EFFECT OF EXERCISE DURING DIALYSIS ON QUALITY-OF-LIFE FOR INDIVIDUALS WITH END-STAGE RENAL DISEASE. Ann M. Wilson; Nader Jabbour; Jamie Wilde*; Ryan Yorimoto; Kathleen Hummel-Berry Physical Therapy, University of Puget Sound, Tacoma, WA PURPOSE: The purpose of this study was to examine the effects of a low-level exercise program during hemodialysis on health-related quality-of-life in individuals with end-stage renal disease (ESRD), using the Kidney Disease Quality-of-Life (KDQOL) questionnaire developed by the RAND Corporation as an outcome measure. BACKGROUNDS/SIGNIFICANCE: According to the United States Renal Data System, there are approximately 360,000 individuals receiving dialysis in the United States. This number is projected to increase to approximately 600,000 by the year 2010. Many people with ESRD experience depression, fatigue and deconditioning. Although there is currently not a cure for this disease, enhancing function and improving quality-of-life are appropriate goals for this population. The physical benefits of exercise for this population include decreased fatigue, decreased blood pressure, decreased uremia levels and decreased muscle cramping. Exercise can help these individuals regain a level of fitness that will help them become more active, which may be expected to help improve health-related quality-of-life. Current trends in health care suggest that quality-of-life measures such as the KDQOL questionnaire are appropriate measures for chronically ill populations. Research suggests that individuals who exercise during hemodialysis have better adherence to the program than those who exercise on their non-dialysis days, but no previous study has investigated whether exercise during hemodialysis improves health-related quality-of-life. Therefore, the investigators chose to do the intervention portion of this study during regular hemodialysis sessions. SUBJECTS: The study sample was comprised of five participants, three males and two females, ranging in age from 57-81. In addition to having a primary diagnosis of ESRD requiring hemodialysis, all of the participants had at least one of the following co-morbidities that contribute to the development of kidney failure: hypertension, diabetes mellitus or coronary artery disease. METHODS AND MATERIALS: The study was conducted in the out-patient dialysis center at a major medical center in Tacoma, Washington. The study was an A-B single subject design with repeated enrollment. Potential study participants were screened by their physician and a member of the dialysis team for cardiovascular problems or other co-morbidities that may have prevented them from exercising safely. Each participant was asked to complete the KDQOL questionnaire during three consecutive dialysis sessions prior to beginning the intervention phase. The intervention phase consisted of a supervised low-level exercise program during dialysis, three times per week for a period of five weeks. Low-level exercise was defined as arm and leg exercises that could be completed while sitting in a reclining chair, at a level of intensity that did not exceed a Rating of Perceived Exertion (RPE) of 16 on a scale of 6-20 where 20 is the maximum. Specific exercises were selected based on a physical assessment, the location and type of vascular access site used for hemodialysis, the participant's present functional level, interests and personal goals. The exercise program consisted of warm up/cool down exercises, gentle aerobic activities and/or strength training specific to the needs of each participant, as well as a home exercise program designed to maximize functional abilities. The KDQOL questionnaire was administered upon completion of the intervention phase and again two months post- intervention. ANALYSES: Baseline, discharge and two-month follow-up data from the KDQOL questionnaires were scored for each participant using the scoring program from the RAND Corporation and were analyzed graphically. RESULTS: Graphical representation of the data suggest that exercise has a positive effect on the items on the KDQOL concerned with symptoms/problems associated with ESRD, the burden of kidney disease and sleep. The data illustrate no change in work status and a slight decline on the items concerned with cognitive function and quality of social interactions. CONCLUSIONS: The preliminary results of this study support the premise that exercise can improve some aspects of health-related quality of life in individuals with ESRD. Further studies are needed to determine the long-term benefits of exercise during dialysis on quality-of-life. FUNDING SOURCE: None KEYWORDS: end-stage renal disease, exercise, quality-of-life Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. Educators, students, and other academic customers may receive permission to reprint copyrighted material from Physical Therapy (ISSN 1538-6724) by contacting the Copyright Clearance Center Inc, 222 Rosewood Dr, Danvers, MA 01923. Other types of customers who want permission to reprint should contact the APTA Editorial Office, Attn: Physical Therapy.