AN INTRADIALYTIC EXERCISE AT START VERSUS END OF HD SESSION TO IMPROVE STRENGTH WITH NON-IMMERSIVE VIRTUAL REALITY: A RANDOMIZED CONTROLLED TRIAL

Abstract BACKGROUND AND AIMS Haemodialysis (HD) induces changes in addition to the kidney in other organs or systems so that patients usually present symptoms such as fatigue, generalized muscle weakness and low tolerance to exercise that result in functional impairment, decreased work capacity and dependence for activities of daily living. Intra-dialysis exercise programmes may help to partly reverse this situation. Exercise during the first 2-h of dialysis has proven to be safe. Our group showed that an acute session of virtual reality exercise during the last 30 min of HD was safe too. The aim of this study was to compare the impact of non-immersive virtual reality intra-dialysis during the first 2-h versus the last 2-h of dialysis on lower-limbs muscle strength. METHOD This was a randomized controlled trial. Participants were randomized in two groups: group A performed the exercise during the first and second hour of the HD session and group B performed it during the third and fourth hour. Strength was measured bilaterally with a hand-held Lafayette dynamometer in three movements of the lower limbs (hip flexion, hip abduction and plantar flexion) during the HD session. The intradialytic exercise consisted of a non-immersive virtual reality video game adapted to the dialysis session, in which the patient must catch treasures while avoiding bombs by moving the lower extremities, with a progressive duration of 25–45 min, over a 12-week period. RESULTS A total of 33 subjects were included in the analysis, 17 subjects (median age 71.8 years; 10 men) in group A and 16 subjects (median age 73.3 years, 9 men) in group B. At baseline the period analysed, there were no significant differences between the two groups in any of the movements analysed. The force analysed in the different movements showed that there was a significant increase in all the movements analysed in both groups. There was an increase in force in the movements of the lower right limb of 3.31 N in hip flexion, 2.01 N in hip abduction and 1.10 N in plantar flexion, as well as an increase in the outside in the lower left limb of 3.82 N in hip flexion, 2.47 N in hip abduction and 4.63 N in plantar flexion. There were no significant differences in the increase in strength in the movements analysed between both groups in the movements analysed after the 12-week period analysed. CONCLUSION There are no differences in the application of an intradialytic exercise at the beginning versus at the end of the HD session to improve strength with non-immersive virtual reality. An intradialytic exercise with non-immersive virtual reality improves limb strength in HD patients.