The Effects of a Nurse-led Case Management Programme on Home Exercise Training for Haemodialysis Patients
The Effects of a Nurse-led Case Management Programme on Home Exercise Training for Haemodialysis Patients
The purpose of this study is to examine the effects of a nurse-led case management programme
 on home exercise training for haemodialysis patients. We hypothesised that: a. There is no
 significant difference in physical functioning between participants receiving the nurse-led
 home exercise training programme and those receiving the comparison care. b. There is no
 difference in depression between participants receiving the nurse-led home exercise training
 programme and those receiving the comparison care. c. There is no difference in quality of
 life and health perception between participants receiving the nurse-led home exercise
 training programme and those receiving the comparison care. d. There is no difference in
 physical activity levels between participants receiving the nurse-led home exercise training
 programme and those receiving the comparison care. e. There is no difference in perceived
 benefits and barriers of exercise between participants receiving the nurse-led home exercise
 training programme and those receiving the comparison care.

 The study was a randomized controlled trial conducted in two haemodialysis units of two
 tertiary hospitals in Nanjing, China. Participants were randomly assigned to either study
 group or comparison group. Participants in both groups received the in-center exercise
 training (20 minutes) before haemodialysis sessions weekly for 6 weeks and were instructed to
 perform exercise at home. The in-center training was focused on flexibility and strengthening
 exercise. Patients were encouraged to have cardiovascular exercises at home which will
 improve their cardiovascular conditions and endurance. The list of cardiovascular exercise
 included brisk walking, bicycling, jogging. Participants in the study group were instructed
 to start walking or brisk walking at low duration and gradually progress to a maximum of 30
 minutes daily per week. To facilitate exercise progression, the nurse case managers discussed
 exercise benefits, explored exercise barriers and developed mutual goals with patients. The
 nurse motivated them and checked the exercise behaviors to ensure adherence to the
 recommended exercise regime. The nurse case managers interviewed the study group patients
 weekly for six weeks and biweekly for another six weeks. Participants in the comparison group
 only participated in the in-center exercise training. The comparison group patients received
 usual care from the nurse without the interviews and mutual goals developed.
The duration of interventions was 12 weeks. In-center exercise training sessions were
 available for all participants once a week for 6 weeks. Each session lasted about 20 minutes.
 Participants were instructed to perform flexibility and strength exercise in centres prior to
 the haemodialysis session. The researcher performed exercises with the participants and
 emphasised the importance of self-monitoring during the sessions. Symptoms (such as chest
 pain, dyspnea, dizziness, and leg cramps) and vital signs (blood pressure, heart rate, and
 pulse) were checked before exercise and monitored during the entire exercise session.
 Participants were instructed to self-monitor exercise intensity. The exercise programme was
 pause immediately if the patient was feeling short of breath, chest pain or pressure,
 irregular heartbeats, leg cramps, dizziness or lightheadedness, blurring of vision, or any
 discomfort.

 Intervention group During the study period, participants in the intervention group received
 additional face-to-face interviews conducted by the designated case managers every week for
 six weeks and biweekly for another six weeks. During interviews, patients were instructed to
 start aerobic exercise, such as walking, jogging, cycling, or brisk walking at home at low
 duration and gradually progress to a maximum of 30 minutes daily per week. Apart from aerobic
 exercise, patients were recommended to perform strength exercises twice a week and
 flexibility exercises for every day. The key elements of the interview included: 1)
 assessment of patients' knowledge and exercise behaviour; examining patients' attitudes and
 feelings about being physical activity; 2) explore patients' barriers to exercise and
 perceived benefits; 3) patient education on the benefits of exercise if needed; 4)
 development of mutual goals in an exercise plan; 5) explain the purpose of a recording
 exercise log and instruction in correct way to keep an exercise diary; 6) discuss the
 available supports and resources that could motivate patients to initiate and maintain
 exercise, e.g., centre-based exercise programme, support from family members, health care
 providers, peer patients, and so forth.

 In the follow-up interviews, case managers reviewed the exercise log with participants,
 discussed unpleasant experiences related to exercise, exercise progress, and provided
 encouragement. According to the progress participants made, the exercise goals and plan were
 renewed or revised. Referrals were made as needed.

 Comparison group Participants in the comparison group were advised to participate in the
 in-centre exercise training programme which was available before haemodialysis sessions once
 a week for different shifts of patients. The training session lasted about 20 minutes and
 only flexibility and strength training were provided. During the training sessions, patients
 were advised to increase their daily activity levels.
Inclusion Criteria:

 -  Dialysis for >3 months;

 -  Age > 18 years;

 -  Kt/V (dialysis adequacy) >1.2;

 -  Hemoglobin level > 8g/dl;

 -  Ambulatory without assistance ;

 -  Able to communicate in Chinese;

 -  Able to and willing to provide consent.

 Exclusion Criteria:

 -  Unstable physical conditions or severe musculoskeletal diseases that might hinder
 exercise training;

 -  Severe hearing impairment;

 -  Diagnosed with mental diseases;

 -  Meeting or exceeding the exercise recommendation.