{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T16:09:49Z","timestamp":1776960589940,"version":"3.51.4"},"reference-count":44,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2020,3,12]],"date-time":"2020-03-12T00:00:00Z","timestamp":1583971200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Qatar National Research Foundation","award":["NPRP 7-1595-3-405"],"award-info":[{"award-number":["NPRP 7-1595-3-405"]}]},{"name":"Qatar National Research Foundation","award":["NPRP 10-0208-170400"],"award-info":[{"award-number":["NPRP 10-0208-170400"]}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["5T32HL139430-02"],"award-info":[{"award-number":["5T32HL139430-02"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Regular exercise can reduce depression. However, the uptake of exercise is limited in patients with end-stage renal disease undergoing hemodialysis. To address the gap, we designed a gamified non-weight-bearing intradialytic exercise program (exergame). The intradialytic exergame is virtually supervised based on its interactive feedback via wearable sensors attached on lower extremities. We examined the effectiveness of this program to reduce depression symptoms compared to nurse-supervised intradialytic exercise in 73 hemodialysis patients (age = 64.5 \u00b1 8.7years, BMI = 31.6 \u00b1 7.6kg\/m2). Participants were randomized into an exergame group (EG) or a supervised exercise group (SG). Both groups received similar exercise tasks for 4 weeks, with three 30 min sessions per week, during hemodialysis treatment. Depression symptoms were assessed at baseline and the fourth week using the Center for Epidemiologic Studies Depression Scale. Both groups showed a significant reduction in depression score (37%, p &lt; 0.001, Cohen\u2019s effect size d = 0.69 in EG vs. 41%, p &lt; 0.001, d = 0.65 in SG) with no between-group difference for the observed effect (p &gt; 0.050). The EG expressed a positive intradialytic exercise experience including fun, safety, and helpfulness of sensor feedback. Together, results suggested that the virtually supervised low-intensity intradialytic exergame is feasible during routine hemodialysis treatment. It also appears to be as effective as nurse-supervised intradialytic exercise to reduce depression symptoms, while reducing the burden of administrating exercise on dialysis clinics.<\/jats:p>","DOI":"10.3390\/s20061571","type":"journal-article","created":{"date-parts":[[2020,3,12]],"date-time":"2020-03-12T12:22:51Z","timestamp":1584015771000},"page":"1571","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Application of Wearables to Facilitate Virtually Supervised Intradialytic Exercise for Reducing Depression Symptoms"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4278-2891","authenticated-orcid":false,"given":"He","family":"Zhou","sequence":"first","affiliation":[{"name":"Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fadwa","family":"Al-Ali","sequence":"additional","affiliation":[{"name":"Fahad Bin Jassim Kidney Center, Department of Nephrology, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050 Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4791-6839","authenticated-orcid":false,"given":"Gu Eon","family":"Kang","sequence":"additional","affiliation":[{"name":"Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4677-7686","authenticated-orcid":false,"given":"Abdullah I.","family":"Hamad","sequence":"additional","affiliation":[{"name":"Fahad Bin Jassim Kidney Center, Department of Nephrology, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050 Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4241-3746","authenticated-orcid":false,"given":"Rania A.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Fahad Bin Jassim Kidney Center, Department of Nephrology, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050 Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Talal K.","family":"Talal","sequence":"additional","affiliation":[{"name":"Diabetic Foot and Wound Clinic, Hamad Medical Corporation, PO Box 3050, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0320-8101","authenticated-orcid":false,"given":"Bijan","family":"Najafi","sequence":"additional","affiliation":[{"name":"Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"414","DOI":"10.2471\/BLT.17.206441","article-title":"The global burden of kidney disease and the sustainable development goals","volume":"96","author":"Luyckx","year":"2018","journal-title":"Bull. World Health Organ."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/S0033-3182(91)72038-0","article-title":"Psychological factors affecting end-stage renal disease. A review","volume":"32","author":"Levenson","year":"1991","journal-title":"Psychosomatics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1177\/070674378603100513","article-title":"Depression in dialysis patients: A review of psychological factors","volume":"31","author":"Israel","year":"1986","journal-title":"Can. J. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"c256","DOI":"10.1159\/000124749","article-title":"Depression on dialysis","volume":"108","author":"Chilcot","year":"2008","journal-title":"Nephron. Clin. Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.apnr.2018.07.009","article-title":"Prevalence of depression and anxiety in end-stage renal disease: A survey of patients undergoing hemodialysis","volume":"43","author":"Semaan","year":"2018","journal-title":"Appl. Nurs. