Effects of Exercise on Muscle Fitness in Dialysis Patients: A Systematic Review and Meta-Analysis

Abstract

Background: Lack of exercise is a prevalent problem in patients receiving dialysis. Although guidelines recommend these patients to undertake suitable exercise, no exercise type or intensity has been suggested, and the effect of exercise on muscle fitness in dialysis patients is not clear. This study investigated the effect of exercise on muscle fitness, including muscle mass, muscle strength, and physical performance, in patients on dialysis. Methods: A systematic review and a meta-analysis of randomized controlled trials (RCTs) were conducted. Five English and 4 Chinese databases were searched from their inception to July 2018. Two independent reviewers searched the different databases, selected trials, conducted bias assessment, and extracted the data. Results: A total of 21 RCTs meeting the inclusion criteria were included in this review. Pooled results demonstrated that resistance training significantly improved leg mass (standard mean difference [SMD] 0.34, 95% CI [0.06–0.62], p= 0.02) whereas aerobic training did not (SMD 0.87, 95% CI [–0.11 to 1.86], p = 0.08). Resistance training increased both grip strength (weighted mean difference [WMD] 4.71 kg, 95% CI [2.42–6.99], p < 0.00001) and knee extension strength (WMD 3.93 kg, 95% CI [0.59–7.28], p = 0.02) significantly. Aerobic training improved grip strength (WMD 7.70 kg, 95% CI [3.35–12.05], p= 0.005) and the time of finishing short version of the sit-to-stand test (STS; WMD –4.69 s, 95% CI [–9.01 to –0.38], p = 0.03) but with insufficient evidence. In the dimension of physical performance, both aerobic training and resistance training have some beneficial effect on improving the score of 6-min walking test (WMD 85.76 m, 95% CI [63.43–108.09], p < 0.00001; WMD 41.92 m, 95% CI [8.06–75.75], p = 0.02, respectively) and median version of STS test (WMD 4.30 repetitions, 95% CI [1.22–7.39], p = 0.006; WMD 2.60 repetitions, 95% CI [0.64–4.56], p = 0.006, respectively). Conclusions: Regular resistance training with a moderate to high intensity may lead to improvement in muscle mass and muscle strength of patients undergoing dialysis, especially for the trained muscles. Both aerobic training and resistance training may help dialysis patients improve physical performance.

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

“…Therefore, the reduction in BMI that was found was mostly accompanied by an increase in MAMC which means a preservation of muscle mass, with a relevant reduction in FM. These results are in concordance with studies including measurements of muscle mass by BIA and the calculation of SMI in which muscle mass as well as SMI increased after resistance exercise and were found to have a tendency to increase in the aerobic training group [ 46 , 69 ].…”

“…In previous systematic reviews, the beneficial effects of exercise on the physical health of patients undergoing HD [ 33 , 34 , 35 , 36 , 37 , 38 ] as well as on the QoL were illuminated [ 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. In two studies by Lu et al [ 46 ] and Molsted et al [ 47 ], the positive effects of exercise on muscle mass and muscle strength in patients undergoing HD were also stressed out. Nevertheless, according to our knowledge, there are no published studies in which the total body composition and nutritional status of patients undergoing HD in relation to exercise have been examined.…”

Kinesiologist-guided functional exercise in addition to intradialytic cycling program in end-stage kidney disease patients: a randomised controlled trial

“…The majority of previous systematic reviews and meta-analysis have examined the effects of exercise in general within the HD population 49,51,53,55,56 . Moreover, the most recent meta-analysis showed the most beneficial effects of combined (strength and aerobic) exercise in HD patients 57 .…”

Effect of a pedometer-based walking intervention on body composition in patients with ESRD: a randomized controlled trial

“…Our study shows that a walking intervention not only prevented decline in muscle mass but also resulted in a slight increase. Prior studies of moderate or vigorous resistance exercise training in dialysis patients have shown significant improvements in muscle mass [19,22,23], and it may be that more vigorous exercise training results in greater increase in muscle mass [39]. However, only a fraction of dialysis patients are able to participate in such interventions [40].…”