287 - Resistance Training in Pediatric Patients on Maintenance Dialysis – A Pilot Study

Chronic Kidney Disease in children is associated with decreased muscle strength. Sedentary lifestyle and limited exercise in dialysis population are among the causes for increased  cardiovascular morbidity  Exercise programs during dialysis  have shown improved physical functioning, BP  control and quality of life, however pediatric studies are limited and have  high dropout rates. In deconditioned children, low to moderate intensity strength training may be a safe and well tolerated  exercise program. In this study, strength training exercises were implemented in pediatric patients  on maintenance hemodialysis (HD) and peritoneal dialysis (PD) .

Objective:

Measure the baseline physical functioning and quality of life in pediatric patients on maintenance dialysis and to study the  effect and feasibility of exercise training in this patient population.

Design/Methods:

A 24-week strength training exercise program using resistance bands was  implemented in 7–20-year-old eligible pediatric patients on maintenance HD or PD at our center.  HD patients  performed exercises at the dialysis center and PD patients were taught to perform exercises at home.  Validated questionnaires were used to assess physical functioning  (PAQ-C in children and PAQ-A in adolescents), quality of life (Peds QL ESRD 3.0) and perseverance (GRIT-S scale) Grip strength was  measured using a Jamar dynamometer at enrollment, week 12, and week 24 and compared to normative data. An ad hoc questionnaire to assess patient satisfaction and barriers for exercise implementation was also given. 

Results:

We  enrolled 10 HD and 5 PD subjects; , 8-18 years old. The average PAQ score at enrollment was 1.9 (0.74). The median combined hand grip strength score was 121.1 (50.9;162.3) lbs in males and 74.45 (42.5;115.5) lbs in females, which was low (below 2SD) compared to age and sex matched normative data. The subjects' perceptions of quality of life  showed problems related to kidney disease, general fatigue, treatment related problem, impaired family and peer interaction, increased worry, impaired perceived physical appearance, and communication. The median GRIT-S score was 3(2.125;3.6) which is low-borderline.

Conclusion(s): Preliminary findings confirm that our dialysis subjects have lower physical activity scores, grip strength and impaired quality of life at the time of enrollment. Low to borderline GRIT-S score may predict who completes the program. Participants report increased interest to be active and it led to targeted physical therapy referrals in 2 patients.