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1053\/j.ajkd.2005.07.002","article-title":"Physician-diagnosed depression as a correlate of hospitalizations in patients receiving long-term hemodialysis","volume":"46","author":"Hedayati","year":"2005","journal-title":"Am. J. Kidney Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1046\/j.1523-1755.2002.00411.x","article-title":"Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe","volume":"62","author":"Lopes","year":"2002","journal-title":"Kidney Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1053\/j.ajkd.2010.04.018","article-title":"Depression and cognitive function in maintenance hemodialysis patients","volume":"56","author":"Agganis","year":"2010","journal-title":"Am. J. Kidney Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1053\/mr.2000.3878","article-title":"Functional impairment, depression, and life satisfaction among older hemodialysis patients and age-matched controls: A prospective study","volume":"81","author":"Kutner","year":"2000","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1056\/NEJM198502283120905","article-title":"The quality of life of patients with end-stage renal disease","volume":"312","author":"Evans","year":"1985","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1038\/ki.2008.222","article-title":"Depression and end-stage renal disease: A therapeutic challenge","volume":"74","author":"Finkelstein","year":"2008","journal-title":"Kidney Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1177\/0269881115581093","article-title":"Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines","volume":"29","author":"Cleare","year":"2015","journal-title":"J. Psychopharmacol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3736","DOI":"10.1093\/ndt\/gfs295","article-title":"Antidepressants for depression in stage 3-5 chronic kidney disease: A systematic review of pharmacokinetics, efficacy and safety with recommendations by European Renal Best Practice (ERBP)","volume":"27","author":"Nagler","year":"2012","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1111\/nep.12742","article-title":"Depression in dialysis patients","volume":"21","year":"2016","journal-title":"Nephrology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1081\/JDI-120005367","article-title":"Effects of regular exercise on anxiety, depression, and quality of life in maintenance hemodialysis patients","volume":"24","author":"Suh","year":"2002","journal-title":"Ren. Fail."},{"key":"ref_16","first-page":"826","article-title":"A twelve week exercise program improves the psychological status, quality of life and work capacity in hemodialysis patients","volume":"17","author":"Levendoglu","year":"2004","journal-title":"J. Nephrol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1097\/HJR.0b013e32833188c4","article-title":"Depression, heart rate variability, and exercise training in dialysis patients","volume":"17","author":"Kouidi","year":"2010","journal-title":"Eur. J. Cardiovasc. Prev. Rehabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1159\/000184490","article-title":"Exercise training reduces depression and increases the performance of pleasant activities in hemodialysis patients","volume":"47","author":"Carney","year":"1987","journal-title":"Nephron"},{"key":"ref_19","first-page":"182030","article-title":"Effect of Regular Exercise Program on Depression in Hemodialysis Patients","volume":"2015","author":"Rezaei","year":"2015","journal-title":"Int. Sch. Res. Not."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Santhi, A., Samson, R., and Pethuru, D. (2018). Effectiveness of physical activity on depression, anxiety, stress and quality of life of patients on hemodialysis. Biomed. Res., 29.","DOI":"10.4066\/biomedicalresearch.29-18-177"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e020633","DOI":"10.1136\/bmjopen-2017-020633","article-title":"Efficacy and safety of intradialytic exercise in haemodialysis patients: A systematic review and meta-analysis","volume":"9","author":"Pu","year":"2019","journal-title":"BMJ Open"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"c7","DOI":"10.1159\/000286344","article-title":"Physical exercise in patients with severe kidney disease","volume":"115","author":"Kosmadakis","year":"2010","journal-title":"Nephron. Clin. Pract."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"584","DOI":"10.4040\/jkan.2009.39.4.584","article-title":"Effects of exercise intervention on physical fitness and health-relalted quality of life in hemodialysis patients","volume":"39","author":"Jang","year":"2009","journal-title":"J. Korean Acad. Nurs."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Zhou, H., Ibrahim, R., Hamad, A., Talal, T., Al-Ali, F., and Najafi, B. (2018, January 19\u201320). Exergame: A Gamelike Exercise to Improve Motor Functions and Physical Activities in Diabetic Patients Undergoing Hemodialysis. Proceedings of the Qatar Foundation Annual Research Conference, Doha, Qatar.","DOI":"10.5339\/qfarc.2018.HBPD430"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Zhou, H., Ibrahim, R., Hamad, A., Talal, T., Al-Ali, F., and Najafi, B. (2018, January 19\u201320). GameBased NonWeight Bearing Exercise to Improve Postural Balance in Diabetic Patients Underjoining Hemodialysis. Proceedings of the Qatar Foundation Annual Research Conference, Doha, Qatar.","DOI":"10.5339\/qfarc.2018.HBPD429"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Wang, C., Wang, Q., and Shi, S. (2012, January 