Effect Of Intradialytic Exercise Research Articles

#1067 The impact of hemodialysis (HD) versus hemodiafiltration (HDF) on the effect of intradialytic exercise: a multicentre cohort study

Abstract Background and Aims Diminished physical function in HD patients is a critical issue, necessitating strategic approaches to enhance the efficacy of exercise therapy. The differential impacts of HD and HDF on solute clearance, albumin loss, uremic conditions, and malnutrition could influence the success of exercise interventions. Presently, empirical evidence for this is lacking. This investigation explores how HD and HDF modalities influence the efficacy of exercise therapy administered during dialysis sessions. Method This study encompassed intradialytic resistance exercises, involving 414 patients with end-stage renal disease across 10 centers. Participants were voluntarily enlisted in an exercise regimen during their dialysis sessions. The intradialytic regimen comprised stretching and four types of resistance exercises utilizing elastic tubes, conducted thrice weekly over six months. Parameters such as 10-meter walking speed, knee extensor muscle strength, serum albumin levels (Alb), normalized protein catabolic rate (nPCR), and Creatinine Generation Rate (%CGR) were assessed pre-and post-intervention. Statistical analysis included propensity score matching to adjust for baseline characteristics, segregating patients into HD and HDF cohorts. Changes in the aforementioned indicators before and after intervention (Δ) were calculated. Analytical methods included paired t-tests for within-group comparisons and independent t-tests for between-group comparisons of Δ values. A 5% risk threshold was established for statistical significance. Ethical clearance was obtained from the Seirei Christopher University Ethics Committee. Results A propensity score matching yielded 70 matched pairs. There were no significant differences in baseline subject characteristics after propensity score matching. Within-group analyses in the HD group revealed significant improvements in 10-meter walking speed (1.42 ± 0.41→1.60 ± 0.46 m/s, p = 0.000), knee extensor strength (44.3 ± 14.7→49.6 ± 13.8%, p = 0.000), and a reduction in Kt/V (1.69 ± 0.32→1.64 ± 0.32, p = 0.006) after six months. The HDF group significantly enhanced 10-meter walking speed (1.54 ± 0.40→1.72 ± 0.40, p = 0.000), knee extensor muscle strength (51.7 ± 17.1→57.4 ± 17.7%, p = 0.000), nPCR (0.88 ± 0.15→0.94 ± 0.18, p = 0.009), and %CGR (106.3 ± 23.2→112.9 ± 25.2, p = 0.002) (pre to post value, respectively). There are no significant differences in other variables between pre- and post-values in each group. Comparative analysis between groups demonstrated a significantly lower ΔAlb (HD 0.04 ± 0.24 HDF −0.05 ± 0.27, p = 0.045)and a higher 7, p =0(HD 1.47 ± 18.2 HDF 6.65 ± 17.2, p = 0.004)in the HDF group compared to the HD group. Conclusion The study demonstrated a notable HDF group improvement in %CGR, an indicator of muscle mass, despite a decrease in albumin levels. This suggests that albumin loss due to HDF minimally affects the augmentation of physical function. The findings suggest integrating exercise therapy with HDF may positively influence protein consumption and muscle mass enhancement.

The impact of malnutrition on the effectiveness of intradialytic exercise in hemodialysis patients: amulticenter cohort study.

