Restricted accessResearch articleFirst published online 2018-9
Intradialytic exercise training modalities on physical functioning and health-related quality of life in patients undergoing maintenance hemodialysis: systematic review and meta-analysis
To determine the effects of different intradialytic exercise training modalities on physical functioning and health-related quality of life of maintenance hemodialysis patients.
Methods:
We searched MEDLINE, Cochrane Trials Register and CINAHL for controlled trials that evaluated the effects of intradialytic exercise training for maintenance hemodialysis patients and published from the earliest available date to December 2017. Weighted mean difference and 95% confidence interval (CI) were calculated, and heterogeneity was assessed using the I2 test.
Results:
Fifty-six studies met the study criteria, comprising a total of 2586 patients. Compared with no exercise, combined aerobic and resistance exercise resulted in significant improvement in peak VO2 weighted mean difference (5.1 mL kg−1 min−1; 95% CI: 3.4, 6.8 mL kg−1 min−1), depression symptoms (−7.32; 95% CI −9.31, −5.33) and both physical function (10.67 points; 95% CI 1.08, 20.25 points) and vitality (10.01 points; 95% CI 4.30, 15.72 points) domains of health-related quality of life. Resistance exercise alone was significantly associated with improvement in the 6-minute walk test distance (30.2 m; 95% CI 24.6, 35.9 m), knee extensor strength (0.6 N; 95% CI 0.1, 1.0 N) and Physical Component Score of health-related quality of life (9.53 points; 95% CI −3.09, 22.15 points) when compared with control group. Aerobic exercise alone was not significantly associated with aerobic capacity and quality of life improvement.
Conclusion:
The results provide support to interventions that combine intradialytic aerobic and resistance exercises to improve physical functioning and quality of life in end-stage renal disease patients undergoing hemodialysis.
Pena-PolancoJEFriedLF.Established and emerging strategies in the treatment of chronic kidney disease. Semin Nephrol2016; 36(4): 331–342.
2.
BlackCSharmaPScotlandGet al. Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis. Health Technol Assess2010; 14(21): 1–184.
JohansenKLChertowGMda SilvaMet al. Determinants of physical performance in ambulatory patients on hemodialysis. Kidney Int2001; 60: 1586–1591.
5.
WangRTangCChenXet al. Poor sleep and reduced quality of life were associated with symptom distress in patients receiving maintenance hemodialysis. Health Qual Life Outcomes2016; 14(1): 125.
6.
AucellaFBattagliaYBellizziVet al. Physical exercise programs in CKD: lights, shades and perspectives. J Nephrol2015; 28(2): 143–150.
7.
HeiweSJacobsonSH.Exercise training for adults with chronic kidney disease. Cochrane Database Syst Rev2011; 10: CD003236.
8.
PainterPCarlsonLCareySet al. Physical functioning and health-related quality-of-life changes with exercise training in hemodialysis patients. Am J Kidney Dis2000; 35: 482–492.
9.
CheemaBSmithBCSinghMA.A rationale for intradialytic exercise training as standard clinical practice in ESRD. Am J Kidney Dis2005; 45: 912–916.
10.
ShengKZhangPChenLet al. Intradialytic exercise in hemodialysis patients: a systematic review and meta-analysis. Am J Nephrol2014; 40(5): 478–490.
11.
Segura-OrtíE.Exercise in haemodyalisis patients: a literature systematic review. Nefrologia2010; 30(2): 236–246.
12.
GarberCEBlissmerBDeschenesMRet al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc2011; 43(7): 1334–1359.
13.
ChungYCYehMLLiuYM.Effects of intradialytic exercise on the physical function, depression and quality of life for haemodialysis patients: a systematic review and meta-analysis of randomised controlled trials. J Clin Nurs2017; 26(13–14): 1801–1813.
14.
MoherDLiberatiATetzlaffJet al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ2009; 339: b2535.
15.
HigginsJPTGreenS. The Cochrane library, issue 4. Chichester: John Wiley & Sons, 2006 (Cochrane handbook for systematic reviews of interventions 4.2.6, update September2006).
16.
OlivoSAMacedoLGGadottiINet al. Scales to assess the quality of randomized controlled trials: a systematic review. Phys Ther2008; 88(2): 156–175.
17.
VerhagenAPde VetHCWde BieRAet al. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol1998; 51: 1235–1241.
18.
MaherCGSherringtonCHerbertRDet al. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther2003; 83(8): 713–721.
19.
HigginsJPThompsonSGDeeksJJet al. Measuring inconsistency in meta-analyses. BMJ2003; 327: 557–560.
AbreuCCCardozoLFMFStockler-PintoMBet al. Does resistance exercise performed during dialysis modulate Nrf2 and NF-κB in patients with chronic kidney disease?Life Sci2017; 188: 192–197.
22.
