| Summary: | 博士 === 國立臺北護理健康大學 === 護理研究所 === 103 === Background
Patients with end-stage renal disease under hemodialysis (HD) are associated with dramatically impaired physical function, depression, fatigue, and finally with decreased health-related quality of life (HRQoL). Exercise may be effective in improving physical function, psychological factors and health-related quality of life in these patients. Previous studies have concluded that regular exercise might improve individual’s exercise self-efficacy and resilience, which could play an important role in improving the physical, psychological factors and health-related quality of life in these patients.
Purpose
This study aimed to evaluate the effects of intra-dialytic aerobic and resistance cycling exercise program (ARCEP) on physical function, depression, fatigue, and HRQoL in HD patients, and further confirmed the mediator effects of exercise self-efficacy and resilience in the exercise group.
Methods
This was randomized controlled trial. Data were collected from June, 2013 to August, 2014. Seventy-six maintenance HD patients were included and randomly assigned into control and exercise group, with 38 participants each group. The control group received nursing routine care (n= 31), whereas the exercise group received not only nursing routine care but also a 3-month ARCEP (30 minutes per session, 3 times a week) (n= 27). Data were collected at baseline, 1st month, 2nd month, and 3rd month. Outcome measures include 6 minutes’ walk test (6MWT), time taken to complete 10 sit-to-stand-to-sit cycles (STS-10), and number of sit-to-stand-to-sit cycles in 60 seconds (STS-60), Beck Depression Inventory, fatigue scale, and quality of life scale (WHOQOL-BREF). Mediation effects were measured by the exercise self-efficacy, outcome expectations and resilience scale. Data were analyzed by SPSS 20.0 software. Descriptive statistics were calculated for basic characteristics. The independent t-test and Chi-square test were identically distributed to homogeneity of demographic characteristics. Generalized estimating equation (GEE) examined the repeated measurements data, and difference-in-differences estimation (DID) explored the impact of exercise program on physical function, depression, fatigue, and HRQoL scores in the exercise group.
Results
The data shown, firstly, the score of 6MWT was significantly improved in change over-time between groups in each testing month, i.e. baseline, 1st month, 2nd month, and 3rd month (p= .004, p< .001, p< .001) compared with baseline, respectively, the score of STS-10 was significantly improved in change over-time between groups in each testing month (p= .002, p< .001, p< .001), the score of STS-60 was significantly improved in change over-time between groups in each testing month (p= .01, p< .001, p< .001), the depression score was significantly improved over-time between groups in the second and third month (p= .21, p= .003, p< .001), the fatigue score was significantly improved over-time between groups in each testing month (p= .03, p= .02, p= .001), the HRQoL score was significantly improved over-time between groups in third month (p= .68, p= .66, p= .01). Secondly, significant differences were noted in depression (p= .02), and fatigue (p= .04), using exercise self-efficacy as a mediator in the exercise group, but not significantly differed in physical function (6MWT, p= .62; STS-10, p= .18; STS-60, p= .86), and HRQoL (p= .60) between the groups. Moreover, significant differences over-time noted in depression (p= .001), fatigue (p= .03), and HRQoL (p< .001) with resilience as an effect in the exercise group, but no significant difference was noted with physical function (6MWT, p= .78; STS-10, p= .96; STS-60, p= .17).
Conclusion
The 3-month ARCEP revealed improved physical function, reduced depression, improved fatigue and increased HRQoL. Exercise self-efficacy significantly improves depression and fatigue; and resilience improved depression, fatigue and HRQoL. Thus, HD patients are recommended for regular exercise. Future studies might implement this ARCEP in various medical settings, and examining the longitudinal effects of this intervention.
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