Intervention
AV fistula, fistula, shoulder horizontal abduction
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 Additional File The 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 who also monitored the exercise sessions and helped patients with any questions they had. At the end of each session, the exercise physiologist reviewed the adherence checklists. If a person did not attend an exercise session, a counseling session was held in 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. When possible, patients were reminded of previous benefits of exercise they had experienced as an incentive for them to increase adherence with the training.Participants in the control group did not undertake any specific physical activity during dialysis.All other pharmacological, dialysis, dietary and management protocols were identical for participants in both groups and remained unchanged during the study. Despite differences in some hematological parameters at baseline, different medications were not used for intervention group. Major medications related to abnormalities in Ca, P and PTH included phosphate binders like lanthanum carbonate calcium and sevelamer hydrochloride, calcitriol, calcimimetic, and Ca supplement. 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.