BACKGROUND: Patients on maintenance hemodialysis suffer from diminished physical health. Directly supervised exercise programs have been shown to be effective at improving physical function and optimizing well-being. However, nurses seldom include an exercise intervention in the care plan for hemodialysis patients. OBJECTIVES: The purpose of this study was to examine the effects of a 12-week nurse-led case management program on home exercise training for hemodialysis patients. DESIGN: The study was a randomized, two-parallel group trial. SETTINGS: Hemodialysis units in two tertiary hospitals in Nanjing, mainland China. PARTICIPANTS: One hundred and thirteen adult patients who have been in stable condition while on dialysis treatment for more than 3 months were recruited and randomly assigned to either the study group (n = 57) or the control group (n = 56). METHODS: Both groups underwent a brief weekly in-center exercise training session before their dialysis sessions for the first 6 weeks. The study group received additional nurse case management weekly for the first 6 weeks and biweekly for the following 6 weeks. The intervention was to facilitate patients in performing regular exercise at home. Outcome measures, including gait speed, 10-repetition sit-to-stand performance, and quality of life were collected at baseline, and at 6 and 12 weeks into the program. RESULTS: The results revealed that patients in the study group demonstrated greater increases in normal gait speed (F[1,111] = 4.42, p = 0.038) than the control group. For the study group, a mean increase of 12.02 (+/- 3.03) centimeters/second from baseline to week 12 was found. With regard to the fast gait speed, there was a marginally significant between-group effect (F[1,111] = 3.93, p = 0.050). The study group showed a mean improvement of 11.08 (+/- 3.32) cm/s, from baseline to week 12. Patients from both groups showed improvements in their 10-repetition sit-to-stand performance. The between-group differences approached significance (F[1,111] = 3.92, p = 0.050), with the study group showed greater improvement than the control group. The time taken by the patients in the study group to complete the 10-STS test increased by 5.75 (+/- 3.88) s from baseline to week 12. Significant improvements in quality of life across three time points were found only in the study group. CONCLUSIONS: Home exercise using a nurse-led case management approach is practical and effective in improving the physical function and self-perceived health of stable hemodialysis patients.
With permission from Excerpta Medica Inc.

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