Intervention control of aerobic exercise in maintaining quality of life and pulmonary hypertension in hemodialysis patients

Abstract

BACKGROUND

Pulmonary hypertension is a serious complication in the treatment of maintenance hemodialysis patients, which seriously affects the quality of life of patients and threatens their life safety. Prevention, treatment and improvement of pulmonary hypertension are of great significance to improve the quality of life of patients.

AIM

To investigate the intervention and control of pedal-powered bicycle in maintaining quality of life and pulmonary hypertension in hemodialysis patients.

METHODS

73 patients with maintenance hemadialysis combined with pulmonary arterial hypertension at a hemodialysis center in a certain hospital from May 2021 to May 2022 are selected. Patients are divided into two groups, 37 cases in the control group (group C) and 36 cases in the intervention group (group I). Patients are divided into two groups, group C is treated with oral administration of betaglandin sodium combined with routine nursing care. Based on group C, group I conducts power cycling exercises.

RESULTS

After treatment, group I patients had higher muscle strength, 36-Item Short Form Health Survey scores, and Kidney Disease Targets Areas scores; The 6-minute walk distance test index level was higher and the Borg score was lower; The group I had lower systolic blood pressure, greater vital capacity, higher positive emotion, lower systolic pulmonary artery pressure index level, higher arterial partial oxygen pressure level, lower pulmonary vascular resistance index level, and higher blood oxygen saturation level [158.91 ± 11.89 vs 152.56 ± 12.81, 1795.01 ± 603.18 vs 1907.20 ± 574.15, 24.00 (22.00, 29.00) vs 24.00 (22.00, 28.00), P < 0.001].

CONCLUSION

Aerobic exercise combined with Western medicine treatment can effectively improve patients' pulmonary hypertension, alleviate their negative emotions, and enable them to achieve a higher level of quality of life.

Key Words: Aerobic exercise, Hemodialysis, Pulmonary arterial hypertension, Cycle ergometer, Quality of life

Core Tip: This study investigates the effects of aerobic exercise, on the quality of life and pulmonary arterial hypertension (PAH) in patients undergoing hemodialysis. Employing a control design, the research divides patients into a control group receiving standard care and an intervention group undertaking power cycling in addition to standard care. The results demonstrate significant improvements in the intervention group, including enhanced muscle strength, better quality of life scores, reduced systolic blood pressure, and improved pulmonary function indicators. Incorporating aerobic exercise into the care regimen of hemodialysis patients with PAH can significantly improve their health outcomes and quality of life.

INTRODUCTION

The incidence rate of chronic kidney disease (CKD) in the world is increasing year by year, and its incidence rate in adults is 13.7%-17.3%. In China, the incidence rate of CKD is 10.8%. Due to the high incidence rate of CKD and irreversible course of disease development, the number of patients with end stage of renal disease (ESRD) is increasing year by year, and the number of patients is relatively large[1,2]. In China, the majority of ESRD patients undergo hemadialysis (HD) treatment, and under long-term treatment, their physical and mental health will be affected to varying degrees. They are prone to sleep disorder, which can lead to fatigue, anxiety, panic and other negative emotions. These emotions can be detrimental to the patient's treatment and seriously affect their quality of life. Moreover, compared to the general population, the incidence rate of pulmonary arterial hypertension (PAH) in maintenance HD (MHD) patients is higher. Among its main characteristics, pulmonary arteriole will have vasospasm, and intima will proliferate and reconstruct. Patients with PAH may experience progressive breathing difficulties, symptoms such as dizziness and chest pain, and their emotions may also be affected[3-5]. The current pathogenesis of this disease is not yet clear, and the treatment effect is poor, with poor prognosis and a high mortality rate. Therefore, to help MHD-PAH patients receive better treatment, auxiliary measures are used to alleviate their emotions and improve their symptoms. Research has shown that exercise therapy can help alleviate the physical and mental discomfort of HD patients and improve their quality of life[6,7]. Moreover, this therapy can also improve the endothelium-dependent vasodilation function and inhibit the formation of PAH under hypoxia. Considering the physical condition of patients with MHD and PAH, as well as the limitations of the venue, strength cycling exercise is chosen in aerobic exercise. It is easy to practice, relatively safe, and has good effects in improving patients' sleep quality, alleviating anxiety, and promoting blood flow[8,9]. In this regard, this paper applies power cycling exercise to the treatment of patients with MHD combined with PAH, with the aim of improving their quality of life and PAH.

