[[alternative]]Breathing exercises improve fatigue and quality of life in hemodialysis patients

[[abstract]]目的: 疲憊是血液透析病人最常經歷的症狀之一，疲憊不僅會影響病人生活品質也會影響其存活率，呼吸運動對於改善這些病人的疲憊和與健康相關的生活品質可能是有效的，過去的研究已經得出結論，規律運動可以改善疲憊和提升生活品質，本研究目的在探討呼吸運動對血液透析病人之疲憊與生活品質之成效。方法: 本研究採重複測量實驗性設計方便取樣，於2017年3月至2017年6月針對血液透析病人行呼吸運動且符合收案條件者，進行收案，共納入86名，隨機分配實驗組和對照組，每組43人。對照組接受護理常規護理，而實驗組不僅接受常規護理，而且接受12週的呼吸運動。介入措施對照組在第4週、第12週常規透析後測量心率變異、血壓及血氧飽和濃度。實驗組則在第4週、第12週常規透析的後執行呼吸運動後，休息後測量心率變異、血壓及血氧飽和濃度，且進行後測問卷，包含：血液透析病人疲憊量表、醫院焦慮憂鬱量表、台灣簡明版世界衛生組織生活品質問卷WHOQOL-BREF。資料收集由IBM SPSS 22.0軟體進行資料分析，包含百分比、卡方檢定、廣義估計方程、重複變異量分析等統計方法進行分析及檢定，以研究呼吸運動對血液透析病人疲憊及生活品質的成效。結果:本研究結果顯示本次研究介入措施對兩組在疲憊有統計顯著差異（B=-30.65，p=.01），實驗組較對照組疲憊降低，對疲憊而言，考量舒張壓與時間交互作用下，研究介入措施後實驗組疲憊程度降低，第四週（B=.34，p=.01）、第十二週（B=.45，p=.01）達統計顯著差異；而對照組疲憊程度未改善。在時間效應上第12週（p=.01）有統計顯著差異。對生活品質而言LF（B=.003，p=.01）、焦慮（B=-.87，p=.001）有統計顯著差異，考量焦慮與時間交互作用下，研究介入措施後實驗組焦慮程度下降，而對照組焦慮程度上升，第12週（B=.55，p=.04）達統計顯著差異。結論:研究結果顯示12週呼吸運動似乎可以有效改善血液透析病人之疲憊感與生活品質。呼吸運動是安全的並且需長期，可在血液透析期間進行，持續呼吸運動顯著改善疲憊感，減緩生活品質下降程度，研究結果可提供護理實務工作者對血液透析病人照顧之參考`.關鍵字:血液透析、呼吸運動、疲憊、生活品質[[abstract]]Background: Patients with end-stage renal disease under hemodialysis are associated with dramatically impaired fatigue, and eventually with decreased health-related quality of life. Breathing exercises may be effective in improving fatigue and health-related quality of life in these patients. Previous studies have concluded that regular exercise might improve fatigue and quality of life, which could play an important role in decreasing fatigue and improving quality of life in these patients.Aim: This study aimed to evaluate the effects of intra-dialytic breathing exercises on fatigue, and quality of life scale (WHOQOL-BREF) in HD patients.Methods: This study was a randomized controlled trial. From March 2016 to June 2016, 86 patients under maintenance hemodialysis were prospectively recruited and randomly assigned into either a control or exercise groups, with 43 participants in each group. The control group received routine nursing care, whereas the exercise group additionally received 12 week breathing exercises. Data were collected at baseline, 4th week and 12th week of the study. Heart rate variability (HRV), blood pressure and oxygen saturation levels were measured after exercise. Quality of life was assed using WHOQOL-BREF. Outcome measures include fatigue scale, and quality of life scale (WHOQOL-BREF). The data were collected and analyzed by IBM SPSS 22.0 software, including the percentage, chi-square test, generalized estimation equation and repeated variable analysis. Results: Breathing exercises were associated with decreased fatigue in the experimental (B = -30.65, p = .01). For fatigue, the interaction between diastolic blood pressure and time (P = .01), the twelfth week (B = .45, p = .01), there was statistically significant difference in the fourth week (B = .34, p = .01) Overall group fatigue did not improve. There was a statistically significant difference at the 12th week of time effects (p = .01). For quality of life LF (B = .003, p = .01), anxiety (B = - .87, p = .001) were statistically significant differences, considering the interaction of anxiety and time, study intervention group experimental group. Anxiety decreased in the experimental group, while anxiety increased in the control group, which was most visible at week 12 (B = .55, p = .04). Conclusion: 12 weeks of breathing exercises seems to be effective in improving the fatigue and quality of life of hemodialysis patients. Breathing exercise is safe and can be carried out during hemodialysis. Continuous breathing exercises significantly improve the sense of fatigue, and reduce the decline in quality of life. The results of this study provide a reference to nursing practitioners for the care of hemodialysis patients.Keywords: hemodialysis, Breathing exercise program, fatigue, WHOQOL-BRE