Low physical function can be effectively improved via intradialytic exercise. However, the association between the effects of intradialytic exercise on physical function and malnutrition severity has not been studied extensively. This study aimed to investigate the impact of nutritional status severity on physical function in patients undergoing hemodialysis with low physical function to whom intradialytic exercise was prescribed. The participants were patients with decreased mobility [walking speed < 1.0m/s and/or Short Physical Performance Battery (SPPB) < 12] who had been undergoing hemodialysis thrice a week for 6months and performing intradialytic exercise program. Patients were divided into groups based on the Geriatric Nutritional Risk Index (GNRI) [Non-malnutrition group (GNRI > 98), Gentle/slim malnutrition group (GNRI ≤ 98, GNRI ≥ 92), Mild malnutrition group (GNRI < 92, GNRI ≥ 82), Severe malnutrition group (GNRI < 82)]. The primary outcomes were Grip strength, isometric knee extension strength (IKES), SPPB, and 10-m walking speed measured at baseline and at 6months. Statistical analyses were performed using a linear mixed-effects model with the intention-to-treat analysis, including within-group analysis and between-group comparison. A total of 805 participants were included in the study. Within-group comparisons showed significantly improved IKES, 10-m walking speed, and SPPB improved, except in the Severe malnutrition group. Grip strength significantly improved in the Gentle/slim and mild malnutrition groups. Between-group comparison with controls showed that the improvement in Grip strength was significantly bigger in the Gentle/slim malnutrition group [0.98 (0.15to1.82)kg] than in the non-malnutrition group. However, IKES in the Severe malnutrition group [-5.14 (-9.18 to -1.10) %] less significantly improve than that in the non-malnutrition group. No significant differences were found in the other indices. In patients with severe malnutrition, the changes in IKES scores resulting from Intradialytic exercise were significantly smaller than those observed in non-malnourished patients. Therefore, it is necessary to initiate suitable nutritional and exercise therapy based on the severity of malnutrition.

Effect of intradialytic exercise on fall occurrences in older patients undergoing hemodialysis: a single-center non-randomized study

BackgroundGiven rapid aging of the global population, preventing adverse events such as falls is essential for preserving functional capacity and quality of life among older adults, especially those at high risk due to hemodialysis (HD) treatment. We aimed to investigate the effects of a 3-year intradialytic exercise intervention on fall occurrence and physical performance in older patients undergoing HD.MethodsSixty-one patients were non-randomly assigned to the exercise (n = 31) and control groups (n = 30). The exercise group performed aerobic and resistance training during HD three times per week for 3 years. Handgrip strength, lower extremity muscle strength, 10-m walking speed, and Short Physical Performance Battery (SPPB) scores were assessed at baseline. Physical function was reassessed every year in the exercise group. All participants were followed up until the first fall or the end of the study period.ResultsThere were no significant between-group differences in baseline data. Over a median follow-up of 35 months, 10 (16.3%) falls occurred, including 1 (3.2%) in the exercise group and 9 (30%) in the control group. Kaplan–Meier analysis revealed that the exercise intervention significantly reduced the occurrence of falls. No significant differences in physical function were observed among four time points in patients who completed the 3-year program.ConclusionIntradialytic exercise may represent an essential intervention for preventing falls in older patients undergoing HD.Trial registration: This study was retrospectively registered with the University Hospital Medical Information Network (UMIN 00044821, February 4, 2021).

The effect of intradialytic exercise on calcium, phosphorus and parathyroid hormone: a randomized controlled trial

BackgroundPatients with kidney failure experience derangements of circulating markers of mineral metabolism and dysregulation of skeletal and cardiovascular physiology which results in high mortality rate in these patients. This study aimed to evaluate the effect of intradialytic exercise on regulation of these abnormalities in patients receiving chronic hemodialysis (HD).MethodsIn this randomized controlled trial conducted in an HD center in Iran, adult patients receiving chronic HD were randomized to intradialytic exercise (60 min) in the second hour of thrice weekly dialysis for 6 months (intervention) or no intradialytic exercise (control). The primary outcomes were serum calcium, serum phosphorous and parathyroid hormone levels. Secondary outcomes were serum alkaline phosphatase and calcium-phosphorous product.ResultsThe study included 44 participants randomized to intervention (n = 22) or control (n = 22). During the 6-month intervention period, significant between-group changes were observed in all primary and secondary outcomes between the intervention and control groups. Statistical analyses reveal a significant increase in serum calcium (P < 0.05) as well as a significant decrease in serum phosphorous, parathyroid hormone, alkaline phosphatase and calcium-phosphorous product (P < 0.05).ConclusionIntradialytic exercise performed for at least 60 min during thrice weekly dialysis sessions improves bone mineral metabolism in adult patients receiving HD. Further studies should focus on observing and comparing the effect of different types of exercise on bone mineral disorders and all-cause mortality in HD patients.Trial registrationClinicalTrials.gov Identifier: NCT04916743, Registered on 08/06/2021. Registered trial name: The Effect of Intradialytic Exercise on Calcium, Phosphorous and Parathyroid Hormone: A Randomized Controlled Trial.

