The Effect of Home-Based Tele-Exercise on Dialysis Patients

Patients with renal failure undergoing maintenance dialysis (HD) therapy typically have very low levels of physical activity (PA), and this is associated with greatly increased morbidity and mortality.

According to studies, regular exercise is beneficial for patients at all stages, and the current recommendations for the prevention and management of side effects in HD patients, especially in the elderly, is regular exercise because it improves physical performance and PA . Currently, due to the unfamiliarity of dialysis center staff and nephrologists with the benefits of exercise, only 10% of the world's clinics have a plan to exercise during HD. Therefore, home-based exercise programs are a suitable option for patients to reduce their costs and make it easy to adhere to.

Home-based exercise has the potential to utilize higher volume and higher intensity training if activity is monitored. However, many of these programs are unsupervised and this is one of the major disadvantages of home-based exercise programs. Lack of prior knowledge about the safety and benefits of exercise programs, fear of injury, and lack of interest or motivation are barriers to exercise at home.

Tele-rehabilitation is rehabilitation services provided to patients from distant locations using information and communication technologies.Several studies have reported the use of e health-based self-management interventions in chronic kidney disease patients.

However, further research is needed to better understand the extent to which these techniques are acceptable, safe and potentially effective for supporting individuals undergoing HD treatment, given their unique needs and risk profile, is unknown. Our study seeks to address this gap by conducting a pilot evaluation of synchronous home-based tele-exercise intervention designed for HD patient.

Participants were recruited and clinically assessed at Khorshid Dialysis Center in Isfahan, Iran. Eligibility screening and baseline and post-intervention clinical assessments were conducted at Khorshid Dialysis Center. The Pardis Specialized Wellness Institute served as the study sponsor and coordinated the study procedures and the design of the home-based tele-exercise intervention. The synchronous tele-exercise intervention was prescribed, coordinated, and delivered online by the Pardis Specialized Wellness Institute.

Inclusion criteria

• Being Aged 18 years and over
• Regular in-center HD 3 times a week
• Completed at least 1 year of stable HD history
• Without myocardial infarction within past 3 months
• Permission from their doctors
• Have decision making capacity to enable them to give informed consent to take part in the study
• Have access to a smart device (e.g. smart phone, laptop or tablet), and have internet access

Exclusion criteria

• Unstable cardiac status (angina, decompensated congestive heart failure, severe vascular stenosis, uncontrolled arrhythmias, etc.).
• Active infection or acute medical illness.
• Hemodynamic instability.
• Labile glycemic control.
• Unstable HD treatment or an ongoing change or titration in the medication regimen.
• Inability to exercise due to severe mobility limitations, although modifications will be permitted for amputations with prosthesis or seated exercise.
• Severe musculoskeletal pain at rest or with minimal activity.
• Inability to sit, stand, or walk unassisted (walking aids such as a cane or walker will be allowed).
• Shortness of breath at rest or during activities of daily living (NYHA Class IV).
• Participation in exercise ≥3 times per week addressing ≥2 exercise domains