Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Articles Volume 6 Issue 7

Intradialytic Exercise (IDE) for CICU Patients in Heart Hospital -A Quality Improvement Program

Dineshkumar Selvamani1*, Syed Abdul Ansari2, Prince Mathew1, Mincy Thomas1, Julie Ureta1, Janet Cynthia1, Rakhi Singh T3, Suhib Abdul Kareem Bani Amer1, Amal Lahmer1, Gigi Mathew1, Theodoros Papasavvas1, Daniel Martinez-Bussion1, Khaled Mohamed1

1Department of Cardiac Rehabilitation, Hamad Medical Corporation, Qatar
2Cardiac Rehabilitation Department, Harefield Hospital, Royal Brompton and Harefield Hospitals, London, UK
3Community Cardiac Rehabilitation, NHS, Plymouth, UK

*Corresponding Author: Dinesh Kumar Selvamani, Department of Cardiac Rehabilitation, Hamad Medical Corporation, Qatar.

Received: May 05, 2023; Published: June 17, 2023


Problem statement: The rehabilitation of patients receiving dialysis plays an extension of healthy life expectancy. However, the consecutive rehabilitation interventions are difficult to implement due to worsening of physical conditioning or time constraints among patients undergoing dialysis. Reduced kidney efficiency is linked to a progressive deterioration in cardiovascular health, ultimately leading to heart failure, myocardial infarction, and stroke [1]. Currently, efforts to exercise during dialysis are increasing from the viewpoint of continuity and efficiency of exercise [2]. Comprehensive interventions are necessary due to the complex nature of patients in the CICU. Muscle atrophy is associated with poor physical performance [3].

Aim: “To implement Intra dialytic exercise (IDE) to ≥ 95% of patients undergoing dialysis (between the 1st and 2nd hours) in Coronary Intensive Care Unit (CICU) by November 2021”. Interventions: A staff survey was conducted to assess the need for IDE program in the CICU. An evidence-based IDE protocol was created for HD patients. All the HD patients aged above16 years both male and female genders in the CICU were screened for eligibility for the IDE program. Then, the IDE protocol was initiated for hemodynamically stable patients along with mobilization and at least two exercise sessions per week. Based on each patient’s level of mobility, the IDE protocol was implemented. Supine cycle ergometer in the CICU made patients actively involved in the IDE program. The ICU mobility scale was used to measure the progression.

Results: The total number of patients included in the project from 1st March to Nov 2021 was 84, including both males and females. In May 2021, 50% of patients were included in the project. In July 2021, 66.6% of patients were included. Then, in August, the proportion reached to 100%. As a result of this program, more than 95% of patients participated in the IDE program by November 2021.

Conclusion: It is feasible to implement the IDE program among CICU patients after screening patients using a customized protocol.

Keywords:Intradialytic Exercises; Kidney Failure; Critical Care Patients; Quality Improvement Program


