Efeitos de um tratamento com exercícios físicos antes das sessões de hemodiálise sobres desfechos de habilidades motoras: um ensaio clínico randomizado

Abstract

The present study aimed to determine the effects of treatment with physical exercises performed immediately before hemodialysis sessions on motor skills outcomes in patients with chronic kidney disease. Materials and methods: A randomized clinical trial was carried out in a hospital in the city of Pelotas, southern Brazil. Fifty-seven patients from both sexes were randomly assigned to a control group (CG; n=28) and an intervention group (GI; n=29). The intervention period was twelve weeks, with thrice weekly sessions. The GI received balance and strength exercises before starting hemodialysis therapy, for 20 minutes. Regarding the evolution of the loads, the participants performed the maximum number of repetitions in 30 seconds. During the first two hours of the subsequent hemodialysis session, both the GI and CG groups received aerobic training on a cycle ergometer for 20 minutes at the following intensities: weeks 1 to 6 – heart rate between 57 to 63% of maximum heart rate; weeks 7 to 12 – heart rate between 64 to 76% of maximum heart rate. Patients were assessed before and after the intervention. Statistical significance was set at p<0.05 throughout the analysis. The outcome variables were analyzed using the Generalized Estimated Equations (GEE ), followed by the Bonferroni post-hoc test, for comparison between times (pre- and post-intervention) and groups (GI and CG). Statistical analysis by protocol excluded those subjects who participated less than 50% during the entire training period. The comparability of baseline variables between groups was analyzed using Chi-square tests for categorical variables, unpaired t-test for parametric numeric variables, and unpaired Wilcoxon test for non-parametric numeric variables. Results: 42 patients completed the intervention with a minimum frequency of 50% of the sessions, 23 in the CG and 19 in the IG. There was a significant improvement for the variables dynamic balance, lower limb strength and functional capacity in both groups, with no difference between them. Conclusion: An intervention with balance and functional strength exercises performed immediately before the hemodialysis session combined with intradialytic aerobic exercises was as effective as exclusive aerobic training in modifying the motor skills of patients with chronic kidney disease undergoing hemodialysis.