Improvement of physical fitness, muscle strength, aspects of quality of life and decrease of fatigue in children on dialysis

Adults with end stage renal disease who are on haemodialysis report decreased
exercise tolerance, muscle stength, increase in fatigue and decrease in daily
activities. Intervention programs do improve these topics as well as aspects of
quality of life.
No intervention programs in children on haemodialysis/peritoneal dialysis have
been performed regarding increasing exercise tolerance, muscle strength,
functional ability and decreasing fatigue.
Fatigue is a major problem in children with chronic renal failure influencing
daily activities. This was recently reported by a study by TNO. The department
of pediatric physical therapy and pediatric exercise physiology WKZ/UMCU has
experience in designing and conducting exercise programs in children with
chronic conditions, leading to a more active lifestyle and improvement of
ability and participation with eventually decrease of fatigue.

The purpose of this study is to show that participation in an exercise
programme will increase the exercise tolerance, musle power and health-related
quality of life and will diminish the degree of fatigue in children on
dialysis.

1. To assess in children (n=23) treated with haemodialysis/peritoneal dialysis
in the academic hospitals of Nijmegen, Amsterdam (UMCA), Rotterdam (Erasmus
MC), Antwerpen, en Utrecht (UMCU) the amount of fatigue, anthropometrics,
muscle strength, exercise tolerance, physical ability and aspects of quality of
life with valid and reliable instruments and questionnaires.

2. The design of an intervention program, primarily aimed at improvement of
physical fitness, muscle strength and decrease of fatigue.

3. Conducting an intervention program at home by instructed pediatric physical
therapists.The intervention lasts 6 months.

4. To assess the consequences of this program regarding these before mentioned
topics after the intervention and after 6 months after intervention.

5. After the expected improvement to stimulate participants in sport activities.



In these 23 children on haemodialysis/peritoneal dialysis the following
measurements will be performed:

Fatigue
Anthropometrics
Maximal exercise testing
Functional exercise capacity
Muscle strength
Functional ability
Aspects of Quality of life
Activities of daily living

Measurements are performed 3 months before intervention, just before
intervention, after intervention and 3 months after intervention

Intervention will be performed by well instructed and trained pediatric
physical therapists in the city were the child lives.

The intervention program is based on earlier studies we performed and also
based on the guidelines of the American College of Sports Medicine.

Based on a child-friendly fitness program, physical fitness and muscle strength
will be trained. This program has been used in the study 04/311 University
Medical Center Utrecht and is well-appreciated by the participating pediatric
physical therapists as well as children and their parents.

Extent of burden: time: during the whole study 4 assessments of 2 hours. The
exercise tests will be performed at the hospital where the child is treated

The child participates in an intervention program during 6 months (intervention
1.5 hours per week)

The risk is estimated to be nihil