The effect of intradialytic exercise on dialysis patient survival: a randomized controlled trial

BackgroundPatients with kidney failure have a high mortality rate. This study aimed to evaluate the effect of intradialytic exercise on survival in patients receiving hemodialysis (HD).MethodsIn this randomized controlled trial conducted in a HD center in Iran, adult patients receiving chronic HD were randomized to intradialytic exercise (60 min) in the second hour of thrice weekly dialysis for 6 months (intervention) or no intradialytic exercise (control). The primary outcome was survival rate at 12 months. Secondary outcomes were serum albumin, hemoglobin, hematocrit, red blood cell count, serum calcium, serum phosphorous, parathyroid hormone, physical function (6-min walk test) and nutritional status (Geriatric Nutritional Risk Index) during the first 6 months. The trial follow-up period was 12 months.ResultsThe study included 74 participants (44 males) with an age average of 64 ± 12 years old and a dialysis history of 27 ± 12 months, randomized to intervention (n = 37) or control (n = 37). Compared with controls, 1-year survival was higher in the intervention group (94% vs 73%, P = 0.01). The hazard ratio in univariate analysis in intervention group was 0.17 (95% CI 0.04–0.8; P = 0.02) compared to that in control group. During the 6-month intervention period, significant between-group changes were observed in all secondary outcomes between the intervention and control groups.ConclusionIntradialytic exercise performed for at least 60 min during thrice weekly dialysis sessions improves survival in adult patients receiving HD.Trial registrationClinicalTrials.gov Identifier: NCT04898608. Retrospectively registered on 24/05/2021. Registered trial name: The Effect of Intradialytic Exercise on Dialysis Patients Survival.

Effect of intradialytic exercise on physiological parameters, biochemical markers, and quality of life among patients on hemodialysis

Effect of intradialytic exercise on physiological parameters, biochemical markers, and quality of life among patients on hemodialysis

Effect of Intradialytic Exercise on Fatigue, Psychological Distress, and Biochemical Findings among Hemodialysis Children

Effect of Intradialytic Exercise on Fatigue, Psychological Distress, and Biochemical Findings among Hemodialysis Children

The Effect of Intradialytic Exercise on Fatigue-Related Chronic Kidney Disease: A Case Study of Patient Undergoing Hemodialysis

BACKGROUND: Fatigue is one of the most common problems experienced by chronic kidney disease (CKD) patients undergoing hemodialysis. The application of intradialytic exercises can be the best solutions to overcome fatigue related to CKD.&#x0D; CASE PRESENTATION: A 50-year-old male patient with CKD, who complained of severe fatigue, was selected in case study. The FACIT Fatigue Scale questionnaire and clinical indicators were measured before and after intervention. The intradialytic exercise was administered at 3rd hour of hemodialysis for 4 sessions in 2 weeks. Each session required 30 minutes, containing warming up, main exercise and cooling down. After two weeks intervention, there was an improvement of fatigue score (16 to 29) and reduction of weakness, tiredness, washout feeling, sleepy, and tiredness on eating. Moreover, the clinical indicators showed positive improvement after the intervention.&#x0D; CONCLUSION: Thus, intradialytic exercise is practically promising to minimize fatigue related to CKD among patients undergoing hemodialysis. Hemodialysis nurses or other health care providers could utilize this evidence as a program to reduce the fatigue related to CKD.

