Effectiveness of physical activity on depression, anxiety, stress and quality of life of patients on hemodialysis.

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1 Biomedical Research 08; 9 (9): ISSN X Effectiveness of hysical activity on deression, anxiety, stress and quality of life of atients on hemodialysis. Amirtha Santhi S *, Rebecca Samson, Srikanth, Pethuru D 4 Saveetha University, Chennai, Tamil Nadu, India College of Nursing, Pondicherry Institute of Medical Sciences, Pondicherry, India Pondicherry Institute of Medical Sciences, Pondicherry, India 4 Deartment of General Practice, Al Nahil International Clinic, Kuwait, India Abstract Individuals diagnosed with Chronic Kidney Disease (CKD) usually develo sychiatric comlications as the dialysis rocedure causes changes in the hysical health and social life. Though the literature suorts beneficial effects of exercise rogrammes in dialysis atients, the imlementation of exercise as a art of clinical care is very less. Hence, the resent study was undertaken to rovide further evidence for the effectiveness of hysical activity deression, anxiety, stress and quality of life of atients on hemodialysis. A total of 4 atients including males and females who were undergoing hemodialysis at selected hosital and who fulfil the selection criteria were included in the resent study. The quality of life of the articiants was collected by interview method using modified Kidney Disease Quality of Life (KDQOL) scale and Deression, and Scale (DASS ). In this study regular exercise rogram has reduced deression, anxiety and stress and imroved quality of life in hemodialysis atients. Hence, it is suggested to erform more qualitative and quantitative studies in this area to suort adotion of hysical exercise in the routine care of hemodialysis atients. Keywords: Deression,,, Quality of life, Hemodialysis. Acceted on March 07, 08 Introduction Individuals diagnosed with Chronic Kidney Disease (CKD) usually develo sychiatric comlications as the dialysis rocedure causes changes in the hysical health and social life []. This may further decrease the quality of life. Studies have reorted higher levels of deression in atients with chronic kidney diseases []. Further, CKD atients with deression are at high risk of frequent hositalization and death when comared to those without comlications []. It was reorted that dialysis shift may have an imact on slee disorders, quality of life, and mortality [4-6]. It was reorted that all the domains of quality of life was deteriorated in CKD atients. Further, it was suggested that assessment of quality of life in CKD atients is an ideal indicator of the outcome of the intervention [7,8]. Regular ractice of hysical exercise imroves hysical and mental health and imroves the quality of life [9]. Though the literature suorts beneficial effects of exercise rogrammes in dialysis atients, the imlementation of exercise as a art of clinical care is very less. Hence, the resent study was undertaken to rovide further evidence for the effectiveness of hysical activity deression, anxiety, stress and quality of life of atients on hemodialysis. Materials and Methods Particiants A total of 4 atients including males and females who were undergoing hemodialysis at selected hosital and who fulfil the selection criteria were included in the resent study. The articiants were selected using simle random technique and Stratified random samling technique was used to allot the articiants into the exerimental and control grou. The articiants who receive hemodialysis on morning hours were allotted to the exerimental grou (n=7) and articiants who receive hemodialysis on afternoon hours were allotted for control grou (n=7). Inclusion criteria Male and female atients with in the age grou of y, receiving regular hemodialysis for> times a week and can understand Tamil or English languages were included in the study. Biomed Res 08 Volume 9 Issue 9 885

