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Getting healthier with training during dialysis
A groundbreaking study proves it: targeted movement during dialysis improves fitness and cuts hospital stays. Learn how intradialytic training can enhance therapy outcomes – and how your practice might benefit too.
Christian Gorbach
Clinical Applications Specialist, Dialysis
Results of a multicentre study in 21 dialysis centres prove that renal patients benefit from movement exercises
Exercise during dialysis? The evidence for the effectiveness of intradialytic exercise has so far been weak. Study results sometimes yielded contradictory findings. Due to methodological weaknesses of individual studies and a low number of study patients, no clear recommendations for the intervention have been possible so far. Thanks to a large-scale, multicentre trial led by the Technical University of Munich (TUM), it has now finally been proven that patients who follow a targeted movement programme during dialysis are physically fitter and require hospital treatment less often.
The Dialysis Training Therapy (DiaTT) trial, published in June 2023 in the renowned New England Journal of Medicine – Evidence, included an impressive participant group of about 1,000 patients from 21 dialysis centres in Germany. The trial by a consortium of the Technical University of Munich (TUM) led by Martin Halle is currently the world’s most comprehensive investigation of exercise training during dialysis in humans with specific kidney disease.
The Dialysis Training Therapy (DiaTT) trial, published in June 2023 in the renowned New England Journal of Medicine – Evidence, included an impressive participant group of about 1,000 patients from 21 dialysis centres in Germany. The trial by a consortium of the Technical University of Munich (TUM) led by Martin Halle is currently the world’s most comprehensive investigation of exercise training during dialysis in humans with specific kidney disease.
After one year, the participants’ state of health had improved significantly. Among other things, they were able to get up from a sitting position more often within one minute than at the beginning of the trial and to walk longer distances within six minutes.
Interestingly, the composition of participants in terms of age, gender and state of health proved to be representative of the broader population of dialysis patients, as determined by cross-checking the data held by health insurance providers. This supports the generalisability of the findings to the broad population of people with kidney disease in Germany and worldwide.
The trial by a consortium of the Technical University of Munich (TUM) led by Martin Halle is currently the world’s most comprehensive investigation of exercise training during dialysis in humans with specific kidney disease.
The participants were divided into two groups and treated over a period of twelve months. Half of them completed supervised intradialytic training at least once a week and ideally three times a week during dialysis, while the other group received only medical care. The specific training consisted of 30 minutes of endurance training on an ergometer and another 30 minutes of task-specific exercises with weights, resistance bands and balls. The exercises were individually adapted to each patient’s potential in order to ensure optimal implementation.
Significant improvements in standardised tests
After one year, the participants’ state of health had improved significantly. Among other things, they were able to get up from a sitting position more often within one minute than at the beginning of the trial and to walk longer distances within six minutes. In the control group, these values were even lower at the end than at the beginning.
“At first, such standardised tests do not seem very close to everyday life,” Martin Halle explains in a TUM press release. “But, in fact, the results show a gain in quality of life and self-determination. For example, those affected are able to get up from an armchair at home without assistance, which wasn’t always the case previously.” Another sign of the positive effects of the training is that the number of days spent in hospital within the trial period by participants who undertook regular training was only half that of the control group – two days on average compared to five.
After one year, the participants’ state of health had improved significantly. Among other things, they were able to get up from a sitting position more often within one minute than at the beginning of the trial and to walk longer distances within six minutes. In the control group, these values were even lower at the end than at the beginning.
“At first, such standardised tests do not seem very close to everyday life,” Martin Halle explains in a TUM press release. “But, in fact, the results show a gain in quality of life and self-determination. For example, those affected are able to get up from an armchair at home without assistance, which wasn’t always the case previously.” Another sign of the positive effects of the training is that the number of days spent in hospital within the trial period by participants who undertook regular training was only half that of the control group – two days on average compared to five.
“With comparatively little effort, we can improve the health of those affected and also reduce costs for the healthcare system.”
Low costs per training session
As Martin Halle stated in a TUM press release, “For me, the findings are clear.” “With comparatively little effort, we can improve the health of those affected and also reduce costs for the healthcare system.” According to the researchers’ calculations, the cost of individualised training would be around 25 euros per training session and person.
As Martin Halle stated in a TUM press release, “For me, the findings are clear.” “With comparatively little effort, we can improve the health of those affected and also reduce costs for the healthcare system.” According to the researchers’ calculations, the cost of individualised training would be around 25 euros per training session and person.
Positive about the future
This landmark study provides promising insights into how exercise during dialysis can improve the well-being and health of patients with kidney disease. The findings suggest that supervised training during dialysis is a useful adjunct to medical care and can help to reduce hospital stays and improve the quality of life of those affected.
Given these promising results, the researchers recommend that training during dialysis should be implemented as standard. The opportunity to be physically active during treatment could have a significant impact on the health and quality of life of patients and reduce the burden on the healthcare system in the long term.
This landmark study provides promising insights into how exercise during dialysis can improve the well-being and health of patients with kidney disease. The findings suggest that supervised training during dialysis is a useful adjunct to medical care and can help to reduce hospital stays and improve the quality of life of those affected.
Given these promising results, the researchers recommend that training during dialysis should be implemented as standard. The opportunity to be physically active during treatment could have a significant impact on the health and quality of life of patients and reduce the burden on the healthcare system in the long term.
Given these promising results, the researchers recommend that training during dialysis should be implemented as standard.
The DiaTT consortium has already submitted the final report on the trial (financed by the innovation fund set up by the health insurance providers) to the Federal Joint Committee of health insurance providers. This committee will decide whether training during dialysis should be offered to all insured persons. “I hope that our training programme will be covered by the health insurance providers,” Martin Halle adds. “Our trial shows how important it is to take a holistic view of health, particularly for elderly and frail patients. High-tech medicine is important, but it can only reach its full potential in combination with other fields such as preventive medicine.”
Further investigations will certainly be needed in the future. Particularly with regard to understanding the long-term impact of this approach. In the coming years, the trial participants will be followed up in order to learn more about the effects of long-term training.
Further investigations will certainly be needed in the future. Particularly with regard to understanding the long-term impact of this approach. In the coming years, the trial participants will be followed up in order to learn more about the effects of long-term training.
Science
THERAPY 2023-III
THERAPY Magazine
Christian Gorbach
Clinical Applications Specialist, Dialysis
Christian Gorbach specialises in
on the subject of sport during
during dialysis. His experience is based
on his many years of experience
as project manager for dialysis at
THERA-Trainer. He has
broad specialist knowledge and is
with many experts in the industry.
in the industry.
Jakob Tiebel
Health Business Consultant
Jakob Tiebel is OT and studied applied psychology with a focus on health economics. He has clinical expertise from his previous therapeutic work in neurorehabilitation. He conducts research and publishes on the theory-practice transfer in neurorehabilitation and is the owner of an agency for digital health marketing.
References:
- https://www.tum.de/aktuelles/alle-meldungen/pressemitteilungen/details/gesuender-durch-training-waehrend-der-dialyse
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