MO591: Effects of Intradialytic Exercise on Falls in Older Patients Undergoing Hemodialysis: A Single-Center Non-Randomized Study

Abstract BACKGROUND AND AIMS Older hemodialysis patients with low physical function who sustain a fall demonstrate reduced activities of daily living and quality of life. Therefore, it is desirable to examine how improving physical function with exercise therapy affects fall prevention. Several recent studies have shown that intradialytic exercise is effective in improving physical function. However, the effect of intradialytic exercise on falls has not been thoroughly investigated. The purpose of this study was to evaluate the effect of a 3-year, intradialytic exercise program on falls in elderly dialysis patients in a non-randomized, prospective intervention. METHOD In this single-center, prospective, non-randomized, controlled trial, the patients were assigned to either the exercise or control groups. Patients were assigned to the exercise group based on their spontaneous preference for initiation of intradialytic exercise. The inclusion criteria were age ≥70 years, ability to ambulate without assistance. The exercise group was offered 3 years of intradialytic exercise training three times a week. The training program involved both resistance and aerobic training exercises. Four types of resistance exercises were performed using an elastic tube. The aerobic exercise program consisted of 20 min of ergometer cycling. The grip strength (GS), leg extremity muscle strength (LES), short physical performance battery (SPPB) score and 10-min walk speed at baseline were evaluated in both groups. These physical functions were re-evaluated each year in the exercise group only. Falls were monitored during each dialysis treatment. All subjects were followed until the first fall, or until the end of the follow-up period (31 December 2020). The ethical institution at Seirei Christopher University approved all the procedures performed in this study; informed consent was obtained from all the patients. Baseline characteristics and physical function were compared using an unpaired t-test or Mann–Whitney U test. In the exercise group, measurements of physical functioning at the initial 1-, 2- and 3-year time points were conducted using multiple comparison tests. The relationship between exercise intervention and falls was studied using the Kaplan–Meier analysis and the log-rank test. All tests were performed at a statistical significance level of P &amp;lt; 0.05. RESULTS Of the 85 patients, 31 were assigned to exercise groups and 40 to control groups, with the exception of 14 patients who needed walking assistance. In the control group, six patients started to exercise and were excluded from the analysis. Therefore, 65 patients (79.3 ± 6.7 years) were included in this study. There were no significant differences in age, GS, LES, 10-min walking speed, SPPB score, or other laboratory values between the exercise and control groups at baseline. In the exercise groups, 19 patients (61.2%) continued to exercise for over three years; the median duration of exercise was 3 years (interquartile range: 1.25–3 years). The median follow-up time for all subjects was 35 months (interquartile range: 22–35 months), during which 8 (9.4%, 1 of exercise, and 7 of control group) falls were observed; one of the cases had a fracture. The exercise group showed no significant differences in any physical functioning between each measurement time point. However, the exercise intervention was significantly associated with a reduction in falls in the Kaplan–Meier survival analysis and log-rank test. CONCLUSION To our knowledge, this is the first study to show the effect of intradialytic exercise on falls in older adults on HD. This study revealed that physical function did not improve significantly in 3-year intradialytic exercise intervention, contrary to previous studies. However, the effect of exercise on fall prevention in this study supports the results of a previous study in nondialysis patients. This study could provide evidence for the clinical care of older patients undergoing dialysis.

Effects of intradialytic exercise on health-related quality of life in patients undergoing maintenance haemodialysis: a systematic review and meta-analysis.

To summarize the current evidence regarding the effectiveness of intradialytic exercise (IDE) on the health-related quality of life (HRQOL) of patients undergoing maintenance haemodialysis. Five English databases (PubMed, EMBASE, Cochrane Library, Web of Science, and ScienceDirect) and four Chinese databases (VIP, WAN FANG, CNKI, CBM) were comprehensively searched from their inception to 18 March 2021. This study was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two independent reviewers selected the papers and extracted the details of each study therein. Only randomized controlled trials were included. The risk of bias tool version 2.0 was used to evaluate the risk of bias of the included studies. A random-effects meta-analysis was conducted to pool the effect size. Thirty-three eligible studies with 1481 participants were included. For the generic HRQOL, assessed by the Medical Outcomes Study Short-Form survey, IDE significantly improved most domains and the physical component summary compared with the control group. Furthermore, aerobic exercise alone significantly improved more domains compared to resistance exercise, combined aerobic and resistance exercise, and other types of exercise. Regarding the kidney-specific HRQOL, IDE improved three of eleven domains, including the symptom/problemlist, the effect of kidney disease, and the quality of social interaction. No significant effect was found on other domains of kidney-specific HRQOL. Intradialytic exercise could benefit patients undergoing haemodialysis in improving most domains of generic HRQOL, but the effect on most domains of kidney-specific HRQOL is insufficient.

