Results of a preliminary study on the subjective patient benefit of physical activity during dialysis

The results of this study confirm a positive user experience of CKD patients who completed assistive ergometer training with the THERA-Trainer bemo during dialysis. The majority of respondents rated the training as fun, pleasant and motivating, indicating that this form of exercise intervention meets with approval among dialysis patients. After only 6 weeks of training during dialysis, the patients confirmed that they felt physically fitter, more balanced, in better shape, more satisfied and happier, and had more energy overall. More detailed interviews with larger groups of patients are necessary to verify the results and to gain further insights into the subjective benefit functions.

It is widely known that patients with CKD conditions receiving haemodialysis benefit from an increase in their physical activity level. Decades of clinical studies on physical activity have shown improvements in various areas of health and quality of life in dialysis patients. The results of the world’s largest multi-centre dialysis training therapy trial with over 1000 patients (DiaTT, see p. 48) were recently published.

The DiaTT trial proves that intradialytic cycling is a particularly effective and at the same time gentle and practicable exercise intervention for kidney patients. During dialysis, patients train their strength and endurance in a recumbent or semi-recumbent position on a motorised bicycle ergometer, which is operated over the bed or dialysis couch.

In addition to clinically measurable parameters that can be demonstrably improved through regular training, the subjective benefit of the intervention for patients is also important for research and clinical practice. To this end, Patient Reported Experience Measurements (PREMs) and Patient Reported Outcome Measurements (PROMS) were collected in our study by conducting acceptance surveys among patients for intradialytic exercise with the THERA-Trainer bemo in several German dialysis centres. PREMs and PROMS are an important complement to standard clinical outcome measures. PREMs, on the one hand, can be influenced by patient expectations and are used in particular to measure subjective experiences. In this case, the satisfaction and direct experience of intradialytic exercise. PROMs, on the other hand, which are also self-reported by the patients, reflect the influences of the intervention on the state of health of the patients, for example relating to vitality, quality of life, symptoms and treatment effects.

The PREM survey consisted of four evaluation dimensions on training with the THERA-Trainer bemo during dialysis:

1. I enjoy training with the bemo;
2. Training with the bemo is very pleasant;
3. Training with the bemo is motivating;
4. Training with the bemo is strenuous.

The participants rated the statements on a 6-point Likert scale from 0 = “not applicable” to 5 = “strongly agree” according to their subjective perception.

The PROM survey consisted of six assessment dimensions on the treatment effects:

1. Training with the bemo makes me feel physically fitter;
2. Training with the bemo makes me feel more physically balanced;
3. Training with the bemo makes me feel in better shape;
4. Training with the bemo gives me more energy overall;
5. Training with the bemo makes me feel more satisfied and happier;
6. Training with the bemo makes me feel safer in everyday life.

PROM ratings of < 3 points on the Likert scale were considered rejected by the subjects and PROM ratings of ≥ 3 points on the Likert scale were considered accepted. The data was collected using paper questionnaires, which were then digitised and then analysed descriptively in Microsoft Excel.

A total of 27 patients from three different dialysis centres participated in the PREM and PROM survey after six weeks of training. The subjects had an average age of 76 (± 8.5) years, with 52% male and 48% female.

The results of the PREM survey show a strong tendency towards a positive user experience with the training. The participants rated the training as fun, pleasant and motivating with a median of 4 out of 5 points each. The training was perceived as moderately strenuous with a median of 2 out of 5 points.

The results of the PROM survey provide first indications of the positive effects of the treatment. Of the 27 participants, 74% said they felt physically fitter after the training. Similarly, 70% said they felt a sense of physical balance.

63% confirmed they felt in better physical shape as a result of the training. In addition, 67% said they had more energy as a result of the training. A pleasing result is also shown in terms of satisfaction and happiness. 56% of the participants felt more satisfied and happier as a result of the training.

It is particularly noteworthy that 37% of the respondents noticed some transfer effects after only 6 weeks of training. This manifested itself in the fact that they felt safer in everyday situations.

Overall, these findings indicate that the training has positive effects on the physical and emotional condition of the participants and may also contribute to an increased feeling of safety in everyday life.

It is important to note that these findings should be considered preliminary and that more comprehensive surveys of larger patient collectives are needed to corroborate the findings. In the future, particular attention should be paid to the PREM factor “motivation”, as it can play a critical role in long-term exercise adherence and the results here show a strong dispersion. An investigation of the correlations between the subjective perception of exertion and the factors of fun, well-being and motivation also appears interesting. In addition, a stronger focus should be placed on PROMs in the future in order to further investigate the subjective treatment effects, particularly with a focus on vitality, quality of life and disease-specific symptoms. It would also be advantageous to evaluate the user experience on the part of the staff who are entrusted with the setup and handling of the technical device.