Kuan, Chooi Lai
(2016)
A randomized controlled trial comparing the effect of conventional and modified handgrip exercise towards the vein size and blood flow of upper limbs in healthy subjects.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction
The rising trend of end-stage renal disease (ESRD) has seen a higher rate of
arteriovenous fistula (AVF) creation. Creating a durable vascular access for
hemodialysis is a challenge especially in the unfavorable vein size. Smaller vein size
(< 2mm) is associated with higher AVF failure rate. Post-operative handgrip exercise
had been advocated in ESRD patients and results shown better AVF maturation. We
took advantage of this favorable outcome to investigate the effect of handgrip exercise
in native vein to explore the potential of implementing pre-operative handgrip
exercise as part of the management in ESRD patients. The current study compared the
efficacy of two types of handgrip exercises (conventional and modified) in healthy
subjects.Method
Thirty-two healthy volunteers (11 male, 21 female) were randomized into two types
of handgrip exercises. Exercised hand was randomized and the non-exercising hand
served as the control. Both interventions followed the same duration (6weeks), same
frequency (30min/day) and same intensity (5 sec contraction, 2 sec relaxation), except
for the addition of wrist flexion in the modified group. A standardized stress ball was
provided to all subjects. Measurements of vessel diameter and blood flow rate done
via Doppler ultrasound were taken before and after 6 weeks of exercise. Prior to
imaging, subjects were refrained from coffee, alcohol or strenuous activity for 48
hours. The sonography technician who performed Doppler ultrasound imaging was
blinded.
Results
There is no statistically significant difference between conventional and modified
handgrip exercise when comparing the vessel diameter and arterial blood flow rate.
When compared to their control counterpart, conventional exercise showed significant
increment in distal cephalic vein (DCV) (p=0.003) and proximal cephalic vein (PCV)
(p<0.001), as well as improvement in brachial artery flow (BAF) rate (p=0.025) but
not the modified handgrip exercise. However, the modified handgrip exercise showed
a higher percentage of increment in DCV and PCV compared to the conventional
group (34.5 vs 27.8%, 26.6 vs 21.1%) although not being statistically significant
(p=0.316, p=0.489).
Conclusion
The conventional handgrip exercise with our proposed protocol could be implemented
in ESRD patients before AVF creation. Given the higher percentage of improvement
seen in modified handgrip exercise, future investigation is needed to evaluate the
outcome of AVF maturation in patients subjected to pre-operative handgrip exercise.
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