Tesis

Efek Pemberian Program Latihan Fisik Intradialisis terhadap Perubahan Ketahanan Kardiorespirasi dan Kualitas Hidup Pasien Dewasa dengan Gagal Ginjal Kronis = The Effect of Intradialysis Physical Exercise Program on Cardiorespiratory Endurance and Quality of Life Changes in Adult Patients with Chronic Kidney Failure.

Latar belakang: Pasien gagal ginjal kronis (GGK) yang menjalani hemodialisis rutin cenderung memiliki tingkat aktivitas fisik, ketahanan kardiorespirasi, dan kualitas hidup yang rendah. Latihan fisik intradialisis berpotensi menjadi strategi terstruktur, terukur dan aman meningkatkan kebugaran fisik dan kualitas hidup pasien GGK. Tujuan: Penelitian ini bertujuan untuk menganalisis efek pemberian program latihan fisik intradialisis terhadap perubahan ketahanan kardiorespirasi dan kualitas hidup pada populasi ini. Metode: Penelitian ini merupakan studi awal yang menggunakan desain kuasieksperimental pre–post dengan satu kelompok. Subjek penelitian adalah pasien dewasa GGK yang menjalani hemodialisis rutin di Rumah Sakit Universitas Indonesia. Intervensi berupa latihan aerobik intradialisis menggunakan alat ergocycle (Kinesia®) yang dilakukan selama 4 minggu, 2x/minggu, durasi 30 menit/sesi, dengan target intensitas sedang dan supervisi ketat. Ketahanan kardiorespirasi diukur menggunakan six-minute walking test (6MWT), sedangkan kualitas hidup dinilai menggunakan kuesioner Kidney Disease Quality of Life-36 (KDQOL-36). Analisis statistik dilakukan untuk menilai karakteristik subjek, perubahan sebelum dan sesudah intervensi, serta hubungan antara jumlah kehadiran latihan, usia dan tingkat aktivitas fisik terhadap perubahan luaran tersebut. Hasil: Setelah intervensi selama 4 minggu, terdapat peningkatan ketahanan kardiorespirasi dan skor kualitas hidup, namun tidak bermakna secara statistik. Terjadi perubahan signifikan dalam peningkatan tingkat aktivitas fisik dan penurunan lingkar pinggang. Selain itu, ditemukan kenaikan indeks massa tubuh, persentase lemak dan massa otot, namun tidak bermakna secara statistik. Analisis hubungan menunjukkan bahwa tingkat kehadiran latihan tidak memiliki hubungan signifikan dengan perubahan ketahanan kardiorespirasi dan kualitas hidup. Terdapat korelasi negatif dan signifikan antara tingkat aktivitas fisik dan kualitas hidup domain beban penyakit ginjal. Hal ini menunjukkan bahwa subjek dengan tingkat aktivitas fisik yang lebih tinggi mengalami peningkatan skor kualitas hidup domain beban penyakit ginjal yang lebih kecil. Kesimpulan: Latihan fisik intradialisis selama 4 minggu mampu laksana dan aman pada pasien GGK yang menjalani hemodialisis rutin di RSUI, namun belum menunjukkan peningkatan ketahanan kardiorespirasi dan kualitas hidup yang bermakna secara statistik. Terdapat peningkatan tingkat aktivitas fisik dan penurunan lingkar pinggang bermakna secara statistik. Diperlukan penelitian lanjutan dengan durasi intervensi yang lebih panjang dan ukuran sampel yang lebih besar untuk mengevaluasi manfaat jangka panjang latihan fisik intradialisis.
Kata kunci: gagal ginjal kronis, hemodialisis, latihan fisik intradialisis, ketahanan kardiorespirasi, kualitas hidup


Background: Chronic kidney disease (CKD) patients undergoing regular hemodialysis tend to have low levels of physical activity, cardiorespiratory endurance and quality of life. Intradialysis physical exercise has the potential to be a structured, measurable, and safe strategy to improve physical fitness and quality of life in CKD patients. Objective: This study aims to analyze the effect of intradialysis physical exercise program on cardiorespiratory endurance and quality of life changes in this population. Methods: This pilot study used a quasi-experimental pre-post design with one group. The subjects were adult CKD patients undergoing regular hemodialysis at the University of Indonesia Hospital. The intervention consisted of intradialysis aerobic exercise using an ergocycle (Kinesia®) for four weeks, twice a week, for 30 minutes per session, with a moderate intensity target and close supervision. Cardiorespiratory endurance was measured using the six-minute walk test (6MWT), while quality of life was assessed using the Kidney Disease Quality of Life-36 (KDQOL-36) questionnaire. Statistical analysis was performed to assess subject characteristics, changes before and after the intervention, and the relationship between exercise attendance, age, and physical activity level on these outcomes. Results: After the four-week intervention, there was an increase in cardiorespiratory endurance and quality of life scores, but this was not statistically significant. There was a significant increase in physical activity levels and a decrease in waist circumference. Additionally, there was an increase in body mass index, fat percentage, and leg muscle mass, but this was not statistically significant. Correlation analysis showed that exercise attendance was not significantly associated with changes in cardiorespiratory endurance and quality of life. There was a significant and negative correlation between physical activity levels and the quality of life domain of kidney disease burden. This indicates that subjects with higher levels of physical activity experienced a smaller increase in quality of life scores in the kidney disease burden domain. Conclusion: Four weeks of intradialysis physical exercise was feasible and safe for chronic kidney disease (CKD) patients undergoing routine hemodialysis at RSUI, but did not show statistically significant improvements in cardiorespiratory endurance and quality of life. There was a statistically significant increase in physical activity levels and a decrease in waist circumference. Further research with a longer intervention duration and a larger sample size is needed to establish the long-term benefits of intradialysis physical exercise.
Keywords: chronic kidney disease, hemodialysis, intradialysis physical exercise, cardiorespiratory endurance, quality of life