Exercise training in dialysis patients.

We have observed that both voluntary and electrostimulated muscle exercises during the hemodialysis session increase blood flow, venous return, and muscle perfusion, and in this way can favor the removal of urea nitrogen from the extracellular space and intracellular space, establishing an improvement in dialysis efficacy (2). Our work was carried out on 20 motivated patients on maintenance hemodialysis treatment (11 males and 9 females; mean age 48.5 ± 11.1 years). The study planning concerned three observation phases of 2 weeks each. During the first phase, the patients had muscular rest sittings; during the second phase, the patients practiced muscular mobilization through voluntary physical isotonic exercises; and during the third phase, the patients underwent muscular mobilization through electrical muscle stimulation. The patients were trained to use a portable electronic muscle stimulator (Compex Technologies, Minneapolis, MN, U.S.A.) during the third hour of dialysis treatment. The electrode pads were placed on the quadriceps muscles. The progression of current intensity and duration was performed to maximum tolerability (≥25 mA). The session lasted for 25 min and the program had three different phases: warming up (5 min), strength and resistance (15 min), active recovery (5 min). We observed improvement of Kt/V from 1.29 ± 0.13 on the basal condition to 1.40 ± 0.15 after active exercise and 1.37 ± 0.16 after electrical stimulation; postdialytic rebound (%) decreased from 6.17 ± 2.5 on the basal condition to 4.61 ± 2.8 after active exercise and 4.57 ± 2.9 after electrical stimulation