MATERIALS AND METHODS

General information

From May 2021 to May 2022, 73 patients with MHD combined with PAH were selected as the study subjects at the HD center of a certain hospital. The patients were divided into a control group (group C) with 37 cases and an intervention group (group I) with 36 cases. This study has received the consent of the Medical Ethics Committee and the informed consent of the relevant patients and their families.

Inclusive: (1) Age ranges from 23 to 67 years old; (2) Meet the judgment criteria of the World Health Organization and the Chinese Medical Association for MHD merging with PAH; (3) The patient has a complete understanding of the research plan and is able to actively cooperate; (4) Patients are able to communicate without barriers; (5) After dialysis, the patient's weight meets the standard requirements; (6) The glomerular filtration rate is less than 15 mL/ (min × 1.73 m²); and (7) The patient has no severe anemia and hemoglobin is greater than or equal to 80 g/L.

Exclusive: (1) Under 23 years old or over 67 years old; (2) Dialysis time is less than 3 months; (3) Patients who also suffer from heart disease and other diseases; (4) The patient is at risk of rheumatic or malignant tumors; (5) Having stubborn hypertension; (6) Acute kidney failure; (7) The presence of severe glaucoma; and (8) Not participating in the research process. Figure 1 shows the relevant research ideas.

Figure 1 Related research routes. MHD: Maintenance hemadialysis; PH: Pulmonary hypertension.

In Figure 1, the first step is to preliminarily screen patients with MHD combined with PAH and obtain patients who meet the diagnostic requirements. According to the inclusion and exclusion criteria, MHD-PAH patients are further screened to obtain intervention targets for Laughter Yoga. According to the results in group C and group I, the group C patients receive routine treatment, while group I receives power cycling exercise on the basis of routine treatment. The correlation between the two groups of patients is tested using positive and negative emotion scales, blood pressure, and other indicators. The obtained results are organized and statistically analyzed.

Research method

Both group C and group I receive oral treatment with betaglandin sodium. On the basis of routine treatment, group I adopts power cycling exercise as the treatment plan. During the intervention period, it lasts for a total of 12 weeks, and the patient also undergoes power cycling exercise while undergoing dialysis. Under the guidance and guidance of professionals, appropriate strength circulation exercises should be carried out according to the patient's condition. Each practice lasts for 30 min and cannot be completed at once. Take a break midway, continue to accumulate time, and record the duration of the first and last runs. During the power cycling exercise, the patient's relevant data are recorded. In addition, during the practice period, patients with excellent performance can be given appropriate rewards to maintain their enthusiasm for practice and enable them to continue exercising every day.

Observation target

After the patient has rested for 5 min, the patient's blood pressure are measured with a standard desk mercury sphygmomanometer for 3 times at an interval of 2 min. The average of the 3 measurements are taken to obtain systolic and diastolic blood pressure. The domestically produced WCS-100II electronic grip strength meter is selected to measure the arm strength on the non arteriovenous fistula side of the patient. The number of measurements is 3, with an interval of 15 s between each measurement. The value with the highest measurement value is selected as the measurement result of muscle strength. The patient's vital capacity is measured through the relevant vital capacity measuring instrument. When measuring, the patient needs to be in a quiet state, with 3 measurements taken and the average of the measurement results taken. The Positive and Negative Affect Scale is selected to measure the patient's emotions. The scale is segmented into two dimensions: positive and negative emotions. The number of entries in one dimension is 10, and a Likert 5-level score is used. The higher the score, the stronger the positive or negative emotions of the patient[10]. The Kidney Disease Quality of Life Short Forms is selected, which includes two scales: the MOS 36-Item Short Form Health Survey (SF-36) and the Kidney Disease Targets Areas (KDTA). Through these scales, the patient's health status, quality of life, and other factors are evaluated, including a total of 20 dimensions. Each dimension is scored using a percentage system, with a high score indicating a high quality of life for the individual; On the contrary, it is low[11,12]. Pulmonary vascular resistance (PVR), blood oxygen saturation (SaO₂) and arterial partial oxygen pressure level (PaO₂) of femoral artery are measured. The patient's breathing condition is evaluated using the Borg dyspnea score. The higher the score, the more difficult the patient's breathing is. The patient's motor function is evaluated and analyzed through the 6-minute walk distance test (6MWD)[13,14].

