FO028EFFECTS OF MUSIC AND EXERCISE TRAINING DURING HEMODIALYSIS ON THE CARDIAC AUTONOMIC NERVOUS SYSTEM ACTIVITY

Abstract

Introduction and Aims: Cardiac autonomic nervous system (CANS) dysfunction is a common complication in Chronic Kidney Disease (CKD), linked with increased cardiovascular morbidity and mortality. It is known that exercise training during hemodialysis (HD) improves physical function and quality of life in HD patients. Moreover, it is shown that exercise training can suppress the sympathetic over-excitation, restoring the sympathetic (SNS) to parasympathetic nervous system (PNS) balance. Music has been also shown to positively affect CANS activity. However, the combination of music and physical training has never been used in CKD to further improve the relative clinical outcome. Therefore, the aim of this study was to investigate the effectiveness of a 6-month, music and physical training combined protocol during HD. Methods: Heart rate variability (HRV) data - accepted as indicators of cardiac autonomic flow - were collected from 40 HD patients (aged 50.0±14.7 yrs) who were free of any other systemic disease. Patients were randomly assigned to four equally numbered [n=10] groups, employing (a) a joint music and exercise training program for Group A, (b) a sole music program for Group B, (c) a sole exercise training program for Group C and (d) an absence of any of the above-mentioned interventions for Group D, being the control group. The dialysis prescription, medications and the level of anemia were constant during the study. At entry, as well as at the end of the study all patients underwent a six-minute walking test (estimation of functional capability) and an ambulatory 24-hour Holter monitoring for time- and frequencydomain HRV calculation. The following HRV indices were obtained: mean heart rate (HR); standard deviation of NN intervals (SDNN); root mean square of successive differences (RMSSD); and the low frequency (LF) and high frequency (HF) components of the autoregressive power spectrum of the NN intervals, as well as the very low frequency component (VLF). Results: Results indicated a variable mode of measurement fluctuations between the three main research groups, promoting however the combined usage of music and physical training to a more significant level. More specifically, the six-minute walking test provided a significant outcome on the functional ability of the joint music-exercise group [F(3,21)=55,81;p<0,01], while similar results were observed for the HR [F(3,21)=18,77;p<0,01.]; the SDNN [F(3,21) =200,03;p<0,01]; the RMSSD [F(3,21)=62,12;p<0,01]; the LF [F(3,21) =165,36; p<0,01]; the HF [F(3,21)=297,52; p<0,01] and the VLF [F(3,21)=80,64;p<0,01] respectively. Conclusions: In conclusion, musical auditory stimulation when jointly used with exercise training during HD has the strongest influence on CANS activity, improving the dynamic interaction between the SNS and the PNS. These favorable changes may positively affect cardiovascular morbidity and mortality. (Table Presented).