Effects of intradialytic aerobic exercise on hemodialysis patients: a systematic review and meta-analysis

Abstract

Objective Intradialytic exercise (IDE) is not yet a routine practice for hemodialysis patients, the lack of guidelines supporting it being a major reason. This systematic review and meta-analysis of aerobic IDE interventions examined the efficacy of IDE regarding quality of life (QOL), serum phosphorus, dialysis efficiency, inflammatory status, vitamin D3, parathyroid hormone, intake of phosphate binders, mortality and hospitalization rate. Methods Pubmed, Medline (Ovid), Embase (Ovid), Cochrane, and Cinahl (EBSCO) databases were searched to retrieve studies up to June 12, 2018. A manual reference search was also performed. Studies were included if they evaluated (a) aerobic IDE effect on at least one of our study parameters, (b) adult hemodialysis patients, (c) patients for > 1 month. Results Twenty-two studies were retrieved (706 participants), of which 12 were eligible for meta-analysis. Aerobic IDE had a significant positive effect on the QOL physical component score (QOL-PSC) and on mental component score (QOL-MCS) of SF36, but not on serum phosphorus or Kt/V. Conclusions IDE incorporation into clinical practice has a significant positive effect on QOL-PSC and QOL-MCS. In the reviewed studies, IDE did not result in any health hazard in hemodialysis patients. Nevertheless, future research should assess the long-term effectiveness and safety of IDE. The limitations of this review include the lack of quality analysis of the studies, the limited number of studies that could be included in the meta-analysis, the diversity in the exercise intensity, duration and modality, and the limited data for several outcomes. Prospero registration ID CRD42016052062.

Gait speed and handgrip strength as predictors of all-cause mortality and cardiovascular events in hemodialysis patient

“…Based on the significant correlation between poor physical performance and high mortality in CKD patients, several prospective trials and metanalysis have assessed whether exersice intervention could improve patient outcomes [38][39][40][41][42][43][44][45]. Although physical training significantly improved patient quality of life and inflammatory parameters in most studies, these benefits were not translated into better patient survival.…”

Gait speed and handgrip strength as predictors of all-cause mortality and cardiovascular events in hemodialysis patient

“…Based on the significant correlation between poor physical performance and high mortality in dialysis patients, several prospective trials have assessed whether intradialytic exercise could improve patient outcomes [36][37][38][39][40][41]. Although physical training significantly improved patient quality of life in most studies, these benefits were not translated into better patient survival.…”

Green nephrology and eco-dialysis: a position statement by the Italian Society of Nephrology

“…A number of studies have addressed the effects of physical exercise on dialysis efficiency and phosphate clearance. While the data are still inconclusive, the lack of side effects should be underlined [147][148][149][150][151]. Furthermore, while there is still no clear-cut evidence that exercise reduces the incidence of hard cardiovascular outcomes, a positive impact on frailty could reduce hospitalization and associated costs [152].…”