2 Santhi/Samson/Srikanth/Pethuru Exclusion criteria Patients diagnosed with heatitis B, heatitis C and HIV, those receiving emergency dialysis, with history of uncontrolled hyertension, heart failure, heart block, cardiac arrhythmias, third degree AV heart block, susected aneurysm and recent significant change in resting ECG and any orthoaedic or musculoskeletal limitations were excluded from the study. Study design After recording the baseline values, the quality of life of the articiants were collected by interview method using modified Kidney Disease Quality of Life (KDQOL) scale and Deression, and Scale (DASS ). Then exerimental grou was involved in 5 minutes of hysical activity during hemodialysis for the eriod of months. Control grou received the routine care racticed in the hosital. The routine ractice in the hosital is, after starting the hemodialysis the atients were allowed to take rest and no secific hysical activity was racticed. At the end of nd month the Quality of life of the articiants were collected by interview method using modified kidney disease quality of life (KDQOL) scale and Deression, and Scale (DASS ). The nd month assessment was taken for ost-test. Study setting The resent exerimental study was conducted in dialysis unit at Pondicherry Institute of Medical Sciences, Pondicherry. Methods Intervention: The study articiants were connected to the hemodialysis machine. After 0 min of hemodialysis the articiants were instructed to do the hysical activity of the extremities for 5 min duration. The articiants are instructed not to do any activity in the extremity that is connected to the hemodialysis machine. During hemodialysis the hysical activity done by the articiants were suervised by the staff nurse or the hysiotheraist. Vital signs of the articiants were monitored during exercise. This hysical activity is done by the articiants during hemodialysis for the eriod of months. The hysical activity includes elbow flexion/ extension, forearm suination/ronation, wrist circumduction, fingers flexion/extension, ankle rotation, toes flexion, extension and hyer extension. Statistical analysis The aired t test is used to comare the re-test and ost-test level of biochemical values in exerimental grou. Ethical consideration The resent study was aroved by Institutional Human Ethical Committee of Saveetha University, Chennai (00/08/06/IEC/SU Dated th August 06) and Institutional Review Board, Pondicherry Institute of Medical Sciences, Pondicherry. Results Table shows the re-test kidney disease quality of life in exerimental and control grou. Both the grous are comarable as there is no significant difference in the values. Table shows the comarison of re-test and ost-test kidney disease quality of life scores in exerimental grou. There is a significant difference (=0.008) between the re-test and osttest symtoms of atients in the exerimental grou. But there is no significant difference in the general health, hysical activity, social activity, ain, effect of kidney disease, sexual function, slee, social suort and atient satisfaction. The aired t test is used to comare the re-test and ost-test quality of life scores. Table shows the comarison of re-test and ost-test kidney disease quality of life scores in control grou. There is no significant difference in the general health, hysical activity, social activity, ain, symtoms, effect of kidney disease, sexual function, slee, social suort and atient satisfaction. The aired t test is used to comare the re-test and ost-test quality of life scores. Table 4 shows the distribution of re-test and ost-test Deression, and score Levels in exerimental and control grou. In retest deression 4.9% of the articiants do not have deression and 4.9% had moderate deression in exerimental grou. In ost-test 57.% articiants do not have deression. In re-test anxiety 4.% had moderate anxiety. But no one had moderate anxiety in ost-test in exerimental grou. According to stress score 8.6% had moderate stress in re-test, but in ost-test no one had moderate stress. In control grou 4.9% articiants had mild and 4.9% had moderate deression. In anxiety 85.7% do not have anxiety and 4.% had moderate anxiety. There is no change in the ost test deression and anxiety score in control grou. In stress score 7.4% do not have stress in re-test but in ost-test only 57.