Abstract
Background: Exercise provides beneficial effects in ESRD, however few studies compare efficacy of different modalities of exercise in this population. To overcome the restrictions of limited available comparisons we employed network meta-analysis of randomized clinical trials (RCTs) to compare the efficacy of different modalities of exercise on aerobic capacity, arterial blood pressure and hemodialysis efficacy in ESRD adults patients on hemodialysis treatment. Methods and Findings: We searched PubMed, EMBASE, COCHRANE CENTRAL, WEB OF SCIENCE and LILACS databases for RTCs with adults ESRD patients on hemodialysis that compared aerobic exercise (AE), resistance training (RT) or combined training (CT) with a control group. Were included 28 trials involving1045 ESRD patients on hemodialysis. Direct meta-analysis show that both, AE (3.35, 95% CI: 1.79, 4.91 ml/kg/min) and CT (5.0, 95% CI: 3.50, 6.50 ml/kg/min) improved aerobic capacity while only CT reduced systolic (-5.88, 95% CI: -9.83, -1.93 mmHg) and diastolic (-3.93, 95% CI: -6.23, -1.60 mmHg) arterial blood pressure. Regarding hemodialysis efficacy, only AE was able to improve Kt/V (0.16, 0.05, 0.26). Network meta-analysis showed that AE and CT was superior to control group for aerobic capacity and CT presented 92.8% of probability to be ranked as first most effective treatment. For arterial blood pressure, only CT was superior to control group and for diastolic blood pressure combined training was also significantly superior to AE. Moreover, CT presented 94.7% probability of being best treatment for systolic arterial pressure and 98.7% for diastolic arterial pressure. None modality of exercise was superior to control treatment for hemodialysis efficacy. Conclusions: The main contribution of this network meta-analysis is to ranking the potential benefits of different exercise modalities on health outcomes in hemodialysis patients. The analysis found that combined training, aerobic plus resistance training, is the most effective modality to increase aerobic capacity, and blood pressure control, in hemodialysis patients. This finding comes to fill the gap created by the lack of head-to-head comparison of different modalities of exercise in chronic kidney disease patients.
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