Annals of Rehabilitation Medicine

"Hypotension"

Original Article

Cardiopulmonary rehabilitation

Effect of Pre- and Post-Dialysis Exercise on Functional Capacity Using Portable Ergometer in Chronic Kidney Disease Patients: Tae-Seok Chae, Da-Sol Kim, Myoung-Hwan Ko, Yu Hui Won; Ann Rehabil Med 2024;48(4):239-248. Published online August 30, 2024; DOI: https://doi.org/10.5535/arm.240005

Objective
To assess whether performing exercises during hemodialysis reduces the risk of developing intradialytic hypotension and enhances exercise capacity in patients with chronic kidney disease.
Methods
This study included patients aged ≥18 years undergoing hemodialysis. Participants performed exercises using a portable lower extremity ergometer during hemodialysis sessions for 3 weeks. Data regarding walking distance, knee strength, quality of life, fat-free mass, arterial pressure, blood pressure, heart rate, frequency of intradialytic hypotension, fatigue, and duration of hemodialysis were collected and analyzed.
Results
Significant improvements in walking distance and knee strength were observed following the implementation of exercise training during hemodialysis. Although there was no significant reduction in the frequency of intradialytic hypotension, a decreasing trend was noted. Other parameters such as quality of life and fatigue did not show significant changes.
Conclusion
Using a portable ergometer during hemodialysis improved exercise capacity and knee strength in patients with chronic kidney disease. There was a trend toward reduced intradialytic hypotension, suggesting potential cardiovascular benefits. Further research with larger sample sizes is needed to confirm these findings.

Citations

Citations to this article as recorded by

Resistance Training Improves Fluid Imbalance Symptoms in Hemodialysis Patients: A Randomized Controlled Trial
Fatemeh Pourmahdigholi
Journal of Clinical Nephrology.2026; 10(1): 008. CrossRef
Can exercise reduce fatigue in people living with kidney disease?
Thomas J. Wilkinson, Lisa Ancliffe, Jamie H. Macdonald
Current Opinion in Clinical Nutrition & Metabolic Care.2025; 28(3): 200. CrossRef
Effect of intra-dialytic exercise on hemodialysis session adequacy and solutes clearance and rebound in prevalent hemodialysis patients
Howaida Elshinnawy, Hisham Elsayed, Hayam Hebah, Waleed Abdelmohsen, Dina Farrag, Mostafa Abdelnasier
Egyptian Rheumatology and Rehabilitation.2025;[Epub] CrossRef

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Case Report

Persistent Autonomic Dysfunction in Guillain-Barre Syndrome: A case report.: Lee, Sang Jee , Choi, Eun Suk , Jung, Sung Hee , Cho, Ye Rim , Han, Zee A , Yu, In Hee; J Korean Acad Rehabil Med 2008;32(5):586-590.

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Autonomic dysfunction is a common manifestation in Guillain-Barre syndrome (GBS), but it rarely persists. We report a case involving a 22-year-old man who presented with glove-and-stocking type sensory loss, symmetric weakness, urinary distension, orthostatic hypotension, decreased perspiration, and the syndrome of inappropriate secretion of antidiuretic hormone. He was subsequently diagnosed as having GBS with autonomic failure that persisted for more than six months, despite regaining muscle strength. Orthostatic hypotension progressively improved after rehabilitation and administration of midodrine and fludrocortisone. Extensive evaluation and management should be performed in patients with GBS because severe autonomic dysfunction is a major source of disability. (J Korean Acad Rehab Med 2008; 32: 586-590)

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Original Articles

Factors Inhibiting Recovery of Orthostatic Hypotension with Ischemic Stroke Patients.: Jeong, Ho Joong , Kim, Ghi Chan , Sim, Young Joo , Eom, Moon Sub , Hong, Jin Young , Lee, Jong Hwa; J Korean Acad Rehabil Med 2008;32(3):289-293.

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Objective
To determine the time period and factors inhibiting recovery of orthostatic hypotension during head up tilt with ischemic stroke patients.Method: Fourty two ischemic stroke patients with orthostatic hypotension were included. Blood pressure and heart rate were taken after resting in the supine position for 10 minutes and again after standing for one minute every week. Age, gender, body mass index, laboratory findings, diabetes mellitus, anti-hypertensive use, side of involved hemisphere and K-MBI were obtained.Results: The numbers of orthostatic hypotension patients were significantly decreased at 3rd week. Non recovering group until 3rd week were older in age and had higher plasma creatinine level. On the other hand, body mass index and K-MBI were lower than the group without orthostatic hypotention. Multivariate analysis revealed that age, body mass index, anti-hypertensive medication were independently associated factors for resistant orthostatic hypotension during head up tilt.Conclusion: For 7 weeks, especially at 3rd week, the numbers of orthostatic hypotension patients significantly decreased. Age, BMI, and antihypertensive medication were inhibitiing factors for recovery of orthostatic hypotension. (J Korean Acad Rehab Med 2008; 32: 289-293)

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The Effect of Midodrine on Exercise-induced Hypotension in Cervical Cord Injury Patients.: Jung, Hyun , Seo, Jeong Hwan , Ko, Myoung Hwan , Park, Sung Hee , Sim, Young Joo; J Korean Acad Rehabil Med 2008;32(1):45-50.

