Statement of the problem:
Is there a difference between of inspiratory muscle training with aerobic exercise or inspiratory muscle training for hemodialysis patients with AF??
Purpose of the study:
To find out the effect of combined inspiratory muscle training with aerobic exercise OR inspiratorty muscle traiting for hemodialysis CKD patients with atrial fibrillation as regards The following outcomes:
1. medical state of patient (heart rate, blood pressure, oxygen saturation) 2. lab analysis (GFR, Serum creatinine, blood urea and nitrogen (BUN) and INR) 3. maximum Inspiratory pressure (MIP) 4. period, duration of dialysis 5. short form questionnaire(SF36) 6. modified Borg scale
Patients from both gender
With chronic kidney failure(GFR>30)
with atrial fibrillation
Unemployed living a sedentary lifestyle
Real difficulties with understanding and signing The written informed consent
Recent sequela of cerebrovascular accidents
Osteoarticular or musculoskeletal diseases
Un controlled systemic hypertension
Parallel
inspiratoy muscle training
Deviceintervention : (inspiratory muscle training) (inspiratory muscle training at 30% of maximal inspiratory pressure for20 minutes/ session, 3 days a week, for 3 months Each patient breathes through a separate mouthpiece. The resistance is adjusted 30% of maximum inspiratory pressure detected from maximum inspiratory pressure meter and is marked on the training device. A single training session consists of five sets, each contains five inspirations with total of twenty five breaths with one minute of recovery between each set. The resistance was adjusted every month at 30%of the new maximum pressura and if it remain the subject remain at the same level
Aerobic exercise +inspiratory muscle training
Deviceb) Active phase: * Mode:moderte -intensity interval aerobic training (MIIT). * Intensity: With MODERTE intensity continous of 60 %of heart rate reserve (HRR) monitored by ECG and a 5-minute cool-down following exercise at intensity (30- 40%HR RESERVE) were carried out each time. In addition, the exercise was performed in the first half of the dialysis session over a 3 months period for 3 sessions per week by cycling for 20 min at a moderate intensity(60%HR RESERVE) participants were trained to use stationary bicycle ergometer in a supine position for minimum of 30 minutes at each HD session. The speed, load, and duration were gradually increased with change of mode (automatic and passive). inspiratory muscle training)
6 minute walk test
6 minute walk test : (To detect functional capacity, carry out in a 20 -meter line along The passage way, The tape is placed every 30 meters .patients are instructed to walk The longest possible distance in 6 minutes continuously, turning around at The final Mark without stopping. they are further instructed to walk as far as they can for 6minutes without running or jogging, covered distance in meters is measured at the end of the rest for analysis
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