Hemodynamic tolerance of exercise with virtual reality performed during the first versus the second part of the hemodialysis session

Abstract

Background and Aims It is recommended intradialysis exercise implementation in the first part of the HD session to avoid hemodynamic instability or cramping, but the time restriction to exercise worsens clinical feasibility of exercise as a routine. Exercise using non-immersive virtual reality is a novel rehabilitation method for patients undergoing hemodialysis treatment. This method has shown in a pilot study improved physical function and health-related quality of life.

Objective: to determine effect of exercise with virtual reality during the first two hours and the last two hours of dialysis session on hemodynamic control.

Method The design was a randomized clinical trial. Patients were randomized to exercise in the first (Start group) or last two hours (End group) of dialysis session. Intradialysis exercise consisted of a video game adapted to dialysis: Treasure hunting. It is a non-immersive virtual reality game in which the patient must catch some objectives avoiding obstacles by moving the lower limbs. The exercise session lasted from 20 to 40 minutes. Intensity was checked through the rate of perceived exertion. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), episodes of hypotension and episodes of clinical instability are monitored throughout the session. The intervention has already begun and will continue for twelve months. The control analysis is performed during the three months at rest prior to starting the intervention (Rest) and then the intervention begins, every three months. Now we present the results at thirth month with exercise (Exercise) . An mixed ANOVA of repeated measures is used to assess the effect of the intervention.

Results 43 patients participated, 11 dropouts, 17 in Start group and 15 in End group. Mean age 73 years, males 28. The mean baseline (SD) was Body Mass Index 26.2 (5.5) kg/m2, Overhydration 2.1 (1.3) liters, Kt/V was 1.65 (SD 0.21), Serum Albumin 3.84 (0.29) mg/dl and Hemoglobin 11.81(1.27) g/dl . Analysis by time Rest versus Exercise showed as mean (SD): HR 64 (8) vs 64 (7) bpm, SBP 143 (18) vs 141 (18) mmHg and DBP 61 (10) vs 60 (11) mmHg, no significant differences. The change in measurements at the end of dialysis showed in Rest vs Exercise were HR – 1.34 (5.7) vs -0.9 (5.9) bpm, SBP 1.2 (12) vs 2.65 (16) mmHg and DBP 2.65 (5.8) vs 1.09 (7.1) mmHg, no significant differences. Analysis by groups Start versus End showed as means (CI95%): HR 66 (62,69) vs 63 (59,67) bpm, SBP 145 (136,154) vs 136 (126,146) mmHg and DBP 63 (58,68) vs 56 (50,62) mmHg, no significant differences. The change in measurements at the end of dialysis showed in Start group vs End group neither showed significant differences. There were no differences between the groups regarding episodes of hypotension or clinical instability.

Conclusion Performing intradialysis with virtual reality is well tolerated at any time during the session. This result improves the opportunities to implement exercise in hemodialysis.