Statistical methods

The data was analyzed using SPSS23.0 software. When P < 0.05, it indicates statistical significance. Researchers and another person alternated and mutually reviewed the input experimental results. The experimental results were described in the form of mean, sample rate, standard deviation, etc. Relevant statistical processing involved processing and analyzing relevant data through -tests, t-tests, and other forms.

RESULTS

The general information of group C and group I

The experiment organizes relevant data of patients with group C and group I. There are 37 cases in group C and 36 cases in group I. Comparing these two groups, there is no statistically significant difference in gender, age, work status, per capita monthly household income, primary cause, dialysis time, and dialysis frequency (P > 0.05). Before treatment, the general information of group C and group I is shown in Table 1.

Table 1 General information for groups C and I, n (%).

Characteristic	Group I (n = 36)	Group C (n = 37)	P value
Gender	-	-	0.859
Male	10 (27.78)	11 (29.73)	-
Female	26 (72.22)	26 (70.27)	-
Age (yr)	48.76 ± 9.05	47.84 ± 9.02	0.608
Work situation	-	-	0.675
Be on the job	3 (8.33)	2 (5.41)	-
Depart	4 (11.11)	2 (5.41)	-
Retire	6 (16.67)	5 (13.51)	-
Farmer	21 (58.33)	24 (64.86)	-
Other	2 (5.56)	4 (10.81)	-
Per capita monthly income of households	-	-	0.874
< 1000	15 (41.67)	18 (48.65)	-
1001-2000	8 (22.22)	10 (27.03)	-
2001-3000	8 (22.22)	3 (8.11)	-
> 3000	5 (5.56)	6 (16.22)	-
Primary etiology	-	-	0.963
Nepahritis	21 (56.76)	19 (51.35)	-
Diabetes	1 (2.70)	2 (5.41)	-
Hypertensive nepahropathy	8 (21.62)	9 (24.32)	-
Other	6 (16.22)	9 (24.32)	-
Dialysis time (yr)	-	-	0.481
< 2	11 (30.56)	14 (37.84)	-
2-5	17 (47.22)	13 (35.14)	-
> 5	8 (22.22)	10 (27.03)	-
Dialysis frequency	-	-	0.624
Twice a week	16 (44.44)	14 (37.84)	-
3 times a week	10 (27.78)	9 (24.32)	-
5 times per 2 weeks	8 (22.22)	13 (35.14)	-
Other	2 (5.56)	1 (2.70)	-

Physiological indicators of patients with group C and group I

Table 2 shows the relevant physiological indicators of patients with group C and group I. Before treatment, there are differences in systolic blood pressure, muscle strength, and other indicators between group C and group I patients (P > 0.05). After treatment, group I patients have greater muscle strength (P < 0.05), lower systolic blood pressure, and greater vital capacity (P < 0.001) than group C. After treatment, the diastolic pressure, muscle strength and vital capacity of patients in group N are P > 0.05, and the systolic pressure is lower (P < 0.05). After treatment, group I has lower diastolic blood pressure, greater muscle strength (P < 0.05), lower systolic blood pressure (P < 0.01), and greater vital capacity (P < 0.001).

Table 2 Pahysiological indicators of patients in groups C and I.

Project	Group	Before treatment	After treatment	P value
Systolic pressure	Group I	155.21 ± 10.45	147.95 ± 10.10	0.004
	Group C	158.91 ± 11.89	152.56 ± 12.81	0.030
	t	-1.423	-3.545	-
	P value	0.160	0.001	-
Diastolic pressure	Group I	86.30 ± 13.15	80.83 ± 8.33	0.039
	Group C	86.78 ± 13.09	85.39 ± 10.88	0.621
	t	-0.175	-1.953	-
	P value	0.864	0.065	-
Myodynamia	Group I	24.17 ± 6.53	28.41 ± 7.51	0.013
	Group C	24.68 ± 9.19	25.50 ± 7.80	0.680
	t	-0.281	1.623	-
	P value	0.780	0.033	-
Vital capacity	Group I	1801.01 ± 568.86	2341.83 ± 569.82	< 0.001
	Group C	1795.01 ± 603.18	1907.20 ± 574.15	0.405
	t	0.045	4.210	-
	P value	0.967	0.000	-

Positive emotional scores of group C and group I

Table 3 shows the positive emotional scores of group C and group I after treatment. After treatment, group I patients performs better in strong willed, inspired, and energetic emotions (P < 0.05), better in energetic, proud, enthusiastic, and energetic emotions (P < 0.01), and higher in positive emotions (P < 0.001); However, there is no difference in positive emotions among group C patients (P > 0.05). After treatment, group I performs better in strong willed emotions (P < 0.05), better in interested and encouraged emotions (P < 0.01). Overall, group I has higher positive emotions (P < 0.001).

