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

Abstract

Background: 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. Exercise training can suppress the sympathetic over‐excitation, restoring the sympathetic (SNS) to parasympathetic nervous system (PNS) balance. Music can positively affect CANS activity. The combination of music and physical training has never been used in CKD. 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 were collected from 40 free of any systemic disease HD patients (age 50±14.7 yrs). Patients were randomly assigned to four equally numbered [n=10] groups, employing a joint music and exercise training program for Group A, a sole exercise training program for Group B, a sole music program for Group C and none of the above‐mentioned interventions for Group D. At entry and at the end of the study all patients underwent a 6‐minute walking test (6MWT) and ambulatory 24‐hour Holter monitoring for time‐and frequency‐domain HRV calculation. The HRV indices obtained were: mean heart rate (HR); standard deviation of NN intervals (SDNN); root mean square of successive differences (RMSSD); proportion of NN50 divided by total number of NNs (pNN50) and very low frequency (VLF). Results: All indices were significantly better for Group A: 6MWT [F(3,36)=13.095, p=0.000], HR[F(3,36)= 1.910, p=0.145]; SDNN [F(3,36)=11.671, p=0.000]; RMSSD [F(3,36)=12.395, p=0.000]; pNN50 [F(3,36)=45.752, p=0.000]; and VLF [F(3,36)=3.141, p=0.037]. Conclusions: 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 PNS. These favorable changes may positively affect cardiovascular morbidity and mortality.