Amino Acid Removal During Hemodialysis Is Compensated By Protein Ingestion And Not Compromised By Exercise

PURPOSE: Hemodialysis (HD) is a life-saving treatment for end-stage renal disease (ESRD) patients. However, it removes amino acids (AAs) from the circulation, thereby lowering plasma AA concentrations and stimulating muscle catabolism. To prevent deterioration in the nutritional status of HD patients, protein ingestion and exercise during HD are increasingly implemented in clinical practice. Nevertheless, it is not known whether these interventions modulate the removal of AAs from the circulation. METHODS: Therefore, we recruited ten ESRD patients (age: 65 ± 16 y, BMI: 24.2 ± 4.8 kg·m-2) undergoing HD to participate in this double-blind, crossover trial. During four 4-h HD sessions each patient ingested, in a randomized order, 40 g protein (PRO) or a placebo (PLA) both at rest, as well as following 30 min of intradialytic exercise (PRO+EX and PLA + EX, respectively). Blood and spent dialysate samples were collected every 30 min throughout HD to assess AA concentrations and, as such, to quantify plasma AA availability and AA removal. RESULTS: Baseline plasma AA concentrations averaged 2.93 ± 0.40 mmol·L-1, with no differences between interventions (P = 0.66). During PLA and PLA + EX interventions, subsequent plasma AA concentrations decreased over time to 1.84 ± 0.18 and 1.83 ± 0.16 mmol·L-1, respectively (time effect P < 0.001), with no differences between interventions (P = 0.94). Plasma AA concentrations increased following protein ingestion up to peak values of 4.40 ± 0.45 and 4.37 ± 0.73 mmol·L-1 during PRO and PRO+EX interventions, respectively (time effect P < 0.001), with no differences between interventions (P = 0.18). Accordingly, a significant effect of protein ingestion (P < 0.001), but no effect of intradialytic exercise (P = 0.22) was observed in AA availability during PLA, PLA + EX, PRO, and PRO+EX interventions (incremental AUC: -227 ± 54, -208 ± 68, 49 ± 87, and 70 ± 34 mmol·L-1·240 min-1, respectively). AA removal was greater during PRO and PRO+EX interventions (16.6 ± 2.2 and 17.3 ± 2.3 g, respectively) when compared to PLA and PLA + EX interventions (9.8 ± 2.0 and 10.2 ± 1.6 g, respectively; protein effect P < 0.001; intradialytic exercise effect P = 0.32). CONCLUSIONS: Removal of AAs during HD can be compensated for by protein ingestion and is not compromised by intradialytic exercise in ESRD patients.

Effect of intradialytic exercise on bone profile in hemodialysis patients

BackgroundChronic kidney disease increases the risk of fractures and altered bone and mineral metabolism. Exercise training could be a non-pharmacological therapeutic intervention. The aim of this work is to evaluate the effect of intradialytic exercise training on bone markers in hemodialysis (HD) patients.ResultsForty adult patients on regular HD participated in the study. Twenty of which completed 3 months supervised intradialytic cycling exercise program and 20 served as controls. At baseline, there was no difference between both groups regarding age, sex, physical performance, and laboratory studies performed. After 3 months, the exercise group showed significant improvement in short performance battery test (SPBT) total score (P<0.001) associated with significant decrease in serum parathormone (PTH) (P=0.01) and increase in serum alkaline phosphatase (ALP) and bone specific alkaline phosphatase (BALP) (P<0.05 and P<0.001 respectively). Controls did not show similar change in SPBT or laboratory studies. There was no significant change in serum calcium or phosphorus in both groups. A significant positive correlation was observed between SPBT scores post-exercise and both BALP and ALP levels (r=0.432, P=0.01 and r=0.645, P<0.01 respectively). Also, an inverse relation was observed between SPBT and PTH (r=−0.503, P=0.01).ConclusionIntradialytic cycling exercise program resulted in significant increase in physical performance associated with decrease in serum PTH and increase in BALP and ALP in HD patients. This indicates the positive influence of exercise not only on physical performance in dialysis patients but also on bone metabolism.

