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Title:VPLIV GIBALNO-KOGNITIVNE MED-DIALIZNE VADBE NA FUNKCIONALNI STATUS HEMODIALIZNIH BOLNIKOV
Authors:ID Kren, Aljaž (Author)
ID Bogataj, Špela (Mentor) More about this mentor... New window
Files:.pdf DR_Kren_Aljaz_2025.pdf (4,32 MB)
MD5: 7213DDF22791146159BACCCDF0D6ECC0
 
Language:Slovenian
Work type:Doctoral dissertation
Typology:2.08 - Doctoral Dissertation
Organization:UNM FZV - University of Novo mesto - Faculty of Health Sciences
Abstract:Teoretična izhodišča: Bolniki s kronično ledvično boleznijo, ki se zdravijo s hemodializo, doživljajo raznoliko paleto simptomov, kot so zmanjšana telesna pripravljenost, osteoporoza, sarkopenija, utrujenost, krhkost, motnje spanja, sindrom nemirnih nog in upad kognitivnih sposobnosti. Posledica tega je pomembno zmanjšanje funkcionalne zmogljivosti in kakovosti življenja, kar dodatno zmanjšuje telesno in kognitivno aktivnost ter s tem poslabšuje simptome. Do danes še ni jasnih farmakoloških ali nefarmakoloških intervencij, ki bi lahko preprečile ali zmanjšale te škodljive učinke. Pri zdravi starejši populaciji so raziskave prikazale spodbudne rezultate gibalne in kognitivne vadbe, medtem ko so učinki kombiniranih oblik vadbe pri hemodializnih bolnikih slabo raziskani. Metode: Za izdelavo doktorske disertacije smo uporabili kvantitativni raziskovalni pristop z metodo eksperimenta. V centru za kronično hemodializo Leonišče v Ljubljani smo izvedli unicentrično randomizirano kontrolirano klinično raziskavo. Glede na vključitvene in izključitvene kriterije smo naključno razporedili 44 hemodializnih bolnikov v eksperimentalno (n = 22) in kontrolno (n = 22) skupino. Eksperimentalna skupina (65,7 ± 9,7 let) je med hemodializo (trikrat tedensko; 12 tednov) izvajala program med-dializnega kolesarjenja na prilagojenem ergometru in med-dializne kognitivne vadbe na platformi CogniFit na tabličnih računalnikih. Kontrolna skupina (67,2 ± 12,5 let) je bila deležna le standardne hemodializne oskrbe. Primarni izidi raziskave so rezultat pri oceni pozornosti z računalniškim testom sistema pozornosti (test aktivne pozornosti, test deljene pozornosti), rezultat na Montrealski lestvici spoznavnih sposobnosti in rezultat na testu mentalnega sledenja A in B. Sekundarni izidi raziskave so telesna zmogljivost (test 10 ponovitev vstajanja s stola, test moč stiska pesti, test spontane hitrosti hoje, test ravnotežja), vrednosti mediatorjev vnetja (Interlevkin 6 in C-reaktivni protein), vrednost možganskega nevrotrofičnega faktorja in ocena krhkosti (Edmontonska lestvica krhkosti). S testom analize variance z mešanim načrtom za ponovljene meritve med skupinama smo preverjali statistične razlike med skupinama po času za spremenljivke, ki so imele normalno porazdelitev. Za nenormalno porazdeljene spremenljivke smo za primerjavo uporabili test posplošene enačbe ocenjevanja. Rezultati: Raziskavo je zaključilo 43 hemodializnih bolnikov. Vadbena udeležba med-dializnega kolesarjenja je bila 79,9 %, s povprečnim časom 37,6 minut na posamezno vadbeno enoto. Vadbena udeležba med-dializne kognitivne vadbe je bila 84,2 %, s povprečnim časom 30 minut na posamezno vadbeno enoto. Ugotovili smo statistično značilno interakcijo med faktorjema čas in skupina pri testu aktivne pozornosti (p = 0,017), Montrealski lestvici spoznavnih sposobnosti (p < 0,001), testu mentalnega sledenja A (p < 0,001), testu mentalnega sledenja B (p < 0,001), spontani hitrosti hoje (p < 0,001; ?p2 = 0,313) in Edmontonski lestvici krhkosti (p < 0,001). Prav tako ugotavljamo statistično značilen učinek časa pri merjenju moči stiska pesti (p = 0,002, ?p2 = 0,210), testu ravnotežja (p = 0,029), Montrealski lestvici spoznavnih sposobnosti (p < 0,001), Interlevkinu 6 (p = 0,007), faznem kotu (p = 0,003; ?p2 = 0,198) in možganskem nevrotrofičnem faktorju (p = 0,007; ?p2 = 0,218). Razprava: Integracija inovativne, nefarmakološke, bimodalne intervencije med-dializnega kolesarjenja in kognitivne vadbe v standardno hemodializno oskrbo predstavlja celostni pristop k obravnavi hemodializnih bolnikov, ki se je izkazal kot učinkovit, varen ter enostaven za izvajanje med hemodializo, in sicer s pozitivnim vplivom na funkcionalni status bolnikov. Ključne besede: kronična ledvična bolezen, hemodializa, med-dializno kolesarjenje, kognitivna vadba, telesna pripravljenost, kognitivne sposobnosti.
Keywords:kronična ledvična bolezen, hemodializa, med-dializno kolesarjenje, kognitivna vadba, telesna pripravljenost, kognitivne sposobnosti
Year of publishing:2025
PID:20.500.12556/ReVIS-12073 New window
COBISS.SI-ID:233718275 New window
Publication date in ReVIS:27.08.2025
Views:137
Downloads:12
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Secondary language

