Abstract
Patients with chronic kidney disease show poorer functional and cardiorespiratory capacity than healthy individuals, and these impairments result in sedentarism. The aim of this study was to conduct a systematic review and meta-analysis of randomized clinical trials on the effects of different intradialytic exercise protocols on cardiopulmonary capacity in chronic kidney disease patients. The primary outcome was peak oxygen consumption (VO2peak) and the secondary outcomes were exercise duration and ventilation in the cardiopulmonary test. The quality of the evidence was evaluated using the GRADE guidelines. Seven studies with a total of 124 participants met the inclusion criteria. Compared to the non-exercise group, the exercise group improved in mean VO2peak (MD 4.06 [IC 0.81; 7.31]). In a separate analysis according to exercise modality, aerobic exercise plus strength training performed better than aerobic exercise alone (MD 5.28 [IC 3.90; 6.66]). In the exercise group, both exercise tolerance values (MD 3.10 [IC 1.70; 4.51]) and ventilation values in the cardiopulmonary test were better than those of the control group (MD 13.10 [IC 7.12; 19.09]). Thus, intradialytic exercise protocols can improve cardiopulmonary function, exercise tolerance and ventilatory efficiency in chronic kidney disease patients.
Highlights
Seven studies were included in the meta-analysis
The studies included a majority of males: 79 men in the exercise group and 74 in the control group, compared to 46 women in the exercise group and 44 in the control group
Separate analysis according to exercise modality was performed
Summary
Seven studies were included in the meta-analysis. Figure 1 shows the study selection flowchart. Two studies used the cardiopulmonary exercise test to determine the training intensity, which should be considered unreliable for this population due to the fact that beta-blocker drugs, which are widely used by these patients, interfere in the maximum heart rate. These authors did not explain how they obtained a workload of 55–60% peak power[12,13]. Despite the high heterogeneity, there were significant differences between the exercise and control groups in the fixed effect model (MD 2.27 [IC 1.24; 3.31]) and in the random effects model (MD 4.06 [IC 0.81; 7.31]), demonstrating that exercise during hemodialysis can benefit physical functioning (Fig. 2). There was a significant difference in cardiopulmonary test duration (in minutes) between the exercise and control groups in the fixed effect model (MD 2.74 [IC 1.90; 3.57]) and the random effects model
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