Exercise Training in Elderly People Undergoing Hemodialysis: A Systematic Review and Meta-analysis

Abstract

IntroductionPrevious reviews have indicated the effectiveness of exercise in people undergoing hemodialysis. However, these analyses did not take into account whether the subjects were elderly. We performed a systematic review of the effects of exercise training in elderly people undergoing hemodialysis and updated the evidence of exercise for people undergoing hemodialysis by adding recent research data.MethodsWe searched 8 electronic databases up to June 2016. Inclusion criteria were as follows: randomized controlled trial, English publication, subjects aged 18 and older undergoing hemodialysis, evaluation of physical function as an outcome of exercise intervention. We defined elderly as age 60 years and older. The main outcomes were exercise tolerance (peak/maximum oxygen consumption) and walking ability (6-minute walk distance). Secondary outcomes were lower extremity muscle strength and quality of life.ResultsAfter screening of 10,923 references, 30 comparisons were entered into the analysis. However, because we found only 1 study in which elderly subjects were treated, we could not perform a meta-analysis for these people. For the general population undergoing hemodialysis, supervised exercise training was shown to significantly increase peak/maximum oxygen consumption (standard mean difference, 0.62; 95% confidence interval 0.38–0.87; P < 0.001), 6-minute walk distance (standard mean difference, 0.58; 95% confidence interval 0.24–0.93; P < 0.001), lower extremity muscle strength (standard mean difference, 0.94; 95% confidence interval 0.67–1.21; P < 0.001), and quality of life (standard mean difference, 0.53; 95% confidence interval 0.52–0.82; P < 0.001).DiscussionOur analysis on the effectiveness of exercise training in elderly people undergoing hemodialysis as compared with nonelderly people was somewhat inconclusive. Future studies should be carried out for elderly people to identify the most favorable exercise program for this population.

The role of exercise in improving patient‐reported outcomes in individuals on dialysis: A scoping review

“…Once the full text of those articles was screened, 25 RCTs (1.8% of those identified by the search process) met all inclusion criteria . We also included five systematic reviews for our review of generic HRQOL …”

“…Another meta‐analysis of RCTs implementing intradialytic exercise demonstrated a significant improvement in physical subcomponents (SMD 0.3 95% CI 0.04‐0.55) of generic HRQOL questionnaires but no significant difference in the mental component . Similarly, a meta‐analysis of any exercise in individuals on HD demonstrated a significant improvement in physical component summary score of the SF36/KDQOL (SMD 0.53 (95% CI, 0.52‐0.82) . However, this improvement was not seen in elderly HD patients (only one study included).…”

Utility of Regular Management of Physical Activity and Physical Function in Hemodialysis Patients

“…Frailty among hemodialysis patients is primary characterized by physical inactivity and poor physical performance. A comprehensive meta-analysis showed that physical exercise interventions improved physical function, including muscle strength and aerobic capacity, in hemodialysis patients [14,16]. Furthermore, wearing a pedometer, setting activity goals, use of a step diary (self-monitoring), and feedback from medical staff were shown to increase physical activity by providing motivation, reaching approximately 1000 steps per day, in hemodialysis patients [29].…”

“…Furthermore, more than 70% of elderly patients treated with chronic hemodialysis are classified as frail [7,8]. Although physical inactivity and decreased physical function in hemodialysis patients are associated with adverse outcomes, including mortality and hospitalization, [9][10][11][12][13] these are potentially modifiable conditions [14][15][16]. Early identification and interventions for conditions of frailty are essential to implement effective disease management strategies.…”

Impact of Intradialytic Rehabilitation Program on General Health of Chronic Kidney Disease Patients

“…The lack of physical activity has been directly linked to numerous negative health concerns such as: Obesity, High blood pressure, Lower quality of life, Musculoskeletal problems, such as low back pain and muscle tightness [13,14,15].…”