SP440
ACTIVE AGING ON HEMODIALYSIS: AN ADAPTED LOW INTENSITY EXERCISE PROGRAMME IN ELDERLY PATIENTS

Introduction and Aims: Elderly patients on hemodialysis (HD) are a steady increase group. These are characterized by their high complexity, dependency and comorbidity. Multiple benefits of exercise in HD patients have been described; although they have not been specifically evaluated in the elderly population.

The aims were:1.-To analyze the effect of an adapted low intensity intradialytic exercise programme on muscle strength, functional capacity and quality of life in our elderly patients (> 75 years) in HD.2.-To analyze if an intradialysis training program could improve body composition, nutritional parameters and the hormonal anabolic system in these patients.

Methods: A 12 weeks single-center prospective study. HD patients were assigned into exercise training (ET) or control group (C).ET included a combined physical fitness using balls, weights, elastic bands and cycle movements in the first two hours of HD session. C receieved standard HD care. Analized data:(1). Nutritional data (albumin, prealbumin, ferritin and C Reactive Protein, CRP) and lipid profile (triglycerids, total cholesterol and its fractions) biochemical data. (2). Maximum quadriceps length strength (MQLS) and hand-grip dominant arm (HG). (3). Functional capacity tests:“Sit to stand to sit" (STS10) and “six-minutes walking test”(6MWT). (4). Health questionnaire: EuroQol-5D (EQ-5D). (5). Body composition determined by electrical biompedance (EBI). (6). Anabolic Hormones system: Insulin Growth Factor-I (IGF-I), Insulin Growth Factor Binding Protein 3 (IGFBP-3) and ratio IGF-I/IGFBP-3.

Results: 22 patients included.50% male. Mean age 83.2 years and 44.1 months in HD. Charlson index: 9.5. Main ethiology: DM (36.4%) 11 patients assigned to group E and group 11 to C. No related adverse effects were observed. At the end of the study, E group globally improved the tests performed (* p <0.05): MQLS 10.5 ± 7.6 vs 12.9 ± 10.1 kg, HG * 16.6 ± 8.7 vs 18.2 ± 8.9 kg, STS10 * 29.9 ± 10.6 vs 25 ± 7.87 sec, and 6MWT * 14.6%, 234.4 vs 274.7 m and EQ-5D 49 ± 19.1 vs 59.5 ± 20.3. Non significant lower body fat percentage (FAT) (33.2 ± 13.1 vs 32.8 ± 12.8) and higher musculoskeletal tissue percentage (27.2 ± 6.5 vs 28.2 ± 6.2) were observed in ET at the end of the study. No significant changes were observed in both groups in relation to IGF-I, IGFBP-3 and IGF-I/IGFBP-3 ratio. However, additional changes in other routine biochemical HD or dialysis adequacy parameters and anthropometric data at the end of the study were found.

Conclusions: (1). An adapted low intensity exercise programme improved muscle strength, functional capacity and quality of life in our elderly patients on HD and stand out the benefits of exercise in HD patients, even in this elderly population. 2.- Although exercise training was beneficial in terms of physical function and muscular strength, we did not found relevant changes on nutritional data, body composition and the hormonal anabolic system in our elderly HD patients. 3.- Despite an elderly HD patient, we should consider to implement an adapted low intensity intradialytic exercise as a part of comprehensive care.