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V naši raziskavi smo želeli ozavestiti tako oblikovalce zdravstvenih politik kot tudi dializne in ostale kronične bolnike, o pomenu vsakodnevne telesne dejavnosti v boju proti posledicam bolezni. Ključni prispevek naloge je bil ugotoviti, ali vadbeni program, kjer med-dializnem kolesarjenju dodamo še funkcionalno vadbo izboljša zmogljivost bolnikov za aktivnosti v vsakdanjem življenju v primerjavi s trenutno široko uporabljeno metodo vadbe z med-dializnim kolesarjenjem. Zanimalo nas je tudi v kolikšni meri predhodna telesna pripravljenost in starost vplivata na izboljšanje splošne telesne aktivnosti in zmogljivosti dializnih bolnikov. V vzorec je bilo zajetih 40 oseb z diagnozo končne ledvične odpovedi. Vse osebe so bile na nadomestnem zdravljenju s hemodializo v Univerzitetnem kliničnem centru Ljubljana. Za raziskovalni instrument smo uporabili vprašalnik gibalne aktivnosti HAP (Human Activity Profile Questionnaire). Merjenci so izpolnili vprašalnik trikrat (pred začetkom raziskave, po 8. tednu in po 16. tednu). Po prvih, začetnih meritvah, smo bolnike naključno razdelili v eksperimentalno (n=20) in kontrolno (n=20) skupino. Obe skupini sta trikrat tedensko izvajali med-dializno kolesarjenje, eksperimentalna skupina pa je poleg tega še trikrat tedensko pred dializo izvajala 30-45 minutno funkcionalno vadbo. Statistična analiza je obsegala postopke osnovne opisne statistike, test Shapiro-Wilkov, parni t-test in ANOVE. Podatke smo obdelali s SPSS 22.0 in Microsoft Excel 2013. Ugotovili smo, da je prišlo do izboljšanja splošne telesne aktivnosti in zmogljivosti tako v eksperimentalni kot tudi kontrolni skupini, vendar pa med skupinama ni prišlo do statistično značilnih razlik. Poleg tega smo ugotovili, da se splošna telesna aktivnost statistično značilno najbolj izboljša pri osebah, ki so bile v začetku raziskave uvrščene v skupino neaktivnih oseb, najmanj pa pri osebah, ki so bile ob začetku raziskave uvrščene v skupino aktivnih oseb. Kot zadnje smo ugotovili, da starost ne vpliva značilno na izboljšanje maksimalnega številka točk (AAS vrednosti) vprašalnika HAP, statistično značilno pa vpliva na prilagojeno oceno aktivnosti (MAS vrednosti) vprašalnika HAP. Zaključujemo, da bi bilo smiselno ponuditi možnost med-dializnega kolesarjenja in funkcionalne vadbe vsem dializnim bolnikom, ki se zdravijo v hemodializnih centrih. Kljub temu, da nismo ugotovili statistično značilnih razlik med obema oblikama vadbe, bi bilo smiselno vključiti funkcionalno vadbo v vadbeni program, saj je izredno pomembno, da poleg aerobnih sposobnosti bolniki razvijajo tudi moč, koordinacijo, ravnotežje in gibljivost. Z vadbo bi preprečili dodatne pridružene bolezni in zaplete povezane s končno ledvično odpovedjo. Posledično bi prišlo do izboljšanja kvalitete življenja bolnikov. In our study, we wanted to raise awareness among health policy makers, dialysis and other chronic disease patients about the importance of daily physical activity in the fight against the consequences of the disease. The key contribution of the thesis is to determine whether an exercise programme where functional training is added to intra-dialytic cycling improves patients' capacity for activities of daily living compared to the currently widely used method of exercise with intra-dialytic cycling. We were also interested in the extent to which previous physical fitness and age influence the improvement of overall physical activity in dialysis patients. The sample included 40 subjects with a diagnosis of end-stage kidney disease. All subjects were undergoing haemodialysis therapy at the University Medical Centre Ljubljana. The research instrument used was the Human Activity Profile Questionnaire (HAP). Subjects completed the questionnaire three times (before the start of the study, after 8 weeks and after 16 weeks). After the first, initial measurements, patients were randomly divided into an experimental (n=20) and a control (n=20) group. Both groups performed intra-dialytic cycling three times a week, while the experimental group also performed before dialysis 30–45 minutes of functional training three times a week. The statistical analysis included basic descriptive statistics, the Shapiro-Wilk test, paired t-test and the analysis of variance (ANOVA). Data were processed using SPSS 22.0 and Microsoft Excel 2013. We found that there was an improvement in general physical activity and performance in both the experimental and control groups, however, no statistically significant differences were found between the groups. In addition, we found that the most statistically significant improvement in general physical activity was observed in the group considered as inactive at the beginning of the study, and the least improvement in the group considered as active. Finally, we found that age does not significantly affect the improvement of the adjusted activity score (AAS) of the HAP Questionnaire, but it does have a statistically significant effect on the maximum activity score (MAS) of the HAP Questionnaire. We conclude that it would be useful to offer the possibility of intra-dialytic cycling and functional training to all dialysis patients treated in haemodialysis centres. Although we did not find statistically significant differences between the two exercise types, it would be helpful to include also functional training in the exercise programme as it is extremely important that patients develop strength, coordination, balance and flexibility in addition to aerobic capacity. Such an exercise programme would prevent additional comorbidities and complications associated with end-stage kidney failure. As a consequence, the quality of life of patients would be improved. |
