Physical Exercise Affects Quality of Life and Cardiac Autonomic Modulation in Patients With Chronic Kidney Failure Submitted to Hemodialysis: A Randomized Clinical Trial

Abstract

Performing physical exercise during hemodialysis has been debated regarding safety and efficacy for improving life quality for patients with chronic kidney disease (CKD). Thus, we explored the influence of physical exercise during hemodialysis on both autonomic modulation of heart rate and quality of life for patients with CKF in a randomized clinical trial. We randomly allocated participants requiring hemodialysis to an experimental exercise group (EG) and a control no-exercise group (CG) and assessed their quality of life with the Kidney Disease Quality of Life Short Form—KDQOL-SF™ 1.3 and with Polar RS800CX to monitor their heart rate variability (HRV) before and three months after the end of the exercise intervention. EG participants reported a significant increase in their quality of life ( p = .05, physical function, physical aspects, pain, emotional well-being, emotional function; p = .03, energy and fatigue) and showed HRV improvement ( p = .05, RMSSD, SDNN, and SD2; p = .004, SD1) after three months of exercise. Thus, we recommend supervised physical exercise during hemodialysis for carefully selected patients.

Effect of Intradialytic Exercise on Cardiovascular Outcomes in Maintenance Hemodialysis: A Systematic Review and Meta-Analysis

“…Four RCTs (total n =205) assessed the effect of intradialytic cycling for 30–90 minutes, thrice weekly over 12–52 weeks of duration on various measures of HRV (Table 4 ). 49 , 53 , 60 , 68 Meta-analysis of these studies showed no statistically significant difference in the SD of normal R-R intervals during a 24-hour period (SD of N-N intervals [SDNN]) in the exercise group as compared with the control group (MD 16.05 ms; 95% CI, −14.60 to 46.70; I 2 =99%; P < 0.001). By contrast, meta-analysis of three RCTs demonstrated a statistically significant between-group difference in low-frequency/high-frequency (LF/HF) ratio of 0.38 (95% CI, 0.32, 0.44; I 2 =0%; P = 0.90) ( Supplemental Figure 2 ).…”

“…Studies selected include 18 parallel arm RCTs, two randomized cross-over studies, seven nonrandomized studies that included an intervention and control group, and five single-group pre-post studies. 32 , 47 – 77 In total, 1817 individuals participated in these 32 studies, with sample sizes ranging from 6 to 174 participants (Table 2 ).…”

“…Twenty-two studies evaluated the effects of intradialytic aerobic exercise. 32 , 47 , 48 , 50 , 51 , 53 , 55 – 59 , 62 , 64 – 66 , 68 – 70 , 72 , 74 – 76 Four studies examined the effects of resistance exercise. 54 , 61 , 73 , 77 Five studies included both aerobic and resistance exercise.…”

“…53,60,64,66 Cardiac Autonomic Dysfunction/Increased Sympathetic Activity Four RCTs (total n5205) assessed the effect of intradialytic cycling for 30-90 minutes, thrice weekly over 12-52 weeks of duration on various measures of HRV (Table 4). 49,53,60,68 Meta-analysis of these studies showed no statistically significant difference in the SD of normal R-R intervals during a 24-hour period (SD of N-N intervals [SDNN]) in the exercise group as compared with the control group (MD 16.05 ms; 95% CI, 214.60 to 46.70; I 2 599%; P , 0.001). By contrast, meta-analysis of three Cheng et al 61 Cooke et al 48 Fernandes et al 62 Graham−Brown et al 66 Greenwood et al 67 Huang et al 63 Koh et al 47 Kouidi et al 60 Kouidi et al 49 Liao et al 50 Martinez−Olmos et al 70 Momeni et al 32 Oliveira E Silva et al 64 Palar and Lobo 77 Paluchamy et al 65 Parsons et al 51 Pereira et al 68 Petraki et al 52 Reboredo et al 58 Toussaint et al 69 Random sequence generation (selection bias)…”

“…67 Adverse Events, Adherence, and Study Attrition Only 19/32 studies reported adverse events. [47][48][49][50]52,53,58,60,61,[65][66][67][68][69][70]72,74,75,77 Across these studies, 248 adverse events occurred, with 135 (54.4%) occurring in the intervention groups and 113 (45.6%) in the control groups. Of the adverse events in the intervention group, only one was identified to be related to exercise.…”