AfsharREmanyASaremiAet al. Effects of intradialytic aerobic training on sleep quality in hemodialysis patients. Iran J Kidney Dis2011; 5(2): 119–123.
23.
Al RashediSFGhalebMA. Effectiveness of intradialytic leg exercise on dialysis efficacy among patients undergoing hemodialysis. IJARIIE2017; 3(1): 133–144.
24.
BohmIStewartKOnyskie-MarcusJet al. Effects of intradialytic cycling compared with pedometry on physical function in chronic outpatient hemodialysis: a prospective randomized trial. Nephrol Dial Transplant2014; 29: 1947–1955.
25.
ChangYChengSLinMet al. The effectiveness of intradialytic leg ergometry exercise for improving sedentary life style and fatigue among patients with chronic kidney disease: a randomized clinical trial. Int J Nurs Stud2010; 47: 1383–1388.
26.
CookeABTaVIqbalSet al. The impact of intradialytic pedaling exercise on arterial stiffness: a pilot randomized controlled trial in a hemodialysis population. Am J Hypertens. Epub ahead of print 6November2017. DOI: 10.1093/ajh/hpx191.
27.
DobsakPHomolkaPSvojanovskyJet al. Intra-dialytic electrostimulation of leg extensors may improve exercise tolerance and quality of life in hemodialyzed patients. Artif Organs2012; 36(1): 71–78.
28.
DungeyMBishopNCYoungHMLet al. The impact of exercising during haemodialysis on blood pressure, markers of cardiac injury and systemic inflammation—preliminary results of a pilot study. Kidney Blood Press Res2015; 40(6): 593–604.
29.
GiannakiCDHadjigeorgiouGMKaratzaferiCet al. A single-blind randomized controlled trial to evaluate the effect of 6 months of progressive aerobic exercise training in patients with uraemic restless legs syndrome. Nephrol Dial Transplant2013; 28(11): 2834–2840.
30.
GiannakiCDSakkasGKKaratzaferiCet al. Effect of exercise training and dopamine agonists in patients with uremic restless legs syndrome: a six-month randomized, partially double-blind, placebo-controlled comparative study. BMC Nephrol2013; 14: 194.
31.
GiannakiCDSakkasGKKaratzaferiCet al. Combination of exercise training and dopamine agonists in patients with RLS on dialysis: a randomized, double-blind placebo-controlled study. ASAIO J2015; 61(6): 738–741.
32.
GroussardCRouchon-IsnardMCoutardCet al. Beneficial effects of an intradialytic cycling training program in patients with end-stage kidney disease. Appl Physiol Nutr Metab2015; 40(6): 550–556.
33.
HristeaDDeschampsTParisAet al. Combining intra-dialytic exercise and nutritional supplementation in malnourished older haemodialysis patients: towards better quality of life and autonomy. Nephrology2016; 21(9): 785–790.
34.
KohKSharmanJFassetRGet al. Effect of intradialytic versus home-based aerobic exercise training on physical function and vascular parameters in hemodialysis patients: a randomized pilot study. Am J Kidney Dis2009; 55(1): 88–99.
35.
KongCHTattersallJEGreenwoodRNet al. The effect of exercise during haemodialysis on solute removal. Nephrol Dial Transplant1999; 14(12): 2927–2931.
36.
KoufakiPMercerTHNaishPF.Effects of exercise training on aerobic and functional capacity of end-stage renal disease patients. Clin Physiol Funct Imaging2002; 22(2): 115–124.
37.
LiaoMLiuWLinFet al. Intradialytic aerobic cycling exercise alleviates inflammation and improves endothelial progenitor cell count and bone density in hemodialysis patients. Medicine2016; 95(27): e4134.
38.
MakhloughAIlaliEMohseniRet al. Effect of intradialytic aerobic exercise on serum electrolytes levels in hemodialysis patients. Iran J Kidney Dis2012; 6(2): 119–123.
39.
MohseniRZeydiAEIlaliEet al. The effect of intradialytic aerobic exercise on dialysis efficacy in hemodialysis patients: a randomized controlled trial. Oman Med J2013; 28(5): 345–349.
40.
MomeniANematolahiANasrM.Effect of intradialytic exercise on echocardiographic findings in hemodialysis patients. Iran J Kidney Dis2014; 8(3): 207–211.
41.
MortazaviMVahdatpourBGhasempourAet al. Aerobic exercise improves signs of restless leg syndrome in end stage renal disease patients suffering chronic hemodialysis. Sci World J2013; 2013: 628142.
42.
MougSJGrantSCreedGet al. Exercise during haemodialysis: west of Scotland pilot study. Scott Med J2004; 49(1): 14–17.
43.
OrcyRAntunesMFSchillerTet al. Aerobic exercise increases phosphate removal during hemodialysis: a controlled trial. Hemodial Int2014; 18(2): 450–458.