% articiants do not have stress. Table 5 shows the comarison of re-test and ost-test in exerimental grou. There is no significant difference between the re-test and ost-test level of deression, anxiety and stress. Chi square test is used to comare the re-test and ost-test. Table 6 shows the comarison of re-test and ost-test DASS levels in control grou. There is no significant difference between the re-test and ost-test level of deression, anxiety and stress. Chi square test is used to comare the re-test and ost-test. Table 7 shows the comarison of osttest kidney disease quality of life score in exerimental and control grou. There is no significant difference in the general health, hysical activity, social activity, ain, symtoms, effect of kidney disease, sexual function, slee, social suort and atient satisfaction. The unaired t test is used to comare the re-test and ost-test kidney disease quality of life scores. Table 8 shows the comarison of ost-test in exerimental and control grou. There is no significant difference in the ost test levels of deression, anxiety and stress between exerimental and control grou. The chi square 886 Biomed Res 08 Volume 9 Issue 9

3 Effectiveness of hysical activity on deression, anxiety, stress and quality of life of atients on hemodialysis test is used to comare the ost-test between exerimental and control grou. Physical activity ± ± 5.66 Table. Distribution of re-test kidney disease quality of life in exerimental and control grou (n=4). Quality of life scale Exerimental grou (n=7) Control grou (n=7) General health 48. ± ± Physical activity ± ± 6.9 Social activity 8.4 ± ± Pain ± ± Symtoms 8.0 ± ± 7.60 Social activity ± ± Pain 6.57 ± ± Symtoms 8. ± ± 6. 6 Effect of kidney disease 76.4 ± ± Sexual function 9.67 ± ± Slee 7.4 ± ± Social suort 95. ± ± Effect of kidney disease ± ± Sexual function 8.5 ± ± Patient satisfaction 89.9 ± ±.6 8 Slee ± ± Social suort 97.6 ± ± Table 4. Distribution of re-test and ost-test in exerimental and control grou (n=4). 0 Patient satisfaction 89.9 ± ±.6 Exerimental grou (n=7) Control grou (n=7) Table. Comarison of re-test and ost-test kidney disease quality of life scores in exerimental grou (n=7). Pre-test Post-test Pre-test Post-test f (%) f (%) f (%) f (%) Quality of life scale Pre test Post test General health Physical activity 48. ± ± ± ±.9 t value Deression a) Normal (4.9) 4 (57.) (4.) (4.) b) Mild (4.) (4.) (4.9) (4.9) c) Moderate (4.9) (8.6) (4.9) (4.9) Social activity 4 Pain 8.4 ± ± Symtoms 8.0 ± Effect of kidney disease 8.4 ± ± ± * ± ± Sexual function 8.5 ± ± Slee ± ± Social suort 97.6 ± ± a) Normal 5 (7.4) 5 (7.4) 6 (85.7) 6 (85.7) b) Mild (4.) (8.6) 0 0 c) Moderate (4.) 0 (4.) (4.) a) Normal 4 (57.) 5 (7.4) 5 (7.4) 4 (57.) b) Mild (4.) (8.6) (4.) (8.6) c) Moderate (8.6) 0 (4.) (4.) Table 5. Comarison of re-test and ost-test in exerimental grou (n=7). 0 Patient satisfaction * Significant ± ±.0 Pre-test Post-test f (%) f (%) Chi square Table. Comarison of re-test and ost-test kidney disease quality of life scores in control grou (n=7). Quality of life scale re test ost test t value General health 46.4 ± ±.0 Deression a) Normal (4.9) 4 (57.) b) Mild (4.) (4.) c) Moderate ( 4.9) (8.6) a) Normal 5 (7.4) 5 (7.4). 0.5 Biomed Res 08 Volume 9 Issue 9 887

4 Santhi/Samson/Srikanth/Pethuru b) Mild (4.) (8.6) c) Moderate (4.) 0 a) Normal 4 (57.) 5 (7.4) b) Mild (4.) (8.6) c) Moderate (8.6) Deression Ex. grou (n=7) f (%) f (%) Control grou (n=7) a) Normal 4 (57.) (4.) b) Mild (4.) (4.9) c) Moderate (8.6) (4.9) Chi square 0. Table 6. Comarison of re-test and ost-test in control grou (n=7). Pre-test Post-test f (%) f (%) Chi square a) Normal 5 (7.4) 6 (85.7) b) Mild (8.6) 0 (0.0) c) Moderate 0 (0.0) (4.) Deression a) Normal (4.) (4.) b) Mild (4.9) (4.9) 0 a) Normal 5 (7.4) 4 (57.) b) Mild (8.6) (8.6) c) Moderate (4.9) (4.9) c) Moderate 0 (0.0) (4.) a) Normal 6 (85.7) 6 (85.7) b) Mild 0 0 c) Moderate (4.) (4.) a) Normal 5 (7.4) 4 (57.) b) Mild (4.) (8.6) c) Moderate (4.) (4.) Table 7. Comarison of ost-test kidney disease quality of life score in exerimental and control grou (n=4). Kidney disease quality of life scale Exerimenta l grou (n=7) Control grou (n=7) t value General Health Physical activity Social activity Pain Symtoms Effect of kidney disease Sexual function Slee Social suort Patient satisfaction Table 8. Comarison of ost-test in exerimental and control grou (n=4). Discussion Higher deression levels are reorted in the atients with CKD [0-5]. Deression and anxiety decreases the quality