Effectiveness of Intradialytic Exercise and Foot Hand Massage On Physiological Response of Blood Pressure

Background : End-stage acute and chronic kidney disease requires hemodialysis as an option for treating kidney failure. Hemodialysis patients are reported to experience depression and anxiety affecting blood pressure. Controlling blood pressure during hemodialysis is an important factor in supporting the success of hemodialysis treatment. Interventions that can be given to support anxiety management to have stable blood pressure in hemodialysis renal failure patients were intradialityc exercise and foot hand massage. Method : The research design used was pre-experimental in the form of one-group pre-post test design. The sampling technique used purposive sampling with a sample size of 20 respondents. Data analysis for data normality used shaphiro-whilk, for general data univariately used frequency distribution tables, while bivariate analysis in paired groups used the Wilcoxon statistical test with a significance level of ≤ 0.05. Result : The treatment of intradialityc exercise and foot hand massage had an effective effect on the physiological response to the anxiety in patients of renal failure with hemodialysis, including p value: systole blood pressure 0.003, diastole 0.015. Intradialytic exercise and foot hand massage given to patients of renal failure under hemodialysis treatment had an effective effect on the physiological response to the anxiety of systole and diastolic blood pressure. Conclusion : Intradialytic exercise and foot hand massage had an effective effect on stabilizing blood pressure and were recommended to be used as a non-pharmacological nursing

Evaluating the effect of intradialytic exercise on blood pressure, inflammatory markers and dialysis adequacy

Introduction: In spite of widely accepted idea that exercise is beneficial in dialysis, it is not easy to incorporate an exercise program into routine clinical practice of these patients. Objectives: The present study was conducted to evaluate the effects of exercise on hemodialysis patients. Patients and Methods: In this non-pharmacologic clinical trial, a total of 49 clinically stable hemodialysis patients were enrolled in the study and were randomly allocated into two groups; the intervention group (n=27) and the control group (n=22). The intervention group conducted at least 30 minutes of cycling during each hemodialysis session for six months. Intradialytic blood pressure, high-sensitivity C-reactive protein (hs-CRP) blood levels and dialysis adequacy were estimated before and after dialysis. Results: At the end of the 6-month study period, a significant reduction in systolic and diastolic blood pressure in all patients of the intervention group (P&lt;0.05) was detected. Although the dialysis quality increased more than 1.2, it was not statistically significant. Moreover hs-CRP was decreased in the exercise group at the end of the study, while these outcomes were not statistically significant too. Conclusion: Intradialytic exercise can lead to a significant reduction in systolic and diastolic blood pressure in hemodialysis patients. Trial registration: This randomized controlled trial was registered in the Iranian Registry of Clinical Trials (#IRCT2015092324152N1, https://irct.ir/trial/20465, ethical code; ARAKMU.REC.1393.168.1).

Effect of Intradialytic Exercise on the Removal of Tissue Sodium During Hemodialysis

Effect of Intradialytic Exercise on the Removal of Tissue Sodium During Hemodialysis

Effect of intradialytic exercise on quality of life of patients with end-stage renal disease on hemodialysis