44.
PainterPMooreGCarlsonLet al. Effects of exercise training plus normalization of hematocrit on exercise capacity and health-related quality of life. Am J Kidney Dis2002; 39(2): 257–265.
45.
ReboredoMMPinheiroBVNederJAet al. Efeito do exercício aeróbico durante as sessões de hemodiálise na variabilidade da frequência cardíaca e na função ventricular esquerda em pacientes com doença renal crônica. J Bras Nefrol2010; 32(4): 372–379.
46.
ReboredoMMNederJAPinheiroBVet al. Constant work-rate test to assess the effects of intradialytic aerobic training in mildly impaired patients with end-stage renal disease: a randomized controlled trial. Arch Phys Med Rehabil2011; 92: 2018–2024.
47.
ReboredoMMNederJAPinheiroBVet al. Intra-dialytic training accelerates oxygen uptake kinetics in hemodialysis patients. Eur J Prev Cardiol2015; 22(7): 912–919.
48.
SakkasGKHadjigeorgiouGMKaratzaferiCet al. Intradialytic aerobic exercise training ameliorates symptoms of restless legs syndrome and improves functional capacity in patients on hemodialysis: a pilot study. ASAIO J2008; 54(2): 185–190.
49.
SolimanHMM. Effect of intradialytic exercise on fatigue, electrolytes level and blood pressure in hemodialysis patients: a randomized controlled trial. J Nurs Educ Pract2015; 5(11): 16–28.
50.
ToussaintNDPolkinghorneKRKerrPG.Impact of intradialytic exercise on arterial compliance and B-type natriuretic peptide levels in hemodialysis patients. Hemodial Int2008; 12: 254–263.
51.
WilundKRTomaykoEJWuPet al. Intradialytic exercise training reduces oxidative stress and epicardial fat: a pilot study. Nephrol Dial Transplant2010; 25: 2695–2701.
52.
BennettPNDalyRMFraserSFet al. The impact of an exercise physiologist coordinated resistance exercise program on the physical function of people receiving hemodialysis: a stepped wedge randomised control study. BMC Nephrol2013; 14: 204.
53.
CheemaBAbasHSmithBCFet al. Progressive exercise for anabolism in kidney disease (PEAK): a randomized, controlled trial of resistance training during hemodialysis. J Am Soc Nephrol2007; 18: 1594–1601.
54.
CheemaBAbasHSmithBet al. Randomized controlled trial of intradialytic resistance training to target muscle wasting in ESRD: the Progressive Exercise for Anabolism in Kidney Disease (PEAK) study. Am J Kidney Dis2007; 50(4): 574–584.
55.
CheemaBAbasHSmithBCFet al. Effect of resistance training during hemodialysis on circulating cytokines: a randomized controlled trial. Eur J Appl Physiol2011; 111(7): 1437–1445.
56.
ChenJLTGodfreySNgTTet al. Effect of intra-dialytic, low-intensity strength training on functional capacity in adult haemodialysis patients: a randomized pilot trial. Nephrol Dial Transplant2010; 25(6): 1936–1943.
57.
JohansenKLPainterPLSakkasGKet al. Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis: a randomized, controlled trial. J Am Soc Nephrol2006; 17(8): 2307–2314.
58.
KirkmanDLMullinsPJungleeNAet al. Anabolic exercise in haemodialysis patients: a randomised controlled pilot study. J Cachexia Sarcopenia Muscle2014; 5(3): 199–207.
59.
MarinhoSMSAMafraDPelletierSet al. In hemodialysis patients, intradialytic resistance exercise improves osteoblast function: a pilot study. J Ren Nutr2016; 26(5): 341–345.
60.
Martin-AlemañyGValdez-OrtizROlvera-SotoGet al. The effects of resistance exercise and oral nutritional supplementation during hemodialysis on indicators of nutritional status and quality of life. Nephrol Dial Transplant2016; 31(10): 1712–1720.
61.
Olvera-SotoMGValdez-OrtizRLópez AlvarengaJCet al. Effect of resistance exercises on the indicators of muscle reserves and handgrip strength in adult patients on hemodialysis. J Ren Nutr2016; 26(1): 53–60.
62.
PellizzaroCOThoméFSVeroneseFV.Effect of peripheral and respiratory muscle training on the functional capacity of hemodialysis patients. Ren Fail2013; 35(2): 189–197.
63.
RibeiroRCoutinhoGLIurasAet al. Effect of resistance exercise intradialytic in renal patients chronic in hemodialysis. J Bras Nefrol2013; 35(1): 13–19.
64.
SongWSohngK.Effects of progressive resistance training on body composition, physical fitness and quality of life of patients on hemodialysis. J Korean Acad Nurs2012; 42(7): 947–956.
65.
