Impacto de um protocolo de exercício físico pré-diálise na capacidade funcional, fadiga e fragilidade de pacientes em hemodiálise

Abstract

INTRODUCTION: Physical inactivity increases the relative incidence of chronic diseases, especially considering that the adult population does not reach the minimum recommended levels. An example of this is individuals with Chronic Kidney Disease undergoing hemodialysis, a tiring and restrictive treatment in which factors such as fatigue, pain, systemic inflammation, decreased muscle strength and functional capacity can make the patient frail. OBJECTIVE: To analyze the impact of a pre-dialysis strength exercise program on functional capacity, levels of frailty and fatigue in people with chronic kidney disease. METHODOLOGY: this is a randomized clinical trial with a quantitative, experimental, analytical and cross-sectional approach, carried out at the Center for the Prevention and Treatment of Renal Diseases - Renal Center (Maceió, AL, Brazil) from January to December 2024. Participants over the age of 18 and who had started hemodialysis treatment at least 3 months previously were eligible. They were randomized by lot into two groups: control with non-resisted movement and experimental with strength training. Data collection included a sociodemographic questionnaire; an international physical activity questionnaire; the Edmonton Frailty Scale; the Piper Fatigue Scale; functional capacity tests (flexibility tests; muscle strength, dynamometry; gait speed tests; sit and stand tests; and stand and walk). The physical intervention protocol in the groups was established three times a week, for 12 weeks, totaling 36 sessions, with 2 to 3 sets of 10 to 15 repetitions and 30'' to 50'' rest. The results were expressed as means and standard deviations, adjusted mean differences between the groups and 95% confidence intervals. The JASP program, version 0.13.1.0, was used for all the analyses. The Shapiro-Wilk test was used to check for homogeneity. For comparison before and after the paired T-test. Intention-to-treat analysis was used. Cohen's d was used to determine the clinical effect size of the interventions. RESULTS: Participants were 58 ± 10.2 years old and had been on dialysis for 16 ± 23.0 months. 63 participants were eligible, eight of whom dropped out. Fifty-five individuals remained for the intentionto-treat analysis, 28 in the control group and 27 in the experimental group. After 36 sessions, 42 (66.6%) had adhered to the protocol and of these, 19 (30.1%) had attended 75% of the training. The control group showed a significant difference in the variables sit and stand (p=0.016), gait speed (seconds) (p=0.001) and total frailty (p=0.045); and the experimental group in the variables sit and stand (p=>0.001), stand and walk test (p=0.018) and gait speed (seconds) (p=0.007). CONCLUSION: The protocol with strength exercises before hemodialysis sessions showed considerable adherence, even if the minimum frequency desired for greater benefits was not achieved by the participants, but it may still have benefits for improving lower limb muscle strength levels, functional performance and frailty.