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Objective: To evaluate the effect of midodrine, an Ձ₁ agonist, on symptom and hemodynamic response during standing and arm bicycle ergometer exercise in patients with cervical cord injury. Method: Twelve cervical spinal cord injury patients with orthostatic hypotension symptoms and post-exercise hypo- tension were enrolled. They were positioned on a 90°standing frame for 3 minutes. After 15 minutes of resting on supine position, 5 minutes of arm bicycle ergometer exercise was done. These tests were done without midodrine initially, but, with 5 mg midodrine on the next day. Heart rate, self-perceived presyncope score (PPS), systolic and diastolic blood pressure were measured before, during and after the exercise. Results: With 5 mg midodrine, the decrease of systolic and diastolic blood pressures after 3 minutes' standing was significantly smaller than without midodrine (p＜0.05). PPS was also significantly decreased with midodrine on standing frame test. Arm ergometer exercise induced less systolic blood pressure decrease and better PPS on immediate and 5 minutes after exercise with midodrine (p＜0.05). The change of diastolic blood pressure and heart rate was not significant after the exercise with midodrine. Conclusion: In cervical spinal cord injury patients with orthostatic and post-exercise hypotension, 5 mg midodrine significantly improved the symptoms and the systolic blood pressures. (J Korean Acad Rehab Med 2008; 32: 45-50)

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Risk Factors of Orthostatic Hypotension in the Ischemic Stroke Patients.: Jeong, Ho Joong , Kim, Ghi Chan , Eom, Moon Sub , Hong, Jin Young; J Korean Acad Rehabil Med 2007;31(3):305-309.

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Objective
To determine risk factors of orthostatic hypotension in ischemic stroke patients. Method: In 98 ischemic stroke patients, blood pressure and heart rate were measured after resting in the supine position for 10 minutes and again after standing for one minute. Presence of orthostatic hypotension was correlated with age, gender, body mass index, laboratory findings, diabetes mellitus, anti-hypertensive use, side of involved hemisphere, smoking and K-MBI (Korean Modified Barthel Index). Results: 30 out of 98 patients had orthostatic hypotension. Those patients with orthostatic hypotension were older in age and had a higher average blood pressure, heart rate and plasma creatinine. On the other hand, body mass index, K-MBI and serum sodium levels were lower in the orthostatic hypotension group. Multivariate analysis revealed that age, body mass index, anti-hypertensive use and smoking were independently associated with orthostatic hypotension. Conclusion: Old age, low BMI, anti-hypertensive use, smoking were risk factors of orthostatic hypotension in the ischemic stroke patients. Patients in the higher risk categories should receive regular monitoring of blood pressure in order to detect orthostatic hypotension and prevent its complications. (J Korean Acad Rehab Med 2007; 31: 305-309)

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Relationship between Nocturnal Polyuria and Antidiuretic Hormone in Chronic Spinal Cord Injury.: Yu, Ji Yeon , Shin, Kyeong Ho , Kim, Jeong Tae , Bae, Ji Hyae , Park, Yeong Ok , Cho, Young Jin; J Korean Acad Rehabil Med 1999;23(5):961-967.

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Objective: To delineate the role of antidiuretic hormone (ADH) in relation to nocturnal polyuria, and to identify the factors influencing on the diurnal antidiuretic hormone level.

Method: The ADH was measured by radioimmuoassay at daytime (2:00 PM) and at nighttime (2:00 AM) with nocturnal polyuria group (11) and without nocturnal polyuria group (8). Urine volume, serum osmolarity, urine osmolarity, and blood pressure were also measured at the same time.

Results: 1) The ADH at 2:00 AM did not increase in nocturnal polyuria group, although it increased in no-symptom group. 2) There was a statistically significant correlation between wheelchair ambulation time and daytime ADH level. 3) The difference of ADH level between daytime and nighttime showed decrease in orthostatic hypotension group.

Conclusion: There was relationship between nocturnal polyuria and diurnal variation of ADH level. The ADH concentration seems to be influenced by the postural factors and sympathetic factors.

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Cardiovascular Instabilities Accompanying Acute Spinal Cord Injured Patients.: Sung, In Young , Cho, Seung Chan , O, Je Hong; J Korean Acad Rehabil Med 1997;21(1):55-61.

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Traumatic spinal cord injury causes profound changes in blood pressure, pulse rate and cardiac rhythm. Because the cardiovascular system is highly dependent on autonomic influences, acute spinal cord trauma might interfere with the complex mechanisms involved in cardiovascular homeostasis. These abnormalities has been generally attributed to autonomic instability. However, relatively little attention has been paid to the acute aspects of autonomic dysfunction in humans.

Therefore, this study was performed retrospectively on 62 patients with acute spinal cord injuries to evaluate incidence, time course and severity for cardiovascular instability. In this study, the incidence of persistent bradycardia and hypotension in the cervical injury group was significantly higher than that of the thoracolumbar injury group. These signs occurred earlier in the cervical group than the thoracolumbar group and also lasted longer in the cervical group. This study suggests that there is a direct correlation between the level of spinal cord injury and the incidence of cardiovascular problems.