Effect of muscle stretching and isometric exercises on quality of life in children undergoing regular hemodialysis

Global Kidney Trials Insights: A guide for Everyone

Effect of muscle stretching and isometric exercises on quality of life in children undergoing regular hemodialysi

Global Kidney Trials Insights: A Guide for Everyone

1. The Question for Investigation

Can exercise during regular hemodialysis help children with kidney failure feel and function better in daily life?

To answer this question, research scientists conducted a study with 68 children who received regular hemodialysis. The children were divided into two groups. One group did a simple exercise program during each dialysis session, and the other group received regular care without exercise. The exercise program lasted 2 months. Children in the exercise group stretched their legs for 20 minutes and did simple strength exercises during dialysis for another 20 minutes. A physical therapist taught them how to do the exercises safely.

The goal was to see if exercise could help the children feel better in daily life. This was measured using a survey that asked about how they felt physically, emotionally, socially, and in school.

Most of the children were boys (65%) and between 14 and 18 years old. Many had been on dialysis for 1 to 5 years, and most had kidney problems since birth.

2. The findings of the study

After 2 months, the children who did exercises reported feeling much better in all areas of life. Their total scores improved significantly. They had better physical health, felt less worried or sad, got along better with friends, and did better in school. The children who did not do exercises did not show any real improvement in how they feel and function.

At the beginning, most children in both groups had a poor quality of life. But at the end of the exercise program, only 20% of the exercise group still felt this way, compared to 86.7% of the group that didn’t exercise.

· Why this matters

Children with kidney disease may feel unwell in many ways and often don’t get enough physical activity. This study showed that doing simple exercises during dialysis is safe and can really help kids feel better.

· Things to keep in mind

This study was done in only one hospital and included a small number of children, so we don’t know whether this exercise program also helps other children in other hospitals and countries to feel and function better. The exercise program lasted only 2 months, so we don’t know if

the benefits will last longer and whether children would stay active for more than 2 months. We also don’t know if the exercises have helped them get stronger and fitter, as assessed by objective criteria.

More research is therefore needed with larger groups of children and for longer periods of time. New ideas, like using games to make exercise more fun, might also help more kids stay active during dialysis. Overall, this study presents a promising, inexpensive and safe way for children with kidney failure to have a better quality of life by making them feel better and participate more in daily activities.

This edition was edited by Andrea Viecelli, ISN-ACT Committee Deputy Chair, and Bill Wang, Chair of the Patient Liaison Advisory Group.

Glossaries

Read the GTF editorial team’s review of the SMART trial here.
Access the complete study here.
Any questions? Contact us at research@theisn.org

Glossaries

A person's overall sense of well-being, including how they feel physically and emotionally, and how they are able to manage daily activities and enjoy their life.

A healthcare professional who helps people improve their movement and manage pain through exercises and hands-on care.

Strength exercises where a person tenses their muscles without moving their joints. (For example, pushing palms together).

Adrenal glands are small glands that sit on top of the kidneys.

Efficacy refers to how well a medication or treatment works in achieving its intended effect.

Aldosterone is a hormone produced by your adrenal glands, which sit on top of your kidneys. It's kind of like a chemical messenger that helps regulate the amount of water and salt in your body.

Semaglutide is a medication used to treat type 2 diabetes and help with weight loss. It works by mimicking a hormone (called GLP-1) in the body that helps control blood sugar and appetite. It's usually given as an injection.

Random assignment (or randomisation) is a way of putting people into different groups in a study by chance, like flipping a coin. This helps make sure the groups are similar at the start of the study, so researchers can better tell if a treatment is really working.

Cardiovascular disease refers to diseases that affect the heart and blood vessels. This includes problems like heart attacks, strokes, and heart failure. Diabetes, high cholesterol, high blood pressure, and being overweight can damage the blood vessels and cause cardiovascular disease.

refers to the best way to take care of patients

refers to an event over time that is measured to monitor the impact of a treatment in a given population.

Delayed graft function happens when a transplanted kidney does not start working right away and needs additional support with dialysis to help remove excess fluid and waste from the blood, Delayed graft function can be linked to several problems, including the need for ongoing dialysis until the kidney works well enough, longer hospital stays, a higher risk of kidney failure, and death.

This contains the electrolytes commonly found in our bodies. It has extra minerals like potassium and magnesium that are important to help keep our bodies healthy.

It contains primarily salty water. It is commonly used during and early after the transplant surgery; and

Arteriovenous fistula (AVF): irregular connection between an artery and a vein

Hemodiafiltration, is combining this process with direct fluid removal by adding many tiny holes, also called pores, to the membrane. These pores allow fluid and waste to be passed through more easily, including larger wastes that might not otherwise be removed through dialysis. As this process involves much more fluid being removed, some replacement waste-free fluid is added to the filtered blood before it returns to the body. It is unclear if this approach improves heart health and survival. 

In hemodialysis, wastes are removed from the blood by travelling through a barrier (called a membrane) in the filter of the dialysis machine, which allows wastes to pass through but aims to keep important parts of the blood, like blood cells and protein, in the bloodstream. One challenge of this approach is that some larger wastes (called middle-molecular-weight molecules), do not pass through the barrier very well. The build-up of these wastes may increase the risk of health problems, including for heart health.