DOI QR코드

DOI QR Code

자기주도 가상현실 운동프로그램이 혈액투석환자의 심박변이도, 삶의 질에 미치는 효과

Effects of Self-motivated Virtual Reality Exercise Program on Heart Rate Variability and Quality of Life in the Hemodialysis Patients

  • 조혜영 (대원대학교 응급구조학과)
  • Cho, Hye-Young (Department of Emergency Medical Service, Daewon University)
  • 투고 : 2014.08.15
  • 심사 : 2014.09.11
  • 발행 : 2014.09.30

초록

본 연구에서는 혈액투석환자와 같은 만성질환자 대한 운동수행율을 높이기 위해서 접근성과 동기유발이 용이하고 환자들의 자발적 참여에 효과가 있다고 알려진 가상현실 운동프로그램을 적용하여 그 효과를 확인하고자 하였다. 지역 인공신장실에서 혈액 투석을 받는 환자 46명을 대상으로 대조군과 운동군에 각 23명씩 배정하였다. 가상현실 운동프로그램을 위한 기기로는 닌텐도 위 발란스 보드(Wii Balance Board)를 사용하였다. 투석 전 대기시간을 이용하여 40분간, 주 3회씩, 8주 동안 운동군에게 가상현실 운동프로그램을 시행하였고. 실험처치의 효과는 심박변이도와 삶의 질(SF-36)로 평가하였다. 8주간의 가상현실 운동프로그램 적용 후 운동군에서 심박변이도는 SDNN이 유의하게 상승하였고(p<.001) 삶의 질 점수는 신체적 요소에서 유의하게 상승하였고(p=.003) 정신적 요소에서 유의하게 상승하였다(p=.001). 이상의 결과로 가상현실 운동프로그램은 혈액투석환자의 심박변이도 및 삶의 질 개선에 효과가 있는 것으로 나타났다. 이는 자기주도 VREP가 간호중재의 새로운 시도로서 혈액투석환자뿐만 아니라 다양한 만성질환자의 신체적, 정서적인 효과를 기대하는 간호중재로 활용할 수 있을 것으로 기대한다.

In this study, 46 patients from a local hemodialysis center were enrolled to assess the effects of a self-motivated virtual reality (VR) exercise program on the heart rate variability and quality of life control in hemodialysis patients. The VR group (n = 23) completed a VR exercise program, where the subjects performed the exercise 40 min per session, 3 sessions per week, for 8weeks. After the exercise program, the heart rate variability and quality of life were measured. The VR group showed significant improvement in the heart rate variability and quality of life. The self-motivated VR exercise program provided both the role of supervisor as well as feedback, which is important for hemodialysis patients.Therefore, a self-motivated VR exercise program may be a useful tool for improving the psychosocial function in chronic disease patients undergoing hemodialysis.