Background Up to 90% of patients diagnosed with end-stage renal disease (ESRD) regularly receive hemodialysis (HD) as renal replacement therapy. Patients with ESRD have a diminished physical function, so physical therapy during HD sessions can be a significant part of physical rehabilitation for these patients. The improvement in quality of life (QoL) is regarded as a main target in the management of patients with ESRD. Aim The aim of the study was to evaluate the effect of a physical therapy program on the QoL in patients with ESRD on HD. Patients and methods This sectional study was conducted on 60 ESRD patients on regular HD who are allocated from the HD unit, Internal Medicine Department of El-Zahraa University Hospital from March 2018 to August 2018. The patients were subjected to anthropometric measurements including weight, height, and BMI; all laboratory variables were recorded. The QoL was assessed using the short-form 36 questionnaire and the score was calculated at the beginning of the study and after 6 months. Results There was a statistically significant decrease in blood urea (49.54±15.62 to 33.92±13.89) and plasma creatinine (6.19±1.43 to 4.20±1.95) after 6 months of starting intradialytic exercise in comparison to the baseline. There is statistically significant improvement in the results of some items of the short-form 36 health questionnaire after 6 months from the start of the study. Conclusion Exercise program during the intradialytic period can provide a significant improvement of QoL and physical ability of patients with chronic kidney disease.

Effect of Intradialytic Exercise on Physical Performance and Cardiovascular Risk Factors in Patients Receiving Maintenance Hemodialysis: A Pilot and Feasibility Study

Introduction: Although intradialytic exercise is considered a form of “nonpharmacological medicine” for patients receiving maintenance hemodialysis (MHD), this practice has not been widely implemented in most dialysis centers because of clinical limitations. We, therefore, aimed to design an intradialytic exercise training program to improve the implementation of this practice and determine its impact on physical performance and cardiovascular risk factors in patients receiving MHD. Methods: A total of 132 MHD patients at 4 outpatient dialysis units were enrolled and assigned randomly into exercise (n = 67) and control groups (n = 65). During a 2-year period, patients in the exercise group participated in 20-min exercise training sessions within dialysis sessions on 3 days per week. All patients underwent assessments of physical function (6-min walk test) and cardiovascular risk factors (blood pressure [BP], total cholesterol [TC], low-density lipoprotein [LDL], high-sensitivity C-reactive protein [hsCRP], albumin [Alb], hemoglobin [Hb], and erythropoietin [EPO] dose) at the baseline and annually thereafter. Results: Of the participants, 50.8% had completed the study after 2 years. No statistically significant intragroup or intergroup differences were observed in the measures of 6MD, BP, TC, hsCRP, Alb, Hb, and EPO dose. Conclusion: The results suggest that although this low-intensity, nonprogressive intradialytic exercise program may be practical, it was not sufficient to improve physiological function and reduce cardiovascular disease risk factors in patients receiving MHD.

Effects of intradialytic exercise on cardiopulmonary capacity in chronic kidney disease: systematic review and meta-analysis of randomized clinical trials

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.

The effect of intradialytic exercise twice a week on the physical capacity, inflammation, and nutritional status of dialysis patients: A randomized controlled trial.

Inactivity, uremia, and malnutrition in dialysis patients may lead to decreased muscle mass and physical capacity. As a preventative measure, dialysis patients are provided with an intradialytic exercise program. Our study aimed to determine the role of intradialytic exercise performed 2 times per week on physical capacity, inflammation, and nutritional status in dialysis patients and to determine which exercises are more suitable for this population. A randomized clinical trial in which participants were randomly assigned to 1 of 3 groups, i.e., a group of patients performing aerobic exercise, a group of patients performing a combination of aerobic and resistance exercise and the control group. The study was conducted at the Dialysis Unit of Dr. Cipto Mangunkusumo General Hospital, Jakarta for 12 weeks from February to May 2018. The inclusion criteria were dialysis patients aged over 18 years who had undergone routine dialysis for over 3 months. A total of one hundred twenty patients were included in the study. There was a significant increase in lower extremity strength in the group performing aerobic exercise and in the combined exercise group compared to the lower extremity strength of the control group. There was also a significant increase in the physical component score (PCS) of the KDQOL-SF™ instrument in the aerobic training and combination exercise groups compared to the PCS of the control group. No significant differences were found between the combination exercise group and the aerobic training group in any outcome. Both types of exercise programs significantly increased the lower extremity muscle strength and the PCS of the quality of life index. Combination exercise was not more effective than aerobic exercise for dialysis patients.

The Effect of Intradialytic Exercise on the Physical Function of People Undergoing Hemodialysis

The Effect of Intradialytic Exercise on the Physical Function of People Undergoing Hemodialysis