Effects of Home-Based Exercise on Frailty in Patients With End-Stage Renal Disease: Systematic Review

Abstract

Background: New or worsening frailty is a common problem in patients with end-stage renal disease (ESRD) during the prolonged time awaiting kidney transplantation. Structured physical activity in the dialysis setting has been shown to mitigate frailty, but little is known about the benefits of home-based exercise. The purpose of this systematic review was to summarize the effects of home-based exercise interventions on indicators of frailty (weakness, slowness, low physical activity, perceived exhaustion, and shrinking) among patients diagnosed with ESRD. Methods: We searched PubMed, MEDLINE, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar using Medical Subject Heading terms and free text keywords including kidney failure, exercise, and frailty. We identified 13 relevant articles (eight randomized controlled trials, five quasi-experimental studies). Results: Our review found potential effectiveness of home-based exercise interventions on mitigating or preventing selected indicators of frailty (e.g., weakness, slowness, low physical activity, perceived exhaustion), particularly when the interventions combined aerobic walking, resistance exercise, and behavioral components and were delivered for at least 6 months. However, no published studies measured the effect of home-based exercise interventions on frailty as a whole. Conclusions: While existing studies suggest likely benefits of home-based exercise interventions among patients with ESRD, future research is warranted to develop and test home-based physical activity interventions that address all indicators of frailty.

A nurse‐led home‐based exercise program for patients with chronic kidney disease

“…In recent decades, many studies have been published on the different exercise programs for kidney patients, mainly during hemodialysis (HD) sessions, and demonstrate beneficial effects of exercise at both a physiological and psychological level (Ferreira et al, 2021;Heiwe & Jacobson, 2014;Segura-Ortí, 2010;Yoo et al, 2021).…”

“…Home-based exercise program (HBEP) have been of great interest in recent years to overcome some of these barriers (Mahjur & Norasteh, 2021;Yoo et al, 2021). A few published studies show similar beneficial effects of these programs compared to the exercise programs carried out during HD sessions, although their level of adherence is slightly lower (Ortega-Pérez de Villar et al, 2020;Tao et al, 2015Tao et al, , 2017.…”

Home‐based exercise programs in patients with chronic kidney disease: A systematic review and META‐analysis

“…Over the last 10 years, several meta‐analyses focused on the impact of exercise for CKD stages II to V have supported the positive impact of exercise interventions on exercise capacity, HRQoL, physical function, and lower limb muscle strength (Segura‐Ortí, 2010); cardiovascular parameters (Afsar et al, 2018; Heiwe & Jacobson, 2014); functional capacity (Kaltsatou et al, 2016; Young et al, 2018; Clarkson et al, 2019); muscle volume and lower body strength (Chan & Cheema, 2016); metabolic parameters, renal function, mortality, and physical fitness (Nakamura et al, 2020; Villanego et al, 2020); dialysis adequacy and depression and anxiety (Ferreira et al, 2021); and indicators of frailty (Yoo et al, 2021).…”

“…Exercise is beneficial for CKD patients (Ferreira et al, 2021; Heiwe & Jacobson, 2014; Nakamura et al, 2020; Yoo et al, 2021). However, implementing exercise programs is difficult and not all nephrology units have the adequate infrastructure or logistics to implement them (Darawad & Khalil, 2013).…”

“…Exercise is beneficial for CKD patients (Ferreira et al, 2021;Heiwe & Jacobson, 2014;Nakamura et al, 2020;Yoo et al, 2021).…”