키워드

참고문헌

  1. ESRD Registry Committee of korean Society of Nephrology. Current renal replacement therapy in Korea, korean Society of Nephrology, 2013, [http://www.ksn.or.kr/journal/2013/index.html].
  2. Song,W.J., Sohng, K.Y., Effects of progressive resistance training on body composition, physical fitness and quality of life of patients on hemodialysis, J Korean Acad Nurs, 42, pp. 947-56, 2012. DOI: http://dx.doi.org/10.4040/jkan.2012.42.7.947
  3. Jang, E.J., Kim, H.S., Effects of Exercise Intervention on Physical Fitness and Health-relalted Quality of Life in Hemodialysis Patients, J Korean Acad Nurs, (39)4, pp. 584-93, 2009. DOI: http://dx.doi.org/10.4040/jkan.2009.39.4.584
  4. Elder, S. E., Bommer, J., Fissell, R. B., Jadoul, M., Keen, M., Pisoni, R., Saran, R., Port, F., Hemodialysis (HD) facilities in which more patients exercise have lower risks of mortality and hospitalization: international results from the DOPPS [abstract], J Am Soc Nephrol,16, 94A, 2005.
  5. Cheema,B.S., Singh, M.A., Exercise training in patients receiving maintenance hemodialysis: a systematic review of clinical trials, Am J Nephrol, 25, pp. 352-364, 2005. DOI: http://dx.doi.org/10.1159/000087184
  6. Park, C. B., Ji, J.W., Effet of the exercise training before homodialysis in End-stage renal disease patients, The Journal of Physical Education, 28, pp. 261-273, 2000.
  7. Burdea, G. C., Virtual rehabilitation--benefits and challenges, Methods Inf Med, 42, pp. 519-523, 2003.
  8. Chan, C.L., Ngai, E. K., Leung, P. K., Wong, S., Effect of the adapted Virtual Reality cognitive training program among Chinese older adults with chronic schizophrenia: a pilot study, Int J Geriatr Psychiatry, 25, pp. 643-649, 2010. DOI: http://dx.doi.org/10.1002/gps.2403
  9. Lewis, G.N., Woods C, Rosie JA, McPherson KM. Virtual reality games for rehabilitation of people with stroke: perspectives from the users, Disabil Rehabil Assist Technol, 6, pp. 453-463, 2011. DOI: http://dx.doi.org/10.3109/17483107.2011.574310
  10. Lee, S.W., The effects of a virtual reality exercise program on physical function and falls efficacy in elderly persons with type2 diabetes, The Graduate School of Ewha Womans University Master's Thesis, 2011.
  11. Young, W., Ferguson, S., Brault, S., Craig, C., Assessing and training standing balance in older adults: A novel approach using the 'Nintendo Wii' Balance Board, Gait and Posture, 33(2), pp. 303-305, 2011. DOI: http://dx.doi.org/10.1016/j.gaitpost.2010.10.089
  12. Saposnik, G., Teasell, R., Mamdani, M., Hall, J., McIlroy, W., Cheung, D., et al, Effectiveness of Virtual Reality using Wii gaming technology in stroke rehabilitation: A pilot randomized clinical trial and proof of principle, Stroke, 41(7), pp. 1477-1484, 2010. DOI: http://dx.doi.org/10.1161/STROKEAHA.110.584979
  13. Kim, J.J., Kim, Y.S., Kim, D.H., Park, C.S., Yoon, B.C., The comparioon of morion errors with without visual feedback during hipexercise in environment of virtual reality, Journal of Sports and Leisure Studies, 45, pp. 947-953, 2011.
  14. The life options Rehabilitation Advisory Council, Exercise: A guide for people on dialysis, Madison Wl: Amgen Inc, 2000.
  15. Woo, J.M., The concept and clinical application for the measurement of heart rate variability, Korean J Psychosomatic Medicine, 12, pp. 3-14, 2004.
  16. Nam, H.S., Choi,E.H., Park, D.S., Oh,,J..E.,.Kim, S.J.,.Lee,J.Y.,Kim,A.R., The Effects of Intradialytic Exercise on Dialysis Efficacy and Autonomic Function in Hemodialysis Patients -Preliminary Study-, The Korean Journal of Sports Medicine, 28(2), pp. 119-124, 2010.
  17. Ware,T.J., Kosinski, M., Gandek, B., SF-36 health survey: manual & interpretation guide, Lincoln, RI QualityMetric Incorporated, 2000.
  18. Lee, Y.K., Kim, C., Pyo, J.H., Kim, C.H., Ji, J.W., Endurance exercise training before hemodialysis : an effective therapeutic modality for end-stage renal disease patients, Korean J Nephrol, 20, pp. 290-297, 2001.
  19. Cruz, M.C., Andrade, C., Urrutia, M., Draibe, S., Nogueira-Martins LA, Sesso Rde C. Quality of life in patients with chronic kidney disease. Clinics (Sao Paulo), 66, pp. 991-995, 2011. DOI: http://dx.doi.org/10.1590/S1807-59322011000600012
  20. Kouidi, E., Grekas, D., Deligiannis, A., Tourkantonis, A., Outcomes of long-term exercise training in dialysis patients: comparison of two training programs, Clin Nephrol, 61, pp. S31-38, 2004.
  21. Goldberg, A.P., Geltman, E.M., Gavin, J.R., Carney, R.M., Hagberg,J.M., Delmez, J.A., Naumovich, A., Oldfield, M.H., Harter, H.R., Exercise training reduces coronary risk and effectively rehabilitates hemodialysis patients, Nephron, 42, pp. 311-316, 1986. DOI: http://dx.doi.org/10.1159/000183694
  22. Blake, C., Codd, M.B., Cassidy, A., O'Meara, Y.M., Physical function, employment and quality of life in end-stage renal disease, J Nephrol, 13, pp. 142-149, 2000.
  23. Kutner, N.G., Zhang, R., McClellan, W.M., Patient-reported quality of life early in dialysis treatment: effects associated with usual exercise activity, Nephrol Nurs J, 27, pp. 357-367, 2000.
  24. Virk, S., McConville, K.M., Virtual reality applications in improving postural control and minimizing falls, Conf Proc IEEE Eng Med Biol Soc, 1, pp. 2694-2697, 2006. DOI: http://dx.doi.org/10.1109/IEMBS.2006.260751
  25. D'Angelo, M., Narayanan, S., Reynolds, D.B., Kotowski, S., Page, S., Application of virtual reality to the rehabilitation field to aid amputee rehabilitation: findings from a systematic review, Disabil Rehabil Assist Technol, 5, pp. 136-142, 2010. DOI: http://dx.doi.org/10.3109/17483100903387622
  26. Jassal, S.V., Douglas, J.F., Stout, R.W., Prevalence of central autonomic neuropathy in elderly dialysis patients, Nephrol Dial Transplant, 13, pp. 1702-1708, 1998. DOI: http://dx.doi.org/10.1093/ndt/13.7.1702
  27. Deligiannis, A., Kouidi, E., Tourkantonis, A., Effects of physical training on heart rate variability in patients on hemodialysis, Am J Cardiol, 84, pp. 197-202, 1999. DOI: http://dx.doi.org/10.1016/S0002-9149(99)00234-9
  28. Goldsmith, R.L., Bloomfield, D.M., Rosenwinkel, E.T., Exercise and autonomic function, Coron Artery Dis, 11, pp. 129-135, 2000. DOI: http://dx.doi.org/10.1097/00019501-200003000-00007
  29. Oh-Park, M., Fast, A., Gopal, S., Lynn, R., Frei, G., Drenth, R., Zohman, L., Exercise for the dialyzed: aerobic and strength training during hemodialysis, Am J Phys Med Rehabil, 81, pp. 814-821, 2002. DOI: http://dx.doi.org/10.1097/00002060-200211000-00003
  30. DePaul,V., Moreland, J., Eager, T., Clase, C.M., The effectiveness of aerobic and muscle strength training in patients receiving hemodialysis and EPO: a randomized controlled trial, Am J Kidney Dis, 40, pp. 1219-1229, 2002. DOI: http://dx.doi.org/10.1053/ajkd.2002.36887
  31. Konstantinidou, E., Koukouvou, G., Kouidi, E., Deligiannis, A., Tourkantonis, A., Exercise training in patients with end-stage renal disease on hemodialysis: comparison of three rehabilitation programs, J Rehabil Med, 34, pp. 40-45, 2002. DOI: http://dx.doi.org/10.1080/165019702317242695