Effects of physical therapy during hemodialysis in patients with chronic kidney disease.

INTERVENTION: /rehabilitation Breathing Exercises Motor Activity Other Physical Therapy Modalities The study will be performed with 68 adult subjects with chronic kidney disease who are attending a regular hemodialysis program during the first and second semester of 2019 at the Governador Celso Ramos Hospital ‐ Rins Unit, located in Florianópolis ‐ Santa Catarina. Patients who meet the inclusion criteria will be invited to participate in the study through consent and signing of the Informed Consent Term (TCLE). The patients will be divided into two groups (Control Group = CG and Intervention Group = GI), through a simple randomization list obtained by the Research Randomizer program (www.randomizer.org). The GI will perform a physiotherapeutic intervention three times a week for three months during hemodialysis to take advantage of patients' free time, with each session lasting 55 minutes. The physiotherapy session will be applied by the researcher of the study and will be divided as follows: 15 minutes of pedaling on a stationary bicycle on a cycle ergometer; 20 minutes of motor exercises, such as active and passive stretching for upper limbs (MMSS) and lower limbs (MMII) and paravertebral region. Subsequently, muscle strengthening exercises of MMSS: In the limb without vascular fistula will be performed the elbow flexion / extension movements and diagonal movements of the Kabat Method flexion‐abduction‐external rotation and internal extension‐adduction‐rotation using dumbbells of 1 kg being that the load will be progressed according to the patient's perception and the manual compression with the exerciser ball, for vascular strengthening and intrinsic muscles of the hands and flexors of the fingers. In the fistula member, only manual compression with the exercising ball will be performed, for vascular strengthening and intrinsic muscles of the hands and flexors of the fingers. All movements will be performed with 3 sets of 10 repetitions and 15 seconds rest in each series always controlling blood pressure (BP) and venous pressure (PV) of fistula by the CONDITION: End‐stage renal disease Kidney Failure, Chronic Renal Dialysis Renal Dialysis; End‐stage renal disease; Kidney Failure, Chronic. ; Renal Dialysis ; End‐stage renal disease ; Kidney Failure, Chronic PRIMARY OUTCOME: Primary outcome: Quality of Life.; Method: To evaluate the quality of life of the study participants, the instrument KDQOL‐SFTM will be used, in the Portuguese version validated in Brazil, and its use is authorized. It consists of 80 items, including SF‐36 plus 43 items on chronic kidney disease. In the end, to obtain the quality of life score, the numerical values ??of the questionnaire will be transformed from 0% to 100% for each dimension. Afterwards, the scores of the dimensions present in the questionnaire will be distributed in ranges, and the 5th range will indicate good quality of life. SECONDARY OUTCOME: Secondary Outcome 1: Nutritional Assessment ; Methods: Weight and height data will be collected for Body Mass Index calculation following the standards for anthropometric data collection according to the Ministry of Health. The classification will be performed following the norms of the World Health Organization for adult patients and the following. The Nutitrion Screening Initiative standards for elderly patients. ; The values for eutrophic classification in adults will be ? 18.5 <25 and for the elderly> 22 <27. ; Secondary outcome 2: Cardiorespiratory assessment. ; Predicted for the 6MWT = 356,658 ‐ (2,303 x age) + (36,648 x gender) + (1,704 x height) + (1,365 x ?FC) ; (where male = 1 and female = 0) ; MIP: y = ?0.80 × age + 155.3 / MEmax: y = ?0.81 × age + 165.3 ; Women: MIP: y = ?0.49 × age + 110.4 / PEmax: y = ?0.61 × age + 115.6. ; Methods: ‐6‐minute walk test: This is a test that aims to assess the patient's functional capacity by measuring the largest distance an individual is able to walk during a six‐minute interval. A reference equation will be applied to obtain a performance prediction for the test. ; ‐ Peak Flow: This is the strongest flow an individual can generate during expiratory effort initiated after maximum inspiration. The values obtained after the evaluation may indicate some alterations such as the presence of airflow resistance in the airways and also the severity of the obstruction. To interpret the test values, a reference table for men and women will be used. ; ‐ Diaphragmatic Index: Used to assess thoracoabdominal movement determined by changes in the anteroposterior dimensions of the abdomen and chest. It is obtained by measuring with a simple tape measure. And after applying the following formula: ID = ? AB / ? AB + ? CT, where ? refers to the difference between the abdominal (AB) and thoracic (CT) dimensions, measured during inspiration and maximum expiration. The closer to 1 = more diaphragmatic, the less closer to 1 = less diaphragmatic. ; ‐ Manovacuometry: Consists of a technique used to measure maximal inspiratory muscle strength (MIP) and maximal expiratory muscle strength (MEP), performed using the manovacuometer. The MIP and MEP values will be compared with the predicted arable values of the following equation: Men: ; Secondary Outcome 3: Physical Assessment ; ‐Test of Sitting and Getting Up ; Method: The TSL is a simple assessment, which allows in a few minutes and anywhere to evaluate the flexibility, balance, motor coordination and muscle strength of the subject. The score consists of quantifying how many supports the patient will use to sit and get up from the floor, with a maximum score of 5 for each act. ; ‐ Hand Grip Test: The assessment of handgrip strength is used as a parameter to evaluate and treat musculoskeletal hand disorders, as well as to serve as a strength parameter to muscle power and to be related to the mortality rate. This test is mainly performed by measuring the isometric force that can be exerted on a dynamometer, and usually using the power grip grip, which means squeezing a cylindrical object and in that grip, inhibits thumb action. It is recommended to use the equations proposed in the literature to evaluate the results. ; INCLUSION CRITERIA: Patients of both sexes; age between 19 and 75 years; diagnosis of chronic kidney disease and who have been on a regular hemodialysis program for at least three months.