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Background There are still many barriers when implementing exercise routines within daily dialysis care, even though benefits are well-known. Developing cost-effective strategies is necessary to overcome these barriers and include exercise as a complementary therapy in dialysis. Aim To compare several exercise programs on hemodialysis patient's functional capacity and health-related quality of life. Design This study was a 16-week follow-up, two-parallel group trial with balanced randomization. Setting Participants in this study belonged to a private hospitalized care center. Population Referred sample of 71 patients that suffered end-stage chronic kidney disease who underwent hemodialysis for at least 3 months and had a medical stable condition. Methods 36 participants performed during 16 weeks an intradialytic exercise program lead by the nursing staff of the hemodialysis unit and 35 a home-based program supervised by physical therapists of the hospital. Results The main researcher and the data analyst were both blinded to participant allocation. There was a significant effect in time for both groups. Participants improved significantly in the Short Performance Physical Battery (SPPB), One-Leg Heel-Rise (OLHR) and 6 Minute-Walk Test (6MWT), and in the Physical Activity Scale for the Elderly (PASE) and Short Survey Form 36 (SF-36) questionnaires. Conclusions Nurse-led and home-based exercise interventions produce beneficial effects involving physical function, activity levels and health-related quality of life in patients undergoing hemodialysis. Clinical rehabilitation impact The study emphasizes the importance of exercise rehabilitation routines in fragile populations such as dialysis patients, and the potential to overcome barriers for its daily implementation.

Intradialytic exercise (ID) programs are effective and safe for hemodialysis (HD) patients to avoid functional deterioration. However, exercise is not routinely undertaken in most HD units, and we do not know if home-based (HB) programs are as effective as ID programs. The purpose of this study was to compare the effects of 16 weeks of ID exercise versus a HB exercise program for HD patients. A total of 46 patients were randomly assigned to the ID group (n = 24) or HB group (n = 22). They completed a 16-week combined exercise program 3 times/week. We measured physical activity level, physical functioning, depression level, and health-related quality of life at baseline and after 16 weeks. A significant time effect was found in both groups for the physical activity level (p = 0.012). There was also a significant group–time interaction effect for the one-leg standing test (OLST) (p = 0.049) and a significant time effect for the Short Physical Performance Battery (p = 0.013), timed up-and-go test (p = 0.005), sit-to-stand-10 (p = 0.027), right and left hand handgrip (p = 0.044, p p = 0.019), and 6-minute walking (p = 0.006), depression (p = 0.017). HRQoL remained unchanged. There was no difference between the two interventions on the tested outcomes (besides OLST). Both interventions were associated with positive changes of the physical activity levels and physical function.

Introduction There is a lack of supporting evidence for conservative treatments involving Morton’s Neuroma, which has often a clinical presentation with many associated complications such as functional impairment and chronic pain. This case study assessed the effects of a combined physical therapy treatment for Morton’s Neuroma, an injury often referred for surgery. Methods The patient suffered a long-standing Morton’s Neuroma and received 6 combined physical therapy sessions that included soft-tissue massage, joint mobilization, strengthening therapeutic exercises and pain education. Values for pain with deep pressure, pain maladaptive beliefs and functionality were taken using clinical testing and questionnaires. Results After the intervention was successfully completed, pain when applying deep pressure resolved. Functionality involving the toe-to-wall test showed an improvement in ankle dorsiflexion and better results were found in both the LEFS and FAAM questionnaires. Pain maladaptive beliefs, assessed with the Pain Catastrophizing Scale and the Pain Awareness Questionnaire also reflected an improvement. Conclusion A combined physical therapy approach shows encouraging results in the treatment of Morton’s Neuroma.

[EN] Objective The main objective of this investigation was to assess feasibility of conducting a future RCT with an intradialysis non-immersive virtual reality exercise intervention. The secondary aim was to explore the impact of either conventional or VR exercise on physical function. Design Feasibility randomized trial. Participants Eighteen subjects who participated in a 16-week intradialysis combined exercise program. Interventions The program lasted four additional weeks of either combined exercise or virtual reality exercise. Main outcome measures Physical function was measured through several reliable tests (sit-to-stand-to-sit tests 10 and 60, gait speed, one-leg heel-rise tests, and 6-minute walk test) at baseline, after 16 weeks of intradialysis combined exercise and by the end of four additional weeks of exercise. Adherence to the exercise programs was registered. Results There was a significant time effect, so that physical function improved in both groups. By the end of the 20 weeks, function improved as measured through the sit-to-stand-to-sit tests 10 and 60, gait speed, one-leg heel-rise left leg, and the 6-minute walk test. Changes that did not occur due to error in the test were seen after 20 weeks were achieved in the sit-to-stand-to-sit test 60, gait speed, one-leg heel-rise test for the left leg, and 6-minute walking test. Conclusion Virtual reality was a feasible intervention. Both interventions improved physical function. Adherence was not significantly different between groups., Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain, Grant/Award Number: Consolidacion de Indicadores CEU-UCH 2016-2017/I

Este artículo se encuentra disponible en la siguiente URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/1744-9987.12762 En este artículo también participan Erika Meléndez-Oliva, Javier Molina Aracil, María José Murgui Chiva, Olga del Pozo Blanco, Pau Olagüe Díaz, Jose Enrique Fernández Najera, Eduardo Torregrosa de Juan, Caterina Benedito Carrera y Eva Segura-Ortí. This is the peer reviewed version of the following article: García Testal, A., García Maset, R., Hervás Marín, D., Pérez-Domínguez, B., Royo Maicas, P., Rico Salvador, IS. et al. (2019). Influence of physical exercise on the dialytic adequacy parameters of patients on hemodialysis. Therapeutic Apheresis and Dialysis, vol. 23, n. 2 (apr. 2019), pp. 160-166, which has been published in final form at https://doi.org/10.1111/1744-9987.12762. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. Este es el postprint del siguiente artículo: García Testal, A., García Maset, R., Hervás Marín, D., Pérez-Domínguez, B., Royo Maicas, P., Rico Salvador, IS. et al. (2019). Influence of physical exercise on the dialytic adequacy parameters of patients on hemodialysis. Therapeutic Apheresis and Dialysis, vol. 23, n. 2 (apr. 2019), pp. 160-166, que se ha publicado de forma definitiva en https://doi.org/10.1111/1744-9987.12762 It has been suggested that physical exercise in chronic hemodialysis could improve dialysis dose and reduce postdialysis rebound. A randomized controlled trial was performed to compare a group of patients doing physical exercise during the first 2 h of hemodialysis sessions and another group doing physical exercise at home. The descriptive variables, dialysis doses measured by KtV, and rebounds (urea, creatinine, potassium, phosphorus), were recorded. For 69 patients: the mean KtV was 1.84; the 30-min rebound of creatinine was 32.37%, urea 24.39%, potassium 15.31%, and phosphorus 51.29%. For each patient, the basal measurement was compared with those determined when performing physical exercise; no statistically significant differences were observed between the changes determined to dose and rebound in the group with hemodialysis exercise compared to those of the home exercise group. In conclusion, performing physical exercise during the first 2 hours of hemodialysis sessions neither lowered postdialysis molecules rebound nor improved dialysis dose.