World J Nephrol Urol

World Journal of Nephrology and Urology, ISSN 1927-1239 print, 1927-1247 online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Nephrol Urol and Elmer Press Inc

Journal website http://www.wjnu.org

Original Article

Volume 3, Number 2, June 2014, pages 83-91

Psychological and Exercise Intervention Training for Hemodialysis Patients: A Pilot Study

Figure 2. Comparison of selected baseline physical parameters between groups against normal expectations (6MWD were adjusted for age, sex, weight and height; muscle strengths were adjusted for age and sex; steps per day were compared against the recommended value of 10,000 steps per day). Values are expressed as a percentage of the expected value.

Figure 3. Mean change in SF-36 scores between baseline and the end of study. A positive value indicates an improvement at the end of study. The horizontal lines indicate the 95% confidence intervals. IC: white circle; ID: white triangle; CO: black circles.

**Table 1.** Baseline Demographic and Clinical Characteristics
	IC (n = 8)	ID (n = 19)	P value¹	CO (n = 17)	P value²
¹IC vs. CO; ²Intervention arm (IC and ID) vs. control arm (CO). Values (except nominal variables) are expressed in mean (SD).
Age (years)	64 (6)	70 (11)	0.268	67 (15)	0.056
Male gender	7 (88%)	11 (58%)	0.149	9 (53%)	0.276
Dialysis vintage (months)	39 (31)	46 (35)	0.714	50 (38)	0.462
Body mass index	26 (3)	27 (5)	0.165	26 (5)	0.853
Diabetes, n (%)	1 (13%)	7 (37%)	0.216	7 (41%)	0.321
Hypertension, n (%)	6 (75%)	16 (84%)	0.472	14 (82%)	0.635
Myocardial infarct, n (%)	0	3 (16%)	0.331	3 (18%)	0.426
Peripheral vascular disease, n (%)	0	4 (21%)	0.221	2 (12%)	0.574
Cerebral vascular disease, n (%)	1 (13%)	1 (5%)	0.513	3 (18%)	0.285
History of anxiety, n (%)	0	1 (5%)	0.704	0	0.614
History of depression, n (%)	0	2 (11%)	0.487	3 (18%)	0.285
Systolic BP (mm Hg)	137 (15)	139 (14)	0.447	143 (16)	0.348
Diastolic BP (mm Hg)	76 (15)	67 (14)	0.877	70 (13)	0.967
Hb (g/L)	114 (10)	120 (10)	0.856	115 (10)	0.251
Urea reduction ratio	0.74 (0.04)	0.75 (0.03)	0.424	0.76 (0.05)	0.956
Serum albumin (g/L)	37 (4)	36 (3)	0.433	35 (4)	0.528
Total protein (g/L)	66 (4)	67 (5)	0.273	66 (5)	0.651
CRP (mg/L)	8 (3)	19 (7)	0.074	5 (4)	0.587
Phosphate (mmol/L)	1.69 (0.27)	1.54 (0.38)	0.384	1.57 (0.34)	0.838
PTH (pmol/L)	27 (12)	44 (26)	0.053	39 (29)	0.984

Table 1. Baseline Demographic and Clinical Characteristics

IC (n = 8)

ID (n = 19)

P value¹

CO (n = 17)

P value²

¹IC vs. CO; ²Intervention arm (IC and ID) vs. control arm (CO). Values (except nominal variables) are expressed in mean (SD).

Age (years)

64 (6)

70 (11)

0.268

67 (15)

0.056

Male gender

7 (88%)

11 (58%)

0.149

9 (53%)

0.276

Dialysis vintage (months)

39 (31)

46 (35)

0.714

50 (38)

0.462

Body mass index

26 (3)

27 (5)

0.165

26 (5)

0.853

Diabetes, n (%)

1 (13%)

7 (37%)

0.216

7 (41%)

0.321

Hypertension, n (%)

6 (75%)

16 (84%)

0.472

14 (82%)

0.635

Myocardial infarct, n (%)

3 (16%)

0.331

3 (18%)

0.426

Peripheral vascular disease, n (%)

4 (21%)

0.221

2 (12%)

0.574

Cerebral vascular disease, n (%)

1 (13%)

1 (5%)

0.513

3 (18%)

0.285

History of anxiety, n (%)

1 (5%)

0.704

0.614

History of depression, n (%)

2 (11%)

0.487

3 (18%)

0.285

Systolic BP (mm Hg)

137 (15)

139 (14)

0.447

143 (16)

0.348

Diastolic BP (mm Hg)

76 (15)

67 (14)

0.877

70 (13)

0.967

Hb (g/L)

114 (10)

120 (10)

0.856

115 (10)

0.251

Urea reduction ratio

0.74 (0.04)

0.75 (0.03)

0.424

0.76 (0.05)

0.956

Serum albumin (g/L)

37 (4)

36 (3)

0.433

35 (4)

0.528

Total protein (g/L)

66 (4)

67 (5)

0.273

66 (5)

0.651

CRP (mg/L)

8 (3)

19 (7)

0.074

5 (4)

0.587

Phosphate (mmol/L)

1.69 (0.27)

1.54 (0.38)

0.384

1.57 (0.34)

0.838

PTH (pmol/L)

27 (12)

44 (26)

0.053

39 (29)

