given the rising use of digital health solutions, it is crucial to evaluate the comparative effectiveness of these exercise interventions to guide best practices in the management of dialysis-related complications. This study aims to address this gap by comparing the impact of intradialytic exercise and supervised home-based tele-exercise on fatigue, physical activity levels, and quality of life in dialysis patients.
Methods:
A randomized controlled trial was conducted involving 74 dialysis patients. Participants were assigned to either an intradialytic exercise group or a home-based tele exercise group, where the latter involved real-time online supervision by a qualified trainer. Both interventions were conducted over 12 weeks. Fatigue was assessed using multidimensional fatigue inventory (MFI), physical activity levels were measured by low physical activity questionnaire (LoPAQ), and quality of life was evaluated using the kidney disease quality of life questionnaire (KDQOL).
Results:
A total of 71 patients were enrolled and completed the study. Both the intradialytic exercise group and the home-based tele exercise group showed significant improvements in quality of life as measured by the KDQOL, with mean scores increasing from 65.8 ± 7.8 to 72.5 ± 5.1 in the intradialytic group (p < 0.05) and from 66.5 ± 6.1 to 74.2 ± 4.2 in the home-based group (p < 0.05). There was no statistically significant difference between the two groups in terms of quality-of-life improvement (p = 0.3).
In contrast, the reduction in fatigue was significantly greater in the home-based training group compared to the intradialytic exercise group (mean reduction of 8.3 ± 2.1 vs. 5.2 ± 3.4, p < 0.01). Additionally, physical activity levels, measured by LoPAQ, increased more significantly in the home-based group, with a mean increase of 880 ± 73.5 kilocalories/week, compared to 690 ± 65.2 in the intradialytic group (p < 0.01).
Conclusions:
This study demonstrates that both intradialytic exercise and home-based training significantly improve the quality of life in dialysis patients, but home-based training with online supervision shows a more pronounced effect in reducing fatigue and increasing physical activity levels. These findings align with previous research suggesting that structured exercise programs can substantially benefit patients undergoing dialysis. However, the superior outcomes associated with home-based training invite further investigation into the underlying mechanisms.
One possible reason for the enhanced effectiveness of home-based training in increasing physical activity is that patients typically experience significant fatigue and reduced physical capacity on non-dialysis days. This fatigue often discourages movement and physical activity. However, engaging in exercise on non-dialysis days could help patients break this cycle of inactivity, leading to gradual improvements in physical performance and overall activity levels. The ability to exercise on non-dialysis days allows patients to better manage their energy levels and potentially improve their functional capacity over time.
Additionally, the flexibility and convenience of home-based training may play a crucial role. Patients are likely more inclined to participate in regular exercise when it can be seamlessly integrated into their daily lives, rather than being restricted to dialysis sessions. The real-time online supervision component is also important, providing continuous motivation, personalized feedback, and adjustments tailored to individual needs—elements that are often constrained during in-clinic sessions due to time limitations and the presence of other patients.
Moreover, exercising in a home environment may alleviate the psychological stress associated with the clinical setting, allowing patients to engage in physical activity in a more relaxed and familiar space. This reduction in stress could contribute to decreased fatigue and improved adherence to the exercise regimen.
In summary, the findings of this study suggest that integrating online-supervised home-based exercise programs into the standard care for dialysis patients may offer a more effective approach for reducing fatigue and enhancing physical activity. Future research should focus on understanding long-term adherence to these programs and determining how different types of exercises can be optimized to maximize outcomes for this patient population.
I have no potential conflict of interest to disclose.
I used generative AI and AI-assisted technologies in the writing process.
During the preparation of this work the author(s) used ChatGPT in order to improve language. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication.