Exercise training for adults undergoing maintenance dialysis

Bernier-Jean, Amélie; Beruni, Nadim A; Bondonno, Nicola P.; Williams, Gabrielle; Teixeira‐Pinto, Armando; Craig, Jonathan C.; Wong, Germaine

doi:10.1002/14651858.cd014653

Cited by 28 publications

(31 citation statements)

References 211 publications

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“…Given that the minimal clinically important difference for the 6MWT in similar patients is between 14.0 and 30.5 m [37, 38], we estimated the effect size to be moderate to large, with a moderate level of confidence in the evidence. The findings partially align with a published Cochrane meta-analysis [39], which indicated that the pooled effect of all exercise types on the 6MWT was an improvement of 49.91 m for the same population. However, our NMA offers additional insights by ranking different exercise types [13, 28, 39], showing that IAE combined with BFR is likely the most effective intervention for improving the 6MWT.…”

Section: Discussionsupporting

confidence: 87%

Effects of Different Exercises on Physical Function, Dialysis Adequacy, and Health-Related Quality of Life in Maintenance Hemodialysis Patients: A Systematic Review and Network Meta-Analysis

Hu¹,

Wu²,

Kwok³

et al. 2023

Am J Nephrol

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Background: Clinical guidelines recommend exercise training for patients undergoing maintenance hemodialysis (MHD). However, the effectiveness of different types of exercise remains uncertain. Objectives: To compare and rank the effect of different types of exercise on walking capacity, cardiorespiratory fitness, dialysis adequacy, and health-related quality of life (HRQOL) in patients undergoing MHD. Methods: Eight databases (four English and four Chinese) were searched from inception to January 1, 2022. Randomized controlled trials evaluating the efficacy of different exercises for patients undergoing MHD were included. Two independent reviewers screened the literature, extracted data, assessed the risk of bias, and evaluated the certainty of evidence. A frequentist random-effect network meta-analysis was conducted. Results: Ninety trials with 4,084 participants comparing 15 types of exercise were included, reporting on the six-minute walking test (45 trials), peak oxygen uptake (22 trials), dialysis adequacy (30 trials), and HRQOL (23 trials). Network meta-analysis showed that the most effective intervention for walking capacity was intradialytic aerobic exercise combined with blood flow restriction with a mean difference and 95% confidence interval of 97.35 [11.89-182.81], for peak oxygen uptake it was non-intradialytic combined aerobic and resistance exercise (4.35 [2.25-6.44]), for dialysis adequacy it was intradialytic combined aerobic and resistance exercise (0.17 [0.06-0.28]), for the physical component summary of HRQOL it was intradialytic aerobic exercise (4.93 [2.31-7.54]), and for the mental component summary of HRQOL it was non-intradialytic combined aerobic and resistance exercise (6.36 [0.45-12.27]). Ultimately, intradialytic combined aerobic and resistance exercise could improve all the above outcomes compared to usual care. Conclusions: This study concluded that intradialytic combined aerobic and resistance exercise is optimal for MHD patients due to its significant positive effects on multiple outcomes. Walking capacity can be further enhanced by combining blood flow restriction with exercise. For improving dialysis adequacy, intradialytic exercise proves to be more effective than non-intradialytic exercise. Further well-designed clinical trials are needed to investigate the effects of exercise with varying durations, intensities, and frequencies.

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Section: Discussionsupporting

confidence: 87%

Effects of Different Exercises on Physical Function, Dialysis Adequacy, and Health-Related Quality of Life in Maintenance Hemodialysis Patients: A Systematic Review and Network Meta-Analysis

Hu¹,

Wu²,

Kwok³

et al. 2023

Am J Nephrol

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“…This study showed that exercise and social support are significant factors that reduce depressive symptoms and should be considered in the care of patients undergoing HD. Regular exercise or habitual physical activity is a fundamental part of living [34][35][36][37]. HCPs, particularly team members of rehabilitation, should help patients discover a suitable mode of exercise and provide guidance for home exercise.…”

Section: Limitations and Future Directionmentioning

confidence: 99%

Hierarchical multiple regression investigating factors associated with depressive symptoms in the middle-aged and elderly undergoing haemodialysis

Chang

Bai²,

Lai³

et al. 2023

BMC Public Health

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Background Depressive moods are commonly seen in patients who receive haemodialysis. This can cause a lack of compliance in their treatment procedures and increase the rate of hospitalization. This study aimed to investigate the relationship between social support and degree of depression in middle-aged and elderly patients undergoing haemodialysis and the predictors of depressive symptoms. Methods A cross-sectional correlational study was designed with a structured questionnaire survey. Patients over 40 years of age were included from five haemodialysis centres. Measures embraced a demographic and clinical characteristics questionnaire, the Centre for Epidemiologic Studies Depression Scale, and the Personal Resource Questionnaire 2000. Statistical analysis was performed using hierarchical multiple regression analysis. Results A total of 179 patients over 40 years of age were included from five haemodialysis centres in the analysis. The mean CES-D score was 19.0(12.3); the majority of participants (60.3%) had a CES-D score ≥ 15, indicating likely depressive status. The mean PRQ2000 score was 75.7(15.9). The proportional mean of the PRQ2000 was 72.11%, indicating moderate social support for participants in this study. Data disclosed that marital status, number of comorbidities, exercise behaviour, and social support could significantly predict depressive symptoms; total explanatory variance was 31.3%. Conclusion Health care professionals should identify those at high risk of depressive symptoms when they provide care to the middle-aged and elderly patients undergoing haemodialysis. These findings may lead to greater insights into the nursing and rehabilitative care of patients treated by chronic maintenance haemodialysis.

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“…Intradialytic aerobic exercise improves physical function and health-related quality of life and may ameliorate several dialysis-related symptoms. 1 , 2 , 3 , 4 , 5 , 6 , 7 Studies have demonstrated decreased cardiac stunning and improved cardiac structure and function with intradialytic aerobic exercise. 8 , 9 , 10 , 11 , 12 Findings from multiple interventional studies do not support an increased risk of IDH with intradialytic exercise because of postexercise reductions in BP.…”

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confidence: 99%

A Randomized Trial Examining the Impact of Timing of Intradialytic Cycling on Intradialytic Hypotension

Rossum¹,

Hancock²,

Thompson³

et al. 2023

Kidney International Reports

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Exercise training for adults undergoing maintenance dialysis

Cited by 28 publications

References 211 publications

Effects of Different Exercises on Physical Function, Dialysis Adequacy, and Health-Related Quality of Life in Maintenance Hemodialysis Patients: A Systematic Review and Network Meta-Analysis

Effects of Different Exercises on Physical Function, Dialysis Adequacy, and Health-Related Quality of Life in Maintenance Hemodialysis Patients: A Systematic Review and Network Meta-Analysis

Hierarchical multiple regression investigating factors associated with depressive symptoms in the middle-aged and elderly undergoing haemodialysis

A Randomized Trial Examining the Impact of Timing of Intradialytic Cycling on Intradialytic Hypotension

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