of life and increases morbidity and mortality in CKD atients [6-8]. Further the CKD was associated with oxidative stress and inflammation of the systems and leads to cardiovascular diseases []. Hence, there is a need for the theraies that minimize stress and revent the cardiovascular comlications. Physical exercise is one among the non-harmacological methods which is beneficial in reducing the stress and anxiety and revents the deression []. Practicing hysical exercise in routine day life style imroves hysical caacity, strength of muscles, cardiovascular function, and imroves quality of life [-5]. In the current study we have observed decrease in the deression, anxiety and stress levels and increased quality of life followed by the regular hysical exercise. Our results are in accordance with earlier studies reorted beneficial effects of hysical exercise on imroving both hysical and sychological states and overall imrovement in quality of life [7-0]. Milani et al. also reorted the efficacy of exercise on major deression in heart failure atients, which are consistent with the results of this study [,]. However, certain studies demonstrated that exercise and hysical activity have no effect on deression in hemodialysis atients []. Physical exercise rogram imroves muscle ower, flexibility of joints, decreases musculoskeletal ain, imroves aetite and nutrition quality, self-care ability, getting well slee and rest, and reducing fatigue for hemodialysis atients. All these beneficial effects allow the CKD atients on hemodialysis to be indeendent in their regular life so that they can erform their daily activities more effectively. Regular hysical exercise revents deression by increasing blood suly and neurogenesis in brain hiocamus, which acts like antideressant agents [4]. Structured hysical exercise rogramme during hemodialysis imroves hysical function 888 Biomed Res 08 Volume 9 Issue 9

5 Effectiveness of hysical activity on deression, anxiety, stress and quality of life of atients on hemodialysis and quality of life significantly and can be integrated into a hemodialysis routine with a high long-term adherence [5,6]. Release of beta-endorhin during the hysical exercise lays an imortant role in construction of hiocamal neurons and reduces deression [7,8]. Physical exercise may also reduce deression by changing the growth and cortisol hormones [9]. Physical activity increases atient's hysical and mental fitness and romotes their longstanding self-sufficiency and indeendence from heling others. In addition it reduces the financial costs of nursing care [0]. All these effects of hysical exercise contribute in the increase of quality of life. Conclusion In this study regular exercise rogram has reduced deression, anxiety and stress and imroved quality of life in hemodialysis atients. 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6 Santhi/Samson/Srikanth/Pethuru deression, and quality of life in atients with fibromyalgia: a randomized controlled trial. Medicina Clínica 0; 7: Ribeiro R, Coutinho GL, Iuras A, Barbosa AM, Souza JAC, Diniz DP. Effect of resistance exercise intradialytic in renal atients chronic in hemodialysis. Jornal Brasileiro de Nefrologia 0; 5: Kirsten A, Bar T, Hennig JT, Kuchinke S, Krause R, Rost JM. A structured exercise rogramme during haemodialysis for atients with chronic kidney disease: clinical benefit and long-term adherence. BMJ Oen 05; Lee SJ, Jeon JH. A systematic review of effectiveness of exercise on QOL in atients with CKD. Healthcare and Nursing 06; 8: Koeh M, Meerlo P, Gonzales D, Rontal A, Turek FW, Abrous DN. Exercise-induced romotion of hiocamal cell roliferation requires β-endorhin. FASEB J 008; : Hegadoren KM, O'Donnell T, Lanius R, Couland NJ, Masmonteil Lacaze N. The role of β-endorhin in the athohysiology of major deression. Neuroetides 009; 4: Krogh J, Nordentoft M, Nezhad Mohammad M, Westrin A. Growth hormone, rolactin and cortisol resonse to exercise in atients with deression. J Affective Disorders 00; 5: Mahrova A. Physical activity is a necessary art of care in atients with chronic kidney disease-short historical overview. Prim Health Care 07; 7: 7. * Corresondence to Amirtha Santhi S Saveetha University Chennai Tamil Nadu India 890 Biomed Res 08 Volume 9 Issue 9