Table 3 Positive emotional scores in groups C and I.

Project	Group	Before treatment	After treatment	P value
Interested	Group I	3.00 (2.00, 3.00)	3.00 (2.00, 4.00)	0.077
	Group C	2.00 (2.00, 3.00)	2.00 (2.00, 3.00)	0.986
	Z	-0.828	-2.972
	P value	0.407	0.003
Energetic	Group I	3.00 (2.00, 3.00)	3.00 (3.00, 4.00)	0.003
	Group C	2.00 (2.00, 3.00)	2.00 (2.00, 3.00)	0.633
	Z	-1.160	-4.868
	P value	0.246	0.000
Determined	Group I	3.00 (2.25, 4.00)	4.00 (3.00, 4.00)	0.028
	Group C	3.00 (2.00, 4.00)	3.00 (2.00, 4.00)	0.930
	Z	-0.174	-2.206
	P value	0.862	0.027
Highly alert	Group I	3.00 (2.00, 3.00)	3.00 (3.00, 3.75)	0.019
	Group C	2.00 (2.00, 3.00)	3.00 (2.00, 3.00)	0.718
	Z	-0.251	-1.961
	P value	0.802	0.050
Proud	Group I	2.00 (1.00, 3.00)	3.00 (2.00, 4.00)	0.003
	Group C	2.00 (1.00, 3.00)	2.00 (1.00, 2.50)	0.999
	Z	-0.442	-3.614
	P value	0.659	< 0.001
Focused	Group I	3.00 (2.00, 3.00)	3.00 (3.00, 3.00)	0.300
	Group C	3.00 (2.00, 3.00)	3.00 (2.00, 3.00)	0.987
	Z	-0.322	-1.090
	P value	0.747	0.276
Encouraged	Group I	3.00 (2.00, 3.00)	2.00 (2.00, 3.00)	0.031
	Group C	2.00 (2.00, 3.00)	2.00 (2.00, 3.00)	0.610
	Z	-1.080	-3.037
	P value	0.280	0.002
Passionate	Group I	3.00 (3.00, 4.00)	4.00 (3.00, 4.00)	0.009
	Group C	3.00 (2.00, 4.00)	3.00 (2.00, 4.00)	0.926
	Z	-1.532	-3.825
	P value	0.125	< 0.001
Highly energetic	Group I	3.00 (2.00, 3.00)	3.00 (3.00, 4.00)	0.026
	Group C	2.00 (2.00, 3.00)	2.00 (2.00, 3.00)	0.867
	Z	-1.141	-3.699
	P value	0.254	< 0.001
Energetic	Group I	3.00 (2.00, 3.00)	3.00 (3.00, 4.00)	0.004
	Group C	2.00 (2.00, 3.00)	2.00 (2.00, 3.00)	0.831
	Z	-0.606	-3.817
	P value	0.544	< 0.001
Positive emotions	Group I	26.00 (24.00, 31.00)	32.50 (29.25, 35.75)	< 0.001
	Group C	24.00 (22.00, 29.00)	24.00 (22.00, 28.00)	0.987
	Z	-1.350	-5.218
	P value	0.177	< 0.001

Negative emotional scores of group C and group I

Table 4 shows the negative emotional scores of group C and group I after treatment. After treatment, group I shows significant improvement in irritable, guilty, irritable, and fearful emotions (P < 0.05), while it shows significant improvement in tense emotions (P < 0.01). Overall, the negative emotions of group I improves significantly (P < 0.05). Compared to before treatment, there are no significant change in negative emotions in group C patients after treatment (P > 0.05).

Table 4 Negative emotional scores in groups C and I.