13\u201316). A distributed wireless body area network for medical supervision. Proceedings of the 2012 IEEE International Instrumentation and Measurement Technology Conference, Graz, Austria.","DOI":"10.1109\/I2MTC.2012.6229260"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1001\/archpsyc.1983.01790060110016","article-title":"The Mini-Mental State Examination","volume":"40","author":"Folstein","year":"1983","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1093\/ageing\/afp225","article-title":"The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study","volume":"39","author":"Delbaere","year":"2010","journal-title":"Age Ageing"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1111\/j.1464-5491.2012.03729.x","article-title":"Clinical evaluation of a new device in the assessment of peripheral sensory neuropathy in diabetes","volume":"29","author":"Bracewell","year":"2012","journal-title":"Diabet. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1177\/1358863X09356015","article-title":"Ankle-brachial index performance among internal medicine residents","volume":"15","author":"Wyatt","year":"2010","journal-title":"Vasc. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"187","DOI":"10.2337\/diacare.23.2.187","article-title":"Use of GHb (HbA1c) in screening for undiagnosed diabetes in the U.S. population","volume":"23","author":"Rohlfing","year":"2000","journal-title":"Diabetes Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1093\/oxfordjournals.aje.a112455","article-title":"Assessing depressive symptoms in five psychiatric populations: A validation study","volume":"106","author":"Weissman","year":"1977","journal-title":"Am. J. Epidemiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1159\/000338095","article-title":"Virtualizing the assessment: A novel pragmatic paradigm to evaluate lower extremity joint perception in diabetes","volume":"58","author":"Grewal","year":"2012","journal-title":"Gerontology"},{"key":"ref_34","first-page":"354","article-title":"Estimation of Center of Mass Trajectory using Wearable Sensors during Golf Swing","volume":"14","author":"Najafi","year":"2015","journal-title":"J. Sports Sci. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1177\/193229681000400403","article-title":"Assessing postural control and postural control strategy in diabetes patients using innovative and wearable technology","volume":"4","author":"Najafi","year":"2010","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1159\/000493263","article-title":"Instrumented Trail-Making Task: Application of Wearable Sensor to Determine Physical Frailty Phenotypes","volume":"65","author":"Zhou","year":"2019","journal-title":"Gerontology"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Zhou, H., Lee, H., Lee, J., Schwenk, M., and Najafi, B. (2018). Motor Planning Error: Toward Measuring Cognitive Frailty in Older Adults Using Wearables. Sensors, 18.","DOI":"10.3390\/s18030926"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1159\/000452309","article-title":"Instrumented Trail-Making Task to Differentiate Persons with No Cognitive Impairment, Amnestic Mild Cognitive Impairment, and Alzheimer Disease: A Proof of Concept Study","volume":"63","author":"Zhou","year":"2017","journal-title":"Gerontology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"487","DOI":"10.3233\/JAD-130470","article-title":"An intensive exercise program improves motor performances in patients with dementia: Translational model of geriatric rehabilitation","volume":"39","author":"Schwenk","year":"2014","journal-title":"J. Alzheimers Dis."},{"key":"ref_40","first-page":"499","article-title":"Statistical power analysis for the behavioral sciences","volume":"31","author":"Cohen","year":"1988","journal-title":"Technometrics"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1300\/J079v21n04_02","article-title":"Qualitative descriptors of strength of association and effect size","volume":"21","author":"Rosenthal","year":"1996","journal-title":"J. Soc. Serv. Res."},{"key":"ref_42","first-page":"626","article-title":"Exercise training in haemodialysis patients: A systematic review and meta-analysis","volume":"16","author":"Smart","year":"2011","journal-title":"Nephrology"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Zhou, H., Al-Ali, F., Rahemi, H., Kulkarni, N., Hamad, A., Ibrahim, R., Talal, T.K., and Najafi, B. (2018). Hemodialysis Impact on Motor Function beyond Aging and Diabetes-Objectively Assessing Gait and Balance by Wearable Technology. Sensors, 18.","DOI":"10.20944\/preprints201809.0529.v1"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/JGP.0b013e3181c534b5","article-title":"Exergames for subsyndromal depression in older adults: A pilot study of a novel intervention","volume":"18","author":"Rosenberg","year":"2010","journal-title":"Am. J. Geriatr. Psychiatry"}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/20\/6\/1571\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:06:13Z","timestamp":1760173573000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/20\/6\/1571"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,12]]},"references-count":44,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,3]]}},"alternative-id":["s20061571"],"URL":"https:\/\/doi.org\/10.3390\/s20061571","relation":{"has-preprint":[{"id-type":"doi","id":"10.20944\/preprints202001.0272.v1","asserted-by":"object"}]},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,12]]}}}