For patients living with Chronic Kidney Disease who are preparing to start hemodialysis, having a well-functioning arteriovenous fistula (AVF) is essential. Although the AVF is considered the best type of vascular access, its maturation process does not always go as expected-studies show that in 28% to 53% of cases, the fistula does not mature properly, making effective dialysis more difficult. There is growing interest in using physical exercise as a way to support AVF maturation. International guidelines even recommend arm exercises for this purpose. However, there is still no clear agreement on what type of exercise, how often, or how intense it should be. This study aims to evaluate whether a structured exercise program focused on the AVF arm can help improve the fistula's development and overall function.
Age ≥ 18 years
AVF in the upper limb
No cognitive decline and ability to follow instructions
History of previous dysfunctional ipsilateral AVF
History of injury/condition causing pain or loss of function in the AVF limb
Musculoskeletal conditions/osteoarticular pathology (e.g., myopathy, rheumatoid arthritis)
Neurological conditions/cardiovascular events (e.g., stroke, peripheral neuropathy
Parallel
Physical exercise program
Other interventionEvaluation of AVF maturation using clinical and ultrasound criteria, after applying a structured physical exercise program.
Evaluation of AVF maturation using clinical and ultrasound criteria: Diameter of the drainage vein (mm)
-Diameter of the drainage vein (mm). Eight weeks after the application of a physical exercise program, patients in the intervention and control groups will be evaluated through a physical examination (presence of thrill and continuous murmur, increased venous diameter, absence of complications such as stenosis or thrombosis) and ultrasound examination.
Evaluation of AVF maturation using clinical and ultrasound criteria: Venous wall thickness (mm)
\- Venous wall thickness (mm). Eight weeks after the application of a physical exercise program, patients in the intervention and control groups will be evaluated through a physical examination (presence of thrill and continuous murmur, increased venous diameter, absence of complications such as stenosis or thrombosis) and ultrasound examination.
Evaluation of AVF maturation using clinical and ultrasound criteria: Blood velocity (cm/sec)
\- Blood Velocity (cm/sec). Eight weeks after the application of a physical exercise program, patients in the intervention and control groups will be evaluated through a physical examination (presence of thrill and continuous murmur, increased venous diameter, absence of complications such as stenosis or thrombosis) and ultrasound examination.
Evaluation of AVF maturation using clinical and ultrasound criteria: Blood flow volume in the humeral artery (mL/min)
\- Blood flow volume in the humeral artery (mL/min). Eight weeks after the application of a physical exercise program, patients in the intervention and control groups will be evaluated through a physical examination (presence of thrill and continuous murmur, increased venous diameter, absence of complications such as stenosis or thrombosis) and ultrasound examination.
Evaluation of the impact of each physical parameters in FAV maturation: Change in Handgrip Strength (kg)
The Change in Handgrip Strength will be measured: kg
Evaluation of the impact of each physical parameters in FAV maturation: Change in Forearm and Upper Arm Circumference (cm)
The Change in Forearm and Upper Arm Circumference will be measured: cm
Evaluation of the impact of each physical parameters in FAV maturation: Change in Rate of AVF Complications (%)
The Change in Rate of AVF Complications will be measured: %
Evaluation of the impact of each physical parameters in FAV maturation: Change in Blood Flow Velocity in the Humeral Artery (mL/min)
The change in Blood Flow Velocity in the Humeral Artery will be measured: mL/min.
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