Project	Before treatment		After treatment
	Group I	Group C	Group I	Group C
Upset	2.00 (2.00, 3.00)	3.00 (2.00, 4.00)	2.00 (2.00, 3.00)	3.00 (2.00, 3.00)
P value	0.272		0.023
Hung up	2.00 (2.00, 3.00)	2.00 (2.00, 4.00)	2.00 (2.00, 3.00)	2.00 (2.00, 3.00)
P value	0.552		0.231
Guilty	2.00 (2.00, 3.00)	2.00 (2.00, 4.00)	2.00 (1.25, 3.00)	3.00 (2.00, 4.00)
P value	0.890		0.047
Fearful	2.00 (1.25, 3.00)	2.00 (1.00, 3.00)	2.00 (1.00, 2.00)	2.00 (1.00, 2.50)
P value	0.652		0.279
Hostile	2.00 (1.00, 2.00)	2.00 (1.00, 2.00)	1.50 (1.00, 2.00)	2.00 (1.00, 2.00)
P value	0.456		0.782
Irritable	3.00 (2.00, 4.00)	2.00 (2.00, 3.50)	2.00 (2.00, 2.00)	2.00 (2.00, 3.00)
P value	0.372		0.035
Shy	3.00 (2.00, 3.00)	2.00 (2.00, 3.00)	2.00 (1.00, 2.75)	2.00 (1.50, 3.00)
P value	0.402		0.206
Nervous	2.00 (2.00, 4.00)	2.00 (2.00, 4.00)	2.00 (1.00, 3.00)	3.00 (2.00, 4.00)
P value	0.926		0.001
Restless	2.00 (2.00, 3.00)	2.00 (2.00, 3.00)	2.00 (1.00, 3.00)	2.00 (1.50, 3.00)
P value	0.991		0.884
Fearful	2.00 (2.00, 3.00)	2.00 (1.50, 3.00)	2.00 (1.00, 2.00)	2.00 (1.50, 3.00)
P value	0.768		0.019
Negative emotions	25.00 (19.25, 28.00)	22.00 (18.50, 31.50)	20.50 (16.00, 24.00)	24.00 (19.00, 27.50)
P value	0.770		0.028

Irritable group I P < 0.05 vs pre-treatment in the same group, Shy group I P < 0.05 vs pre-treatment in the same group, Fearful group I P < 0.05 vs pre-treatment in the same group, Negative emotions group I P < 0.05 vs pre-treatment in the same group.

SF-36 scores for group C and group I

Table 5 shows the SF-36 scores of group I and group C. In the pre-treatment, compared to group C, group I shows significant improvement in general health status (P < 0.05), as well as significant improvement in energy and mental health (P < 0.01). Overall, group I has a higher SF-36 score (P < 0.05). Compared to the pre-treatment, there are no significant change in negative emotions in group C patients after treatment (P > 0.05). Compared to before treatment, group I shows significant improvement in physiological function (P < 0.001); The physiological function of group C has significantly improved (P < 0.05).

Table 5 36-Item Short Form Health Survey scores for group C and group I.

Project	Before treatment		After treatment
	Group I	Group C	Group I	Group C
General health status	30.72 ± 24.91	28.50 ± 20.79	47.63 ± 22.37	34.21 ± 21.80
P value	0.691		0.011
Pahysiology	76.15 ± 13.97	72.43 ± 14.95	81.94 ± 9.65	79.77 ± 13.79
P value	0.279		0.068
Pahysiological functions	25.01 ± 36.83	23.64 ± 33.29	57.40 ± 37.92	33.07 ± 33.86*
P value	0.868		0.005
Body pain	66.38 ± 22.63	62.98 ± 22.18	68.33 ± 19.21	67.57 ± 20.55
P value	0.518		0.868
Emotional function	35.23 ± 41.35	36.94 ± 39.89	62.96 ± 41.23	47.75 ± 38.12
P value	0.854		0.103
Social function	68.04 ± 23.06	60.75 ± 23.90	73.25 ± 20.97	64.88 ± 23.73
P value	0.189		0.115
Energy	51.53 ± 18.16	49.46 ± 24.46	64.18 ± 15.83	50.16 ± 17.41
P value	0.684		0.001
Mental health	67.18 ± 18.57	64.97 ± 16.80	76.11 ± 10.50	66.49 ± 14.98
P value	0.600		0.002
Total score	55.36 ± 15.48	52.66 ± 15.39	67.85 ± 13.02	57.53 ± 13.30
P value	0.460		0.001

General health status group I P < 0.01 vs pre-treatment in the same group, pahysiology group I P < 0.05 vs pre-treatment in the same group, pahysiological functions group I P < 0.001 vs pre-treatment in the same group, Emotional function emotions group I P < 0.01 vs pre-treatment in the same group, Energy group I P < 0.01 vs pre-treatment in the same group, Mental health group I P < 0.05 vs pre-treatment in the same group, Total score group I P < 0.01 vs pre-treatment in the same group.

