Intervention
shoulder abduction, shoulder horizontal abduction, AV fistula, fistula, adduction
Subjects in the intervention group performed concurrent intradialytic exercise during the 2nd hour of dialysis (60-min exercise sessions three times a week) for 6 months. The intervention was a combination of aerobic and resistance exercises. Workout time at the beginning was 30 min and gradually increased to 60 min. Each workout session included 5 min of warm-up, aerobic exercises, resistance exercises and finally 10 min of stretching exercises to cool down. The fistula arm was kept stationary thoroughly the exercise session, with necessary precautions taken into consideration. Also, the exercise protocol was not performed on the arm with AV fistula.Exercises were individualized in a way that matched the level of physical fitness of participants (See Aditional File 1). Aerobic exercises consisted of continuously performed specified movements, such as moving legs back and forth, shoulder abduction and adduction (hand without fistula), flexing and extending the knee, internally and externally rotating the leg, and abducting and adducting the leg, in time with a played beatThe rhythm of continuous movements was adjusted by the beats per minute of the music. This meant that participants had to coordinate the movements of their arms and legs with the beats per minute of the song being played to them. In this way, the speed and intensity of aerobic exercise was controlled by the rhythm. Resistance training was performed in a semi-recumbent position and included exercises for the upper and lower limbs as well as core strength exercises using body weight, weight cuffs, dumbbells, and elastic bands of varying intensity. Chest press, shoulder press, triceps extension, straight arm shoulder flexion, shoulder horizontal abduction,seated row, supine grip, prone grip, neutral grip, bicep curl, leg abduction, plantarflexion, dorsiflexion, straight-leg/bent knee raises, knee extension, and knee flexion were all part of the resistance training program.All of the exercises were prescribed by an exercise physiologist. He accompanied patients to monitor the performance of the exercises. If the patient had a problem in performing the exercises, he helped them and answered any questions raised. At the end of each session, the exercise physiologist reviewed the adherence checklists. If a person had not attended an exercise session, a counseling session were held with the presence of a nephrologist and the exercise physiologist. The reason for the individual's non-participation was investigated and the positive effects of exercise were explained through motivational statements. In addition, if possible, the positive effects of exercise that have had happened to them so far were explained as an incentive for them to participate more in training sessions.Participants in the control group did not undertake any specific physical activity during dialysis. All participants were followed for 12 months.All other pharmacological, dialysis, dietary and management protocols were identical for participants in both groups. (Despite of differences between some hematological parameters at baseline, different medications were not used for intervention group.) All participants received normal bicarbonate hemodialysis, which was carried out three times a week for an average of 4 h. Volumetric ultrafiltration control was available on all machines. The standard dialysate flow rate was 500 mL/min and blood flow rates were prescribed according to the participant’s needs. Automated methods were applied to perform dialyzer reuse uniformly.