DePaulVMorelandJEagerTet al. The effectiveness of aerobic and muscle strength training in patients receiving hemodialysis and EPO: a randomized controlled trial. Am J Kidney Dis2002; 40(6): 1219–1229.
66.
KonstantinidouEKoukouvouGKouidiEet al. Exercise training in patients with end-stage renal disease on hemodialysis: comparison of three rehabilitation programs. J Rehabil Med2002; 34(1): 40–45.
67.
KouidiEJGrekasDMDeligiannisAP.Effects of exercise training on noninvasive cardiac measures in patients undergoing long-term hemodialysis: a randomized controlled trial. Am J Kidney Dis2009; 54(3): 511–521.
68.
KouidiEKaragiannisVGrekasDet al. Depression, heart rate variability, and exercise training in dialysis patients. Eur J Cardiovasc Prev Rehabil2010; 17(2): 160–167.
69.
MarchesanMNunesVGSRombaldiAJ.Physical training improves physical fitness and the quality of life of patients on hemodialysis. Rev Bras Cineantropom Desempenho Hum2014; 16(3): 324–344.
70.
MolstedSEidemakISorensenHTet al. Five months of physical exercise in hemodialysis patients: effects on aerobic capacity, physical function and self-rated health. Nephron Clin Pract2004; 96(3): c76–c81.
71.
OliverosMSAvendañoMBunoutDet al. A pilot study on physical training of patients in hemodialysis. Rev Méd Chil2011; 139(8): 1046–1053.
72.
OuzouniSKouidiESioulisAet al. Effects of intradialytic exercise training on health-related quality of life indices in haemodialysis patients. Clin Rehabil2009; 23: 53–63.
73.
PetrakiMKouidiEGrekasDet al. Effects of exercise training during hemodialysis on cardiac baroreflex sensitivity. Clin Nephrol2008; 70(3): 210–219.
74.
Van VilsterenMCBAde GreefMHGHuismanRM.The effects of a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counselling for sedentary haemodialysis patients in The Netherlands: results of a randomized clinical trial. Nephrol Dial Transplant2005; 20(1): 141–146.
75.
AfsharRShegarfyLShavandiNet al. Effects of aerobic exercise and resistance training on lipid profiles and inflammation status in patients on maintenance hemodialysis. Indian J Nephrol2010; 20(4): 185–189.
76.
De LimaMCCicotoste CdeLCardoso KdaSet al. Effect of exercise performed during hemodialysis: strength versus aerobic. Ren Fail2013; 35(5): 697–704.
77.
LewisMIFournierMWangHet al. Effect of endurance and/or strength training on muscle fiber size, oxidative capacity, and capillarity in hemodialysis patients. J Appl Physiol2015; 119(8): 865–871.
78.
Segura-OrtíEKouidiELisónJF.Effect of resistance exercise during hemodialysis on physical function and quality of life: randomized controlled trial. Clin Nephrol2009; 71(5): 527–537.
79.
LiSLiQLyuXet al. Alternative statistical analysis shows exercise training-induced improvements in peak VO2 are clinically significant. Sports Med2015; 45(5): 763–765.
80.
WirtzNWahlPKleinöderHet al. Lactate kinetics during multiple set resistance exercise. J Sports Sci Med2014; 13(1): 73–77.
81.
MarcinikEJPottsJSchlabachGet al. Effects of strength training on lactate threshold and endurance performance. Med Sci Sports Exerc1991; 23(6): 739–743.
82.
ØsteråsHHelgerudJHoffJ.Maximal strength-training effects on force-velocity and force-power relationships explain increases in aerobic performance in humans. Eur J Appl Physiol2002; 88(3): 255–263.
83.
LovellDICuneoRGassGC.Strength training improves submaximum cardiovascular performance in older men. J Geriatr Phys Ther2009; 32(3): 117–124.
84.
KohlLMSignoriLURibeiroRAet al. Prognostic value of the six-minute walk test in end-stage renal disease life expectancy: a prospective cohort study. Clinics2012; 67(6): 581–586.
85.
RoshanravanBRobinson-CohenCPatelKVet al. Association between physical performance and all-cause mortality in CKD. J Am Soc Nephrol2013; 24(5): 822–830.
86.
LopesAAAlbertJMYoungEWet al. Screening for depression in hemodialysis patients: associations with diagnosis, treatment, and outcomes in the DOPPS. Kidney Int2004; 66: 2047–2053.
87.
LopesAABraggJYoungEet al. Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe. Kidney Int2002; 62: 199–207.
88.
CukorDRosenthalDSJindalRMet al. Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients. Kidney Int2009; 75: 1223–1229.
89.
TelesFde AzevedoVFDde MirandaCTet al. Depression in hemodialysis patients: the role of dialysis shift. Clinics2014; 69(3): 198–202.
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