Analysis of variance for repeated measurements of SF-36 scores in group C and group I

In Table 6, in the time effect analysis, the P-values of SF-36 score, general health status, physiological function, etc. are all less than 0.05, indicating that the quality of life of MHD patients with PAH is affected by time. In the inter-group effect, the P-values of physiological function, social function, energy, mental health, and SF-36 scores are all less than 0.05, indicating that different intervention methods lead to differences in the quality of life between the two groups. Similarly, there is an interaction between the two groups of patients in terms of mental dimensions (P < 0.05).

Table 6 Analysis of variance for repeated measurements of 36-Item Short Form Health Survey scores in two groups.

Project	Time effect		Intergroup effect		Interaction
	F	P value	F	P value	F	P value
General health status	16.758	< 0.001	3.613	0.058	2.958	0.065
Pahysiology	9.015	< 0.001	2.678	0.108	0.171	0.814
Pahysiological functions	11.446	< 0.001	4.231	0.041	3.143	0.051
Pahysical pain	3.196	0.045	0.429	0.516	0.168	0.842
Emotional function	8.673	0.001	0.765	0.387	1.512	0.226
Social function	2.770	0.076	4.688	0.032	0.325	0.695
Energy	7.597	0.003	5.329	0.026	4.574	0.019
Mental health	5.235	0.008	5.121	0.028	2.509	0.090
Total score	24.485	< 0.001	5.869	0.021	4.028	0.029

KDTA scores for group C and group I

In Table 7, after treatment, group I shows significant improvement in the burden of kidney disease on daily life, overall health assessment, and social support (P < 0.05), with better patient satisfaction and encouragement from medical staff (P < 0.01). Overall, group I has a higher KDTA score (P < 0.05). Compared to before treatment, there is no significant change in negative emotions in group C patients after treatment (P > 0.05); The group I shows significant improvement in the impact of kidney disease on daily life and overall health assessment (P < 0.05), while its other aspects are consistent with the former (P < 0.01); The overall health assessment of group C shows significant improvement (P < 0.05).

Table 7 Kidney Disease Targets Areas scores for groups C and I.

Project	Before treatment		After treatment
	Group I	Group C	Group I		Group C
Cognitive	69.79 ± 17.88	69.99 ± 22.27	71.15 ± 16.16		68.15 ± 20.98
P value	0.972		0.496
Symptoms and discomforts	67.36 ± 15.92	65.10 ± 19.43	72.86 ± 13.98		71.28 ± 13.92
P value	0.589		0.631
The burden of kidney disease on life	26.56 ± 22.82	24.66 ± 14.06	36.81 ± 23.94		24.49 ± 24.49
P value	0.671		0.013
Social quality	72.86 ± 16.61	71.70 ± 18.23	77.79 ± 12.56		71.68 ± 14.42
P value	0.781		0.058
The impact of kidney disease on daily life	48.10 ± 15.94	47.65 ± 15.47	56.69 ± 14.21		50.01 ± 17.57
P value	0.902		0.079
Sexuality	17.34 ± 29.75	18.23 ± 34.68	20.83 ± 29.43		18.24 ± 32.09
P value	0.908		0.721
Sleep	56.39 ± 18.08	55.47 ± 14.43	60.97 ± 13.70		58.24 ± 16.92
P value	0.811		0.452
Social support	66.20 ± 16.68	65.76 ± 11.76	73.60 ± 17.55		65.32 ± 12.66
P value	0.898		0.024
Work situation	26.51 ± 27.89	28.37 ± 25.10	33.34 ± 29.29		32.42 ± 24.19
P value	0.763		0.886
Overall health assessment	49.44 ± 18.18	46.49 ± 13.39	59.57 ± 15.00	53.02 ± 11.93
P value	0.430		0.042
Patient satisfaction	56.48 ± 17.52	57.18 ± 19.47	67.57 ± 17.75	54.01 ± 15.48
P value	0.866		0.001
Encouragement from medical staff	78.83 ± 16.05	78.37 ± 19.25	90.97 ± 15.98	78.72 ± 15.54
P value	0.916		0.001
Total score	55.43 ± 10.66	54.42 ± 10.26	61.96 ± 9.35	56.39 ± 8.91
P value	0.675		0.011

The impact of kidney disease on daily life group I P < 0.05 vs pre-treatment in the same group, overall health assessment group I P < 0.05 vs pre-treatment in the same group, overall health assessment group C P < 0.05 vs pre-treatment in the same group, patient satisfaction group I P < 0.01 vs pre-treatment in the same group, encouragement from medical staff group I P < 0.01 vs pre-treatment in the same group, total score group I P < 0.01 vs pre-treatment in the same group.