0.984

**Table 2.** Baseline Outcomes of Interest
	IC (n = 8)	ID (n = 19)	P value	CO (n = 17)	P value
PF: physical functioning; RP: role physical; BP: bodily pain; GH: general health; VT: vitality; SF: social functioning; RE: role emotional, PCS: physical composite summary; MCS: mental composite summary; CDS: cardiac depression scale; EES: exercise efficacy scale; *: for age-matched controls. All values are expressed in mean (SD).
Health related quality of life
SF-36
PF	37 (12)	33 (14)	0.472	41 (11)	0.167
RP	39 (13)	37 (12)	0.807	42 (11)	0.289
BP	48 (14)	35 (13)	0.028	45 (12)	0.238
GH	40 (13)	38 (8)	0.708	41 (10)	0.556
VT	44 (11)	44 (8)	0.974	47 (11)	0.280
SF	44 (10)	39 (12)	0.307	45 (12)	0.300
RE	49 (9)	34 (17)	0.008	37 (14)	0.961
MH	51 (8)	42 (14)	0.072	47 (10)	0.671
PCS	38 (16)	36 (12)	0.747	42 (9)	0.139
MCS	52 (9)	42 (16)	0.060	45 (10)	0.962
CDS	79 (32)	93 (30)	0.299	81 (20)	0.371
EES	121 (42)	82 (28)	0.019	97 (38)	0.788
Physical performance
6MWD (m)	429 (75)	334 (94)	0.018	-	-
% of predicted 6MWD*	78 (12)	74 (25)	0.684	-	-
Time spent recumbent (h)	19 (3)	21 (2)	0.156	-	-
Steps per day (× 1,000)	6.8 (3.5)	3.7 (2.4)	0.063	-	-
Muscle strength (kg)
Chest press	12 (5)	12 (6)	0.962	-	-
Knee extension	17 (5)	16 (5)	0.571	-	-
Hip extension	16 (3)	15 (5)	0.780	-	-

Table 2. Baseline Outcomes of Interest

IC (n = 8)

ID (n = 19)

P value

CO (n = 17)

P value

PF: physical functioning; RP: role physical; BP: bodily pain; GH: general health; VT: vitality; SF: social functioning; RE: role emotional, PCS: physical composite summary; MCS: mental composite summary; CDS: cardiac depression scale; EES: exercise efficacy scale; *: for age-matched controls. All values are expressed in mean (SD).

Health related quality of life

SF-36

37 (12)

33 (14)

0.472

41 (11)

0.167

39 (13)

37 (12)

0.807

42 (11)

0.289

48 (14)

35 (13)

0.028

45 (12)

0.238

40 (13)

38 (8)

0.708

41 (10)

0.556

44 (11)

44 (8)

0.974

47 (11)

0.280

44 (10)

39 (12)

0.307

45 (12)

0.300

49 (9)

34 (17)

0.008

37 (14)

0.961

51 (8)

42 (14)

0.072

47 (10)

0.671

PCS

38 (16)

36 (12)

0.747

42 (9)

0.139

MCS

52 (9)

42 (16)

0.060

45 (10)

0.962

CDS

79 (32)

93 (30)

0.299

81 (20)

0.371

EES

121 (42)

82 (28)

0.019

97 (38)

0.788

Physical performance

6MWD (m)

429 (75)

334 (94)

0.018

% of predicted 6MWD*

78 (12)

74 (25)

0.684

Time spent recumbent (h)

19 (3)

21 (2)

0.156

Steps per day (× 1,000)

6.8 (3.5)

3.7 (2.4)

0.063

Muscle strength (kg)

Chest press

12 (5)

12 (6)

0.962

Knee extension

17 (5)

16 (5)

0.571

Hip extension

16 (3)

15 (5)

0.780

**Table 3.** Changes in Outcomes Between Baseline and Study End
	Mean change (95% CI)	P value
CDS
IC	-7.33 (-25.00 - 10.31)	0.334
ID	-2.38 (-16.75 - 12.00)	0.708
CO	2.29 (-14.56 - 20.13)	0.751
EES
IC	3.83 (-38.07 - 45.73)	0.823
ID	-18.38 (-64.26 - 27.51)	0.375
CO	17.38 (-31.08 - 65.83)	0.425
6MWD (m)
IC	98 (24 - 172)	0.018
ID	-12 (-103 - 80)	0.769
Time spent recumbent (h)
IC	0.15 (-0.86 - 1.16)	0.730
ID	0.70 (-0.29 - 1.70)	0.123
Steps per day
IC	193 (-2,009 - 2,395)	0.857
ID	-1,286 (-3,110 - 573)	0.128
Chest press strength (kg)
IC	5.21 (0.15 - 10.27)	0.045
ID	3.42 (-15.31 - 8.47)	0.248
Knee extension strength (kg)
IC	2.50 (-3.20 - 8.22)	0.324
ID	-4.73 (-9.55 - 0.08)	0.053
Hip extension strength (kg)
IC	1.33 (0.05 - 2.70)	0.057
ID	-1.49 (-5.30 - 2.31)	0.300

Table 3. Changes in Outcomes Between Baseline and Study End

Mean change (95% CI)

P value

CDS

-7.33 (-25.00 - 10.31)

0.334

-2.38 (-16.75 - 12.00)

0.708

2.29 (-14.56 - 20.13)

0.751

EES

3.83 (-38.07 - 45.73)

0.823

-18.38 (-64.26 - 27.51)

0.375

17.38 (-31.08 - 65.83)

0.425

6MWD (m)

98 (24 - 172)

0.018

-12 (-103 - 80)

0.769

Time spent recumbent (h)

0.15 (-0.86 - 1.16)

0.730

0.70 (-0.29 - 1.70)

0.123

Steps per day

193 (-2,009 - 2,395)

0.857

-1,286 (-3,110 - 573)

0.128

Chest press strength (kg)

5.21 (0.15 - 10.27)

0.045

3.42 (-15.31 - 8.47)

0.248

Knee extension strength (kg)

2.50 (-3.20 - 8.22)

0.324

-4.73 (-9.55 - 0.08)

0.053

Hip extension strength (kg)

1.33 (0.05 - 2.70)

0.057

-1.49 (-5.30 - 2.31)

0.300