Language:English
Title:THE IMPACT OF MOTOR-COGNITIVE INTRADIALYTIC EXERCISE ON THE FUNCTIONAL STATUS OF HEMODIALYSIS
Abstract:Theoretical background: Patients with chronic kidney disease undergoing hemodialysis experience a wide range of symptoms, such as reduced physical fitness, osteoporosis, sarcopenia, fatigue, frailty, sleep disturbances, restless legs syndrome, and cognitive decline. These symptoms significantly reduce functional capacity and quality of life, further diminishing physical and cognitive activity and exacerbating symptoms. To date, no clear pharmacological or non-pharmacological interventions have been identified to prevent or mitigate these adverse effects. In the healthy elderly population, research has shown encouraging results for physical and cognitive training, while the effects of combined forms of exercise in hemodialysis patients remain inadequately researched. Methods: For this doctoral dissertation, we employed a quantitative research approach using the experimental method. A unicentric, randomized-controlled clinical trial was conducted at the Center for Hemodialysis Leonišče in Ljubljana. According to the inclusion and exclusion criteria, 44 hemodialysis patients were randomly assigned to the experimental group (n = 22) and the control group (n = 22). The experimental group (65.7 ± 9.7 years) performed an intradialytic cycling program on an adapted ergometer and intradialytic cognitive training on the CogniFit platform using tablets during hemodialysis (three times a week; 12 weeks). The control group (67.2 ± 12.5 years) received only standard hemodialysis care. The primary outcomes of the study are the results of attention assessment using a computerized test of attentional performance (alertness test, divided attention test), the result on the Montreal Cognitive Assessment Test, and performance on the Trail Making Test A and B. Secondary outcomes include physical performance (10-repetition sit-to-stand test, handgrip strength test, spontaneous gait speed, and stork balance test), levels of inflammatory mediators (Interleukin-6 and C-reactive protein), the brain-derived neurotrophic factor concentration and frailty assessment (Edmonton Frail Scale). Statistical differences between groups over time for normally distributed variables were assessed using Repeated Measure ANOVA. For non-normally distributed variables, the generalized estimating equation test were applied. Results: A total of 43 hemodialysis patients completed the study. Adherence to the intradialytic cycling program was 79.9%, with an average duration of 37.6 minutes per individual exercise unit. Adherence to intradialytic cognitive training was 84.2%, with an average session duration of 30 minutes per individual exercise unit. A statistically significant interaction between time and group factors was observed in the alertness test (p = 0.017), Montreal Cognitive Assessment Test (p < 0.001), Trail Making Test A (p < 0.001), Trail Making Test B (p < 0.001), spontaneous gait speed (p < 0.001; ηp2 = 0.313) and the Edmonton Frail Scale result (p < 0.001). We also find a statistically significant effect of time when measuring handgrip strength (p = 0.002, ηp² = 0.210), stork balance test (p = 0.029), Montreal Cognitive Assessment Test (p < 0.001), Interleukin 6 (p = 0.007), phase angle (p = 0.003; ηp2 = 0.198), and brain-derived neurotrophic factor (p = 0.007; ηp2 = 0.218). Discussion: The integration of an innovative, non-pharmacological, bimodal intervention involving intradialytic cycling and cognitive training into standard hemodialysis care represents a comprehensive approach to the treatment of hemodialysis patients. It has proven to be effective, safe and easy to implement during hemodialysis, positively impacting patients' functional status. Key words: chronic kidney disease, hemodialysis, intradialytic cycling, cognitive training, physical fitness, cognitive abilities.
Keywords:chronic kidney disease, hemodialysis, intradialytic cycling, cognitive training, physical fitness, cognitive abilities


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