Analysis of variance for repeated measurements of KDTA scores in group C and group I

In Table 8, in the time effect analysis, the scores of KDTA, symptoms and discomfort, and the impact of kidney disease on daily life are found to be P < 0.05, indicating that the quality of life of MHD-PAH patients is influenced by time. In the inter-group effect, the burden of kidney disease on life, overall health assessment, patient satisfaction, encouragement from medical staff, and KDTA scores are all P < 0.05. This indicates different intervention methods led to differences in the quality of life between the two groups. Therefore, there is an interaction between the social support and patient satisfaction of the two groups of patients (P < 0.05).

Table 8 Analysis of variance for repeated measurements of 36-Item Short Form Health Survey scores in two groups.

Project	Time effect		Intergroup effect		Interaction
	F	P value	F	P value	F	P value
The burden of kidney disease on life	2.316	0.115	4.237	0.044	2.289	0.116
Cognitive function	0.343	0.686	0.218	0.645	0.502	0.585
Social quality	2.587	0.094	2.587	0.113	2.406	0.109
Symptoms and discomforts	10.124	< 0.001	0.718	0.404	0.246	0.782
The impact of kidney disease on daily life	7.375	0.003	1.993	0.163	2.902	0.068
Sexual function	0.813	0.418	0.025	0.877	0.143	0.807
Sleep	2.587	0.083	0.197	0.658	0.320	0.706
Social support	7.588	0.002	1.558	0.215	9.658	< 0.001
Working conditions	6.746	0.003	0.190	0.664	1.266	0.284
Overall health assessment	3.907	0.021	6.796	0.012	3.655	0.029
Patient satisfaction	2.531	0.083	4.214	0.045	7.403	0.001
Encouragement from medical staff	6.479	0.006	4.563	0.035	6.025	0.007
Total score	14.865	< 0.001	3.995	0.048	3.860	0.029

Systolic pulmonary artery pressure and PaO₂ indicators in patients with group C and group I

In Figure 2, after 6 wk of treatment, the systolic pulmonary artery pressure (SPAP) index level of group I is lower (P < 0.001) and the PaO₂ level is higher (P < 0.01); The PaO₂ level of group C is higher (P < 0.05). After 12 wk of treatment, the SPAP index levels of group I are lower (P < 0.001), and the PaO₂ levels of both group I and group C are higher (P < 0.001).

Figure 2 Systolic pulmonary artery pressure (A) and arterial partial oxygen pressure (B) indicators for both groups. ^aP < 0.05 and ^eP<0.001 vs the same group before treatment; ^fP < 0.001 vs group C. SPAP: Systolic pulmonary artery pressure; PaO₂: Arterial partial oxygen pressure.

PVR and SaO₂ indicators in patients with group C and group I

In Figure 3, after 6 wk of treatment, compared with group C, the level of group I’s PVR index is lower (P < 0.001) and its PaO₂ level is higher (P < 0.05). After 12 wk of treatment, compared with group C, the group I’s PVR index level is lower and the SaO₂ level is higher (P < 0.001). Compared to before treatment and after 6 wk of treatment, the group C’s PVR index level is lower (P < 0.001) and the SaO₂ index level is higher (P < 0.05); After 12 wk of treatment, the group C PVR index level is lower and the SaO₂ index level is higher (P < 0.001). Compared to before treatment, after 4 and 12 wk of treatment, the group I’s PVR index level is lower and the SaO₂ index level is higher (P < 0.001).

Figure 3 Pulmonary vascular resistance (A) and blood oxygen saturation (B) indicators for both groups. ^aP < 0.05 and ^eP < 0.001 vs the same group before treatment; ^fP < 0.001 vs group C. PVR: Pulmonary vascular resistance; SaO₂: Blood oxygen saturation.

