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

Abstract

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.

The Effect of Exercise on Nutritional Status and Body Composition in Hemodialysis: A Systematic Review

“…The assessment of risk of bias was conducted for all the 18 studies. In 11 studies, high or low unclear risk of bias was detected due to the absence of blinding of participants and/or outcome assessment [ 49 , 50 , 51 , 52 , 53 , 55 , 57 , 60 , 62 , 64 , 65 ]. Five studies were considered as low or unclear risk of bias because of selective reporting [ 49 , 55 , 57 , 62 , 65 ], and in only three studies high, or unclear risk of bias was detected due to the incomplete outcome of the data [ 55 , 63 , 66 ].…”

“…In both groups (i.e., cycling and combined exercise), CRP increased [ 57 ]. Endurance-resistance training had an impact neither on sALB nor on CRP [ 54 ], while resistance-stretching exercise led to a greater decrease in CRP compared to the controls after a 2 year follow-up [ 52 ]. Increased CRP was also found in an intervention with resistance-exercise by Marinho et al [ 60 ], and according to the data from Suhardjono et al [ 65 ] there was a greater reduction in CRP only in subjects following combined aerobic-resistance exercise compared to the non-active patients undergoing HD [ 65 ].…”

“…Regarding to the performance status, several studies illuminated a significant improvement in physically active subjects [ 50 , 52 , 53 , 54 , 55 , 62 ] as can be seen in Table 9 . Assessment tools used for the evaluation of performance status were walking tests with modifications in distance and time.…”

“…Incomplete studies, studies with different control groups, studies not in the English language, or published before 2000 were excluded. As a result, 18 RCT studies [ 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ] were characterized as acceptable; details regarding the eligibility process can be found in the flow diagram presented in Figure 1 .…”

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

“…While an in-depth discussion of the potential role of intradialytic exercise in this context is beyond the scope of the present review, the association of physical activity should probably be proposed on a similar scale, from rehabilitation exercises for fitter individuals to mild exercise during dialysis for those who are more fragile and have less support at home and to passive exercise for the patients who are in poor clinical condition [149][150][151][152][153][154][155][156].…”