Long-Term Effect of Physical Exercise on the Risk for Hospitalization and Death in Dialysis Patients

Abstract

Background and objectivesIn the EXerCise Introduction to Enhance Performance in Dialysis (EXCITE) trial, a simple, personalized 6-month walking exercise program at home during the day off of dialysis improved the functional status and the risk for hospitalization in patients with kidney failure. In this post-trial observational study, we tested whether the same intervention was associated with a lower long-term risk of death or hospitalization (combined end point) during a follow-up extended up to 36 months.Design, setting, participants, & measurementsIn total, 227 patients (exercise, n=104; control, n=123) completed the 6-month trial and entered the post-trial observational study. Data were analyzed by unadjusted and adjusted Cox regression analyses and Bayesian analysis.ResultsIn the long-term observation (up to 36 months), 134 events were recorded (eight deaths not preceded by hospitalization and 126 hospitalizations, which were followed by death in 38 cases). The long-term risk for hospitalization or death was 29% lower (hazard ratio, 0.71; 95% confidence interval, 0.50 to 1.00), and in an analysis stratified by adherence to the walking exercise program during the 6-month trial, the subgroup with high adherence (>60% of prescribed sessions) had a 45% lower risk as compared with the control group (hazard ratio, 0.55; 95% confidence interval, 0.35 to 0.87). A Bayesian analysis showed that the posterior probability of a hazard ratio of 0.71 (95% confidence interval, 0.50 to 1.00) for the risk of the composite outcome observed in the post-trial observational study was 93% under the conservative prior and 97% under the optimistic prior. Sensitivity analyses restricted to the risk of hospitalization only or censoring patients at the time of transplantation fully confirmed these findings.ConclusionsA simple, personalized, home-based, low-intensity exercise program was associated with a lower risk of hospitalization.Clinical Trial registry name and registration number:EXerCise Introduction to Enhance Performance in Dialysis (EXCITE), NCT01255969

The Effect of Intradialytic Exercise on Dialysis Patient Survival: A Randomized Controlled Trial

“…This fact, together with the observational designs of the included studies meant that the evidence was very low certainty. Recently, Mallalamaci et al [ 23] Compared with controls, patients allocated to the exercise arm had a borderline significantly lower risk of the composite outcome of hospitalization or death (HR 0.71, 95% CI 0.50 -1.00).…”

“…This fact, together with the observational designs of the included studies meant that the evidence was very low certainty. Recently, Mallalamaci et al [ 23] reported long-term (36 month) follow-up outcomes of the EXCITE study, a prospective, randomized controlled trial of a 6-month home-based walking exercise program in 227 patients on dialysis (192 on HD) at 13 Italian centers.…”

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

“…This fact, together with the observational designs of the included studies meant that the evidence was very low certainty. Recently, Mallalamaci et al [23] reported long-term (36 month) follow-up outcomes of the EXCITE study, a prospective, randomized controlled trial of a 6-month home-based walking exercise program in 227 patients on dialysis (192 on HD) at 13 Italian centers. Compared with controls, patients allocated to the exercise arm had a borderline significantly lower risk of the composite outcome of hospitalization or death (HR 0.71, 95% CI 0.50 -1.00).…”

The Effect of Intradialytic Exercise on Dialysis Patient Survival: A Randomized Controlled Trial

“…This fact, together with the observational designs of the included studies meant that the evidence was very low certainty. Recently, Mallalamaci et al [ 23] reported long-term (36 month) follow-up outcomes of the EXCITE study, a prospective, randomized controlled trial of a 6-month home-based walking exercise program in 227 patients on dialysis (192 on HD) at 13 Italian centers. Compared with controls, patients allocated to the exercise arm had a borderline signi cantly lower risk of the composite outcome of hospitalization or death (HR 0.71, 95% CI 0.50-1.00).…”