6MWD indicators and Borg scores in patients with group C and group I

In Figure 4, after 6 wk of treatment, compared with group C, group I has a lower Borg score (P < 0.01) and a higher 6MWD indicator level (P < 0.05). After 12 wk of treatment, the 6MWD index level of group I is higher and the Borg score is lower (P < 0.01). Compared to before treatment and after 6 wk of treatment, the Borg score of group C is lower (P < 0.01); After 12 wk of treatment, the 6MWD index level of group C is higher and the Borg score is lower (P < 0.001). Compared to before treatment, after 12 wk of treatment, the 6MWD index level of group I is higher and the Borg score is lower (P < 0.001).

Figure 4 6-minute walk distance test indicators (A) and Borg scores (B) for two groups. ^bP < 0.01 and ^eP < 0.001 vs the same group before treatment; ^cP < 0.05 and ^dP < 0.01 vs group C. 6MWD: 6-minute walk distance test.

DISCUSSION

PAH is the most serious complication in the treatment of MHD patients, as they often experience metastatic calcification. This calcification will harden the patient's pulmonary capillaries, thus making the Pulmonary circulation more resistant, thus causing PAH[15-17]. Targeted interventions based on vasospasm and other conditions in PAH can delay the progression of PAH. Beprost sodium is a new type of anti-PAH drug, which can reduce pulmonary artery pressure and reduce heart load by inhibiting the proliferation of vascular smooth muscle cells and platelet aggregation, and relaxing smooth muscle. It is an ideal anti-pulmonary hypertension drug[18,19]. Some scholars, to effectively intervene in patients with autoimmune hemolytic anemia who contain PAH, choose drugs such as beta prostaglandin sodium for treatment. From the perspective of treatment effectiveness, the patient's functional state has been somewhat relieved and PAH has been improved[20]. Therefore, this drug will be applied in the treatment of MHD-PAH patients. Due to the tendency of patients to experience negative emotional issues during dialysis, their quality of life is greatly affected, which hinders their treatment. To improve the patient's mood and physical fitness, aerobic exercise is adopted, and considering the impact of the patient's body, venue, etc., power cycling practice is chosen[21-23]. This type of aerobic exercise is easy to operate and suitable for practice in patients with MHD and PAH. Therefore, it is used as an auxiliary treatment method to study its therapeutic effect.

Overall, compared to group C, group I achieved better therapeutic effects. After treatment, unlike group C, group I patients had greater muscle strength and stronger willpower. They showed significant improvement in their upset, guilty, irritable, and fearful emotions, with more improvement in negative emotions, and higher SF-36 and KDTA scores (P < 0.05); They performed better in emotions of interest and encouragement, had higher levels of 6MWD indicators, and had lower Borg scores (P < 0.01); Its systolic pressure was lower, its vital capacity was larger, and its performance was better in the energetic, proud, enthusiastic, energetic and energetic mood; They had higher positive emotions, lower levels of SPAP and PVR indicators, and higher levels of PaO₂ and SaO₂ (P < 0.001); Meanwhile, their SF-36 and KDTA scores were higher, and the time effect P-values of general health status, physiological function, etc. were less than 0.05, indicating that the quality of life of MHD-PAH patients was influenced by time.

The results of the treatment indicate that the combination of Western medicine treatment with conventional treatment, in conjunction with dynamic circulation exercise, may result in more favorable outcomes. It is beneficial for improving patient emotions, improving their quality of life, and alleviating their PAH symptoms. Some scholars take patients after cardiac surgery as research objects. To improve their functional ability, they use upper limb bicycle force meter. After relevant tests, they find this method is safe and effective[24]. Some scholars focus on hemodialysis patients and provide power cycling training to alleviate their functional impairments. From the results, the patient's related muscle strength has been significantly enhanced[25]. Some researchers choose prostaglandin sodium and record relevant experimental data when treating CKD. The results show that the treatment effect is better[26].

CONCLUSION

To sum up, bicycle riding exercise combined with Western medicine therapy has a good effect, which enables patients to gradually become more positive and better alleviate negative emotions. The PVR level is significantly reduced, and the patients' quality of life is significantly improved. Therefore, the research results validate the effectiveness of using aerobic exercise to promote the prognosis and rehabilitation of HD patients, and can further improve their quality of life while reducing their negative emotions. This has important value for the clinical treatment of HD patients. In future research, it is necessary to further expand the sample size and increase the follow-up period to further enhance the robustness of result analysis, which is beneficial for improving the quality of life of HD patients and obtaining longer-term benefits.