  1. Johansen KL., et al. “Muscle atrophy in patients receiving hemodialysis: effects on muscle strength, muscle quality, and physical function”. Kidney International 63 (2003): 291-297.
  2. Isoyama N., et al. “Comparative associations of muscle mass and muscle strength with mortality in dialysis patients”. Clinical Journal of the American Society of Nephrology 9 (2014): 1720-1728.
  3. Matsubara Y., et al. “Sarcopenia is a prognostic factor for overall survival in patients with critical limb ischemia”. Journal of Vascular Surgery 61 (2015): 945-950.
  4. Matsuzawa R., et al. “Exercise training in elderly people undergoing hemodialysis: a systematic review and meta-analysis”. Kidney International Reports 2 (2017): 1096-1110.
  5. Heiwe S and Jacobson SH. “Exercise training foradults with chronic kidney disease”. Cochrane Database of Systematic Reviews 10 (2011): CD003236.
  6. Song WJ and Sohng KY. “Effects of progressive resistance training on body composition, physical fitness and quality of life of patients on hemodialysis”. Journal of Korean Academy of Nursing 42 (2012): 947-956.v
  7. Stack AG., et al. “Association of physical activity with mortality in the US dialysis population”. American Journal of Kidney Diseases (2005): 690-701.
  8. Chen JL., et al. “Effect of intra- dialytic, low-intensity strength training on functional capacity in adult haemodialysis patients: a randomized pilot trial”. Nephrology Dialysis Transplantation6 (2014): 1936-1942.
  9. Borg G and Linderholm H. “Exercise performance and perceived exertion in patients with coronary insufficiency, arterial hypertension and Vaso regulatory asthenia”. Acta Medica Scandinavica 187 (1970): 17-26.
  10. Faulkner J., et al. “Prediction of maximal oxygen uptake from the ratings of perceived exertion and heart rate during a perceptually-regulated sub-maximal exercise test in active and sedentary participants”. European Journal of Applied Physiology 101 (2007): 397-407.
  11. Johansen KL. “Exercise in the end-stage renal disease population”. Journal of the American Society of Nephrology 18 (2007): 1845-1854.
  12. N Kossari., et al. “Bioreactance: A new Tool for cardiac output and thoracic fluid content monitoring during hemodialysis”. Hemodialysis International4 (2009): 512-517.
  13. P Painter. “Determinants of Exercise Capacity in CKD Patients Treated with Hemodialysis”. Advances in Chronic Kidney Disease6 (2009): 437-448.
  14. Banerjee CH Kong and K Farrington. “The haemodynamic response to submaximal exercise during isovolaemic haemodialysis”. NephrologyDialysis Transplantation6 (2004): 1528-1532.
  15. E Konstantinidou., et al. “Exercise training in patients with end stage renal disease on hemodialysis: comparison of three rehabilitation programs”. Journal of Rehabilitation Medicine1 (2002): 40-45.
  16. MT Liao., et al. “Intradialytic aerobic cycling exercise alleviates inflammation and improves endothelial progenitor cell count and bone density in hemodialysis patients”. Medicine (Baltimore)27 (2016): e4134.
  17. Makhlough E Ilali., et al. “Effect of intradialytic aerobic exercise on serum electrolytes levels in hemodialysis patients”. Iranian Journal of Kidney Diseases2 (2012): 119-123.
  18. S Ouzouni., et al. “Effects of intradialytic exercise training on healthrelated quality of life indices in haemodialysis patients”. Clinical Rehabilitation1 (2009): 53-63.
  19. E Segura-Orti and KL Johansen. “Exercise in haemodyalisis patients: a literature systematic review”. Nefrologia 2 (2010): 236-246.
  20. Kono K., et al. “Investigation of factors affecting the six-minute walk test results in hemodialysis patients”. Therapeutic Apheresis and Dialysis 18 (2014): 623-627.
  21. Steffen TM and Mollinger LA. “Age- and gender-related test performance in community-dwelling adults”. Journal of Neurologic Physical Therapy 29 (2005): 181-188.
  22. Segura-Orti E and Martinez-Olmos FJ. “Test-retest reliability and minimal detectable change scores for sit-to-stand-to-sit tests, the six-minutewalk test, the one-leg heel-rise test, and handgrip strength in people undergoing hemodialysis”. Physical Therapy 91 (2011): 1244-1252.
  23. CP Rizzioli E., et al. “Padova, Italia: Physical exercise during hemodialysis session: effect on quality of life”. Giornale Italiano di Nefrologia30 (2004): S236-240.
  24. National Kidney Foundation. “K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients”. American Journal of Kidney Diseases 45 (2005): S128Y53.
  25. Flythe JE., et al. “Rapid fluid removal during dialysis is associated with morbidity and mortality”. Kidney International 79 (2011): 250Y7.
  26. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 9th Philadelphia (PA): Lippincott Williams and Wilkins (2014): 305.
  27. Smart NA and Steele M. “Exercise training in haemodialysis patients: a systematic review and meta-analysis”. Nephrology 16 (2011): 626Y32.
  28. Greenwood SA., et al. “Intra-dialytic exercise training: a pragmatic approach”. Journal of Renal Care 40 (2014): 219Y26.
  29. Department of Health, Social Services and Public Safety, Scottish Government, Welsh Government, Department of Health. Start Active, Stay Active: A Report on Physical Activity from the Four Home Countries’ Chief Medical Officers (2011).
  30. Colberg SR., et al. “Exercise and type 2diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Exercise and type 2 diabetes”. Medicine and Science in Sports and Exercise 42 (2010): 2282-2303.
  31. Fleg JL., et al. “Secondary prevention of atherosclerotic cardiovascular disease in older adults: a scientific statement from the American Heart Association”. Circulation 128 (2013): 2422-2446.
  32. Christoforos D Giannakihe. “The Effect of Prolonged Intradialytic Exercise in Hemodialysis Efficiency Indices”. ASAIO Journal 3 (2011): 213-218.
  33. Chan CT and Li PK. “The effects of exercise on physical function, muscle muscle strength, and depression in hemodialysis patients”. American Journal of Physical Medicine and Rehabilitation10 (2010): 831-838.
  34. Duncun LW., et al. “Phsical activity during hemodialysis and changes in body mass, strength and functional status”. Journal of Renal Nutrition2 (2008): 54-62.
  35. Fernandez-Rojo MA., et al. “Intradialytic exercise improves functional capacity in patients undergoing hemodialysis”. Americal Journal of Kidney Disease3 (2010): 462-469.
  36. Zhang Y., et al. “Effects of exercise training on physical function, quality of life and mortality in hemodilysis patients: a systematic review and meta analysis”. Journal of Clinical Nursing30 (2021): 375-338.


Citation: Dineshkumar Selvamani., et al. “Intradialytic Exercise (IDE) for CICU Patients in Heart Hospital -A Quality Improvement Program”.Acta Scientific Orthopaedics 6.7 (2023): 38-47.


Copyright: © 2023 Dineshkumar Selvamani., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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