Exercise training during hemodialysis sessions: Physical and biochemical benefits

Abstract

Chronic inflammation, protein‐energy wasting, and poor physical functioning are highly prevalent among patients with chronic kidney disease (CKD). These factors are associated with disability and increase of cardiovascular risk. The aim of this study is to evaluate the effects of exercise training during hemodialysis (HD) sessions on physical functioning, body composition, and nutritional and inflammatory status. We performed a prospective intervention study including patients on prevalent HD therapy. Patients were evaluated at baseline visit by Rehabilitation and Physiotherapy specialists and the exercise program was adapted to each patient's physical capacity. In addition to demographic, clinical, body composition and functional ability data, serum markers regarding nutritional and inflammatory status were collected at baseline and after 3 months of exercise training. We observed a significant improvement after 3‐month follow‐up in functional ability (6 minute walk test [6MWT] [403.15 ± 105.4 vs 431.81 ± 115.5 m, P < .001], sit‐to‐stand repetitions in 30 seconds [12.2 ± 4.2 vs 14.1 ± 5.0 repetitions, P = .003] and dynamometry [24.5 ± 11.9 vs 29.5 ± 12.5 kg, P < 0.001]), body composition with increase of body mass index (BMI) (23.7 ± 4.4 vs 24.1 ± 4.7 kg/m2, P = 0.01) at the expense of lean tissue index (LTI) (14.9 ± 3.7 vs 16.2 ± 2.9 kg/m2, P = 0.038) and lipid parameters with LDL‐cholesterol decrease (70.2 ± 17.9 vs 64.9 ± 21.3 mg/dL, P = .03) and lower serum triglyceride levels (125.8 ± 54.0 vs 108.2 ± 44.6 mg/dL, P = .006). In addition, we found a decrease in iron (155.6 ± 148.2 vs 116.7 ± 110.8 mg, P = .029) and erythropoietin (117.5 ± 84.2 vs 99.2 ± 74.5 μg, P = .023) requirements. The implementation of exercise training programs during HD can improve physical functioning, body composition and lipid and anemia profile. Supervised exercise programs could be included as part of HD patient care to improve physical capacity in these patients.

l‐carnitine supplementation vs cycle ergometer exercise for physical activity and muscle status in hemodialysis patients: A randomized clinical trial

“…Recently, cycle ergometer (Ergo) exercise during HD sessions has focused on the prevention of sarcopenia. 10 However, the efficacy of Ergo exercise during HD session is not well established and it is sometimes difficult to achieve adequate exercise capacity in HD patients. Further, whether LC or Ergo treatment could improve the physical activity and muscle quality of HD patients remains unclear.…”

Effect of Exercise on Inflammation in Hemodialysis Patients: A Systematic Review

“…The 24 studies included were conducted in Iran [ 19 ], Brazil [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], Poland [ 30 ], the United Kingdom [ 31 , 32 , 33 , 34 , 35 , 36 ], Taiwan [ 37 ], China [ 38 ], Indonesia [ 39 ], Spain [ 40 , 41 ] and Greece [ 42 ], and published from 2010 to 2022.…”

“…The characteristics of the included studies are presented in Table 1 . The 24 studies were clinical trials, of which thirteen were randomized controlled trials [ 19 , 25 , 26 , 27 , 28 , 29 , 35 , 36 , 37 , 38 , 39 , 41 , 42 ], four were uncontrolled trials [ 20 , 21 , 30 , 40 ], one was a non-randomized clinical trial [ 23 ], one was a non-randomized controlled trial [ 32 ], four were randomized crossover trials [ 22 , 24 , 31 , 33 ], and one was a non-randomized crossover trial [ 34 ].…”

“…The methodological quality of the studies was evaluated with the PEDro scale, and scores are shown in Table 2 . In total, seventeen studies were evaluated as being of excellent quality [ 19 , 22 , 24 , 25 , 26 , 27 , 28 , 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 41 , 42 ], two studies were of good quality [ 23 , 29 ] and five studies were of acceptable quality [ 20 , 21 , 30 , 32 , 40 ].…”

Can passive pedaling improve sexual function in patients under hemodialysis? A randomized clinical trial

“…PA is a generic term, of which exercise is the major component [19]. Exercise, as a therapeutic tool can potentially be effective in preventing and improving muscle weakness and improving physical function and the health‐related quality of life in patients undergoing HD [14,20]. The results of various studies show that PA improves the complications of dialysis in these patients, including regulation of some laboratory parameters such as potassium, phosphate, calcium, urea and creatinine, hemoglobin, and blood pressure [21,22].…”