An update on the effects of aerobic training during hemodialysis in end stage renal disease 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.…”

“…Five studies ( n =236) examined LVEF, measured using echocardiography or cardiac MRI. 32 , 53 , 55 , 60 , 66 Meta-analysis of four studies ( n =222), which involved intradialytic cycling for 30–90 minutes per session and intervention duration of 12–44 weeks, demonstrated a small statistically significant MD in LVEF of 3.29% (95% CI, 2.48 to 4.11; I 2 =0%; P = 0.72) with exercise as compared with nonexercise controls (Figure 4 A). 32 , 53 , 60 , 66 …”

“…In total, six studies (total n =315) examined outcomes related to myocardial structure (Table 4 ). 32 , 53 , 55 , 60 , 64 , 66 Only left ventricular mass index (LVMI) was eligible for meta-analysis, including four RCTs ( n =210) which demonstrated no statistically significant change in LVMI in individuals who completed 12–44 weeks of intradialytic cycling for 30–90 minutes per session as compared with no exercise controls (MD –1.62 g/m 2 ; 95% CI, −7.46 to 4.22; I 2 =91%; P < 0.001) (Figure 4 B). 53 , 60 , 64 , 66 …”