Explore the latest ISN-ACT Global Trials Focus selection featuring a “Trial of the Month” on the role of targeted exercises for children on hemodialysis
ISN-ACT Global Trials Focus editorial team member Neeru Agarwal summarizes the design and outcomes of the latest “Trial of the Month” featured in ISN-ACT Global Trials Focus.
Trial of the Month:
Effect of muscle stretching and isometric exercises on quality of life in children undergoing regular hemodialysis
Khalf-Allah et al., Pediatric Nephrology. 2024 39:3289-3299.
Summary
In this single-center study, 68 children on maintenance hemodialysis were randomized to receive either a 40-minute thrice weekly exercise program during hemodialysis for 2 months or routine care.
A trained physical therapy researcher taught the exercises, including lower limb stretches (10 repetitions per muscle) during the first 20 minutes of the second hour of dialysis, followed by isometric strength training (3-5 second holds, 10 repetitions per exercise) during the first 20 minutes of the third hour. The primary outcome was quality of life (QoL) at 2 months, which was assessed using the Pediatric Quality of Life (PedsQL) scale that looked at four domains: physical, emotional, social functioning, and school performance.
The majority of children were male (65%), aged 14-18 years (48%), with congenital anomalies as the leading cause of kidney failure (38%), and had been on hemodialysis for 1-5 years (53%). After 2 months, the intervention group demonstrated a significant improvement in the total PedsQL score (increased from 635.0±502.26 to 1648.33±468.62; p=0.001), whilst the control group remained unchanged (629.69±496.21 to 676.56±520.78).
This improvement was apparent across all four domains in the intervention group: physical function increased from 132.50 to 483.33, emotional functioning from 141.67 to 356.67, social functioning from 195.83 to 419.17, and school performance from 165.0 to 389.17. In contrast, the control group showed minimal change in these domains. At baseline, most children also had poor QoL (83.3% intervention group and 83.4% control group); however, after 2 months, this reduced to 20% in the intervention group and remained unchanged in the control group (86.7%).
Commentary
Children with chronic kidney disease and kidney failure experience reduced physical activity and QoL. While exercise has shown some benefits in improving QoL and physical performance in adults on hemodialysis, similar research in children is limited, and adult findings cannot be directly applied to younger populations.
This study was successful in getting children to exercise during hemodialysis, demonstrating that a simple, cheap intervention involving muscle stretching and isometric exercises during hemodialysis significantly improved total QoL scores and positively impacted all domains. Limitations of this study include its lack of generalizability given the single-center setting, small sample size, lack of objective physical fitness measures such as assessments of cardiorespiratory endurance or muscular strength, and a short two-month follow-up. Thus, it is not clear if long-term engagement in children is sustainable and if the benefits attenuate or continue to improve.
Further studies should explore different forms of exercise across larger populations with different dialysis modalities, utilizing objective assessment tools and strategies like exercise gamification to enhance adherence and evaluate long-term benefits.
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