Combined aerobic and resistance exercise in maintenance hemodialysis patients: A meta‐analysis

Abstract

Exercise brings many benefits to patients undergoing maintenance hemodialysis (MHD), but the effect of combined aerobic and resistance exercise remains unclear. English and Chinese databases (PubMed, Cochrane Library, Embase, Web of Science, CNKI, VIP, Wan Fang, and CBM) were searched from inception to January 2023 to retrieve qualified randomized controlled trials. The literature selection, data extraction, and risk of bias assessment of included studies were conducted independently by two reviewers. Meta-analysis was performed using RevMan 5.3 software. A total of 23 studies with 1214 participants were included, and 17 of the interventions were conducted during dialysis. Results showed that combined aerobic and resistance exercise (CARE) improved the peak oxygen uptake, six-minute walking test, 60 s sitto-stand test (STS), 30 s STS, dialysis adequacy, five (out of eight) domains and physical component summary of health-related quality of life (HRQOL) measured by the Medical Outcomes Study Short Form-36, blood pressure, and hemoglobin for MHD patients compared with usual care. No significant changes were found in the mental component summary of HRQOL, C-reactive protein, creatinine, potassium, sodium, calcium, and phosphate. Subgroup analysis showed that intradialytic CARE ameliorated more outcomes, except for handgrip strength and hemoglobin, than nonintradialytic ones. CARE is an effective way to improve physical function, aerobic capacity, dialysis adequacy, and HRQOL for MHD patients. Strategies should be implemented by clinicians and policymakers to motivate patients to do more exercise. Well-designed clinical trials are warranted to explore the effectiveness of nonintradialytic CARE.

Renal Rehabilitation: Present and Future Perspectives

“…Further, subgroup analysis showed that intradialytic CARE resulted in the amelioration of more evaluated outcomes than non-intradialytic CARE, with the exception of handgrip strength and hemoglobin levels [31]. The authors concluded that CARE is an effective way to improve physical function, aerobic capacity, HR-QOL, and dialysis adequacy in patients on maintenance HD [31].…”

“…Meta-analyses of randomized controlled trials (RCTs) have reported that regular exercise training in patients with CKD undergoing dialysis (HD) has benefits in physical function, aerobic capacity, dialysis adequacy, depressive symptoms, and HR-QOL [26][27][28][29][30]. Additionally, a meta-analysis of combined aerobic and resistance exercises (CARE) performed during HD by Liu et al [31] found that CARE improved the peak oxygen uptake; performance on the six-minute walking test; 60-s and 30-s sit-to-stand tests; dialysis adequacy; scores on five (out of eight) domains and the physical component summary for HR-QOL on the Medical Outcomes Study Short Form-36; blood pressure; and hemoglobin levels in patients on maintenance HD compared to those with usual care. Further, subgroup analysis showed that intradialytic CARE resulted in the amelioration of more evaluated outcomes than non-intradialytic CARE, with the exception of handgrip strength and hemoglobin levels [31].…”

“…Additionally, a meta-analysis of combined aerobic and resistance exercises (CARE) performed during HD by Liu et al [31] found that CARE improved the peak oxygen uptake; performance on the six-minute walking test; 60-s and 30-s sit-to-stand tests; dialysis adequacy; scores on five (out of eight) domains and the physical component summary for HR-QOL on the Medical Outcomes Study Short Form-36; blood pressure; and hemoglobin levels in patients on maintenance HD compared to those with usual care. Further, subgroup analysis showed that intradialytic CARE resulted in the amelioration of more evaluated outcomes than non-intradialytic CARE, with the exception of handgrip strength and hemoglobin levels [31]. The authors concluded that CARE is an effective way to improve physical function, aerobic capacity, HR-QOL, and dialysis adequacy in patients on maintenance HD [31].…”