Virtual reality-based exercises found to reduce depression and anxiety among individuals treated with hemodialysis

By Pooja Toshniwal PahariaAug 3 2023Reviewed by Lily Ramsey, LLM

In a recent study published in the Scientific Reports Journal, researchers determined the association between regular physical exercise based on virtual reality (VR) and the development of depression and anxiety symptoms among hemodialysis (HD) patients.

Study: Impact of virtual reality exercises on anxiety and depression in hemodialysis. Image Credit: OleksandrKhmelevskyi/Shutterstock.com

Background

Anxiety is a common psychiatric symptom in individuals suffering from end-stage renal disease (ESRD) managed by HD. Factors contributing to anxiety include chronic kidney replacement treatment, physical symptoms, and limited recovery prospects.

Depression and anxiety significantly impact the life quality of HD patients, causing problems in their family, work, and social lives.

VR, a computer-generated simulation, can supplement rehabilitation by facilitating user interactions with simulated surroundings and providing real-time feedback.

VR programs have been extensively used in treating coordination and balance disorders and improving gait and mobility in neurological diseases. However, data on the rehabilitation of chronic renal disease patients is limited.

About the study

In the present study, researchers assessed the effect of VR-based exercises performed during HD on depression and anxiety symptoms among individuals treated with HD.

The study, performed between March 2021 and February 2022, included 85 patients (27 women and 58 men) who were to receive dialysis treatment at the Transplantology, Internal Medicine, and Nephrology Department of Pomeranian Medical University (PUM). The participants were randomized to the study and control groups.

The study (intervention) group comprised 39 ESRD patients (10 women and 29 men, mean age of 58 years) in the fifth phase of chronic renal disease who were undergoing kidney replacement treatment by HD and were to perform virtual reality-based exercises for 20 minutes during HD.

The non-intervention (control) group comprised 46 (17 women and 29 men, mean age of 63 years) individuals undergoing kidney replacement treatment by HD who did not perform the VR-based exercises.

The team compared the seven-item general anxiety disorder (GAD-7) scale and the Beck Depression Inventory (BDI) scores obtained by participants filling out the corresponding questionnaires at baseline and after three months of intervention. Both group participants received three HD sessions weekly.

The mean values for HD session durations for the intervention and non-intervention groups were 224 and 217 minutes, respectively.

Only individuals aged >18 years, those without diuresis, and those considered for kidney replacement treatment by HD for ≥3.0 months (thrice weekly) were included in the intervention group.

 The team excluded individuals with a history of musculoskeletal disorders, cardiovascular illnesses, acute coronary syndrome (ACS) in 3.0 months before the study, visual disturbances, uncontrolled hypertension, poorly managed diabetes [glycated hemoglobin (HbA1c) >8.0% for three months], dementia and other mental or neurological diseases, malignant tumors, surgery underwent in the previous month, lower limb amputation, and epilepsy.

Results

Before HD treatment, 26 (72%) and 24 (53%) individuals in the intervention and non-intervention groups engaged in professional activities, respectively, which were reduced to 10 (28%) and five (11%), respectively.

In the study group, the nature of work was physical and intellectual among 18 (47%) and 11 (29%) participants, respectively. Among control group participants, the corresponding numbers were 18 (55%) and seven (21%), respectively.

In the intervention and non-intervention groups, there were nine (23%) and 11 (24%) smokers who smoked 14 cigarettes daily.

Diabetes, arterial hypertension, ophthalmologic disorders, and neurological disorders were prevalent among five (15%), 25 (74%), eight (24%), and two (6.0%) study group participants, respectively. The corresponding numbers among control group participants were 12 (29%), 32 (71%), 15 (33%), and three (6.5%), respectively.

After the end of the exercise cycle, the GAD-7 and BDI scores were significantly reduced among study group participants and increased among control group participants. The 3.0-month VR-based low-intensity bicycle exercise regimen significantly reduced depression symptoms, in line with previous studies.

At baseline, in the intervention and non-intervention groups, the mean BDI scores were 9.53 and 9.09, respectively, and the mean GAD-7 scores were 7.15 and 7.10, respectively.

After three months of intervention, the mean BDI scores among study and control group participants were 8.31 and 11.64, respectively, and the mean GAD-7 scores were 5.42 and 8.59, respectively.

Conclusion

Overall, the study findings showed that VR-based physical exercise has been linked to reduced depression and anxiety symptoms among chronic HD patients.

This can be achieved by utilizing patients' time in dialysis centers, promoting a healthy lifestyle, and ensuring safety.

Encouraging patients to engage in virtual reality physical activities can improve their mental health, and similar studies should be conducted on patients treated with other kidney replacement treatment methods.