EXERCISE WITH BLOOD FLOW RESTRICTION DURING DIALYIS IS SAFE AND TOLERABLE

MJ CLARKSON1, CA BRUMBY2, SA WARMINGTON1, SF FRASER1, PN BENNETT1, LP McMAHON2

1 Deakin University, Geelong, Victoria, 2 Eastern Health Clinical School, Monash University, Melbourne, Victoria

Aim: To determine the haemodynamic safety and tolerability of blood flow restriction (BFR) during aerobic exercise in satellite haemodialysis (HD) patients.

Background: Individuals with ESKD have reduced exercise capacity and impaired muscle structure and function. Exercise interventions during HD can improve physical function. BFR exercise enhances muscle strength and size utilising exercise intensities traditionally considered insufficient for these adaptions. Investigation of this technique appeals in ESKD, but is yet to be evaluated in this population.

Methods: 10 satellite HD patients underwent a three-phase crossover design of supervised low-intensity aerobic exercise over 2 weeks. Phase 1: 2 bouts (10min) of unrestricted cycling during 2 consecutive HD sessions. Phase 2: 2 bouts of cycling with BFR while off HD on 2 separate days. Phase 3: 2 bouts of cycling with BFR during 2 HD sessions. Participants with known significant or symptomatic cardiovascular disease or haemodynamic instability on HD were excluded. Outcome measures included haemodynamic response (heart rate HR, blood pressure BP) throughout the intervention/HD session, and participant-perceived exertion and perceived discomfort on a Borg rating scale.

Results: All patients completed the study with three possible (minor) adverse events. Haemodynamic responses were consistent regardless of phase-type. Significant increases in HR, systolic BP and mean arterial BP (P<0.05) were observed post each exercise bout, followed by a delayed mean arterial BP reduction of 11.0 ± 1.3 mmHg (P<0.01). Possible adverse events included two episodes of self-resolving symptomatic hypotension, during and after a Phase 3 exercise session. The third was a bruised AVF, presumably caused by movement during cycling on HD.

Conclusions: Haemodynamic safety and tolerability of BFR during aerobic exercise on HD is comparable to standard aerobic exercise.

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