Intradialytic exercise in end-stage renal disease: An umbrella review of systematic reviews and/or meta-analytical studies

Abstract

Objectives: This umbrella review aimed to understand the clinical benefits and adverse events associated with different modalities of intradialytic exercise in patients with end-stage renal disease undergoing hemodialysis. Data Sources: The search was performed until September 10th, 2020 on Scopus, Web of Science, the Cochrane Database, CINAHL, and PubMed. Methods: This umbrella review was conducted following the PRISMA guideline statement. The methodological quality of the reviews was assessed with the AMSTAR-2. Standardized mean differences with 95% confidence intervals were estimated. The I-squared statistic was used to assess heterogeneity and the Eggers’ test was performed to test asymmetry/small-study effects. Results: Eleven reviews were included and 48 unique meta-analyses were examined. Nine were supported by suggestive evidence ( P < 0.05, small heterogeneity, absence of small-study effects, and excess significance bias). Clinical benefits were found for functional capacity associated with aerobic exercise ( d = 0.81; k = 6), resistance training ( d = 0.58; k = 6), neuromuscular electrical stimulation ( d = 0.70; k = 5), and inspiratory muscle training ( d = 1.13; k = 2), measured by the distance covered in the 6-minutes walking test. This outcome was also associated with aerobic exercise ( d = 0.28; k = 7) and combined exercise, measured by VO2peak ( d = 1.01; k = 5) and by the duration of the cardiopulmonary test ( d = 1.07; k = 4). Isometric quadriceps muscle strength improved with neuromuscular electrical stimulation ( d = 1.19; k = 7) while patients’ perception of vitality improved with combined exercise ( d = 0.60; k = 3). Conclusions: Suggestive evidence was found for the associations between various modalities of intradialytic exercise and functional capacity. Combined exercise was associated with improvements in physical and psychosocial variables. Few or no adverse events were reported.

Profile of professionals working in intradialytic exercise programs in Brazil: a national survey

“…Resistance training was the most commonly prescribed mode of therapy. Considering the data from clinical trials and meta-analyses about IET, aerobic exercises are preferentially prescribed 1 , 4 , 6 . The greater use of resistance training in Brazil is possibly due to the lower cost of exercise equipment and the relative simplicity of training protocols.…”

“…intradialytic exercise training (IET) has been recommended to patients with chronic kidney disease on hemodialysis [1][2][3][4] . Previous studies found that IET leads to lower blood pressure levels and improvements in functional capacity, anemia, muscle strength, muscle oxidative metabolism, and quality of life 2,3,5 .…”

Nurses' and medical doctors' attitudes towards exercise for people with chronic kidney disease in Denmark

“…The Australian data were published in 2016 (Bennett et al, 2016) and there was a minimum of 5 years between the two studies. During that period there has been an increased focus on exercise training to people on dialysis in research and in clinical practice among the staffs' perception of knowledge about effects of exercise training (Martínez‐Majolero et al, 2022), the evidence of exercise training effects (Andrade et al, 2019; Bündchen et al, 2021; Ferrari et al, 2020) and implementation of exercise training interventions (Clarke et al, 2019). During the same period there has been an increased focus on exercise training among the people with CKD and their relatives.…”

“…In addition, there are positive effects of exercise training on physical function related to daily activities (Gomes Neto et al, 2018; Molsted et al, 2019; Sheng et al, 2014), insulin resistance (Molsted et al, 2013) and mortality (Greenwood et al, 2019). Recent systematic reviews have also shown that intradialytic exercise programmes have positive effects on aerobic capacity and other outcomes, and that a combination of aerobic and strength training may have a more positive effect than aerobic training alone on aerobic capacity (Andrade et al, 2019; Bündchen et al, 2021; Ferrari et al, 2020). Recent studies have also presented positive results of exercise training to patients CKD without the need for dialysis (Shlipak et al, 2022; Watson et al, 2022; Yamamoto et al, 2021).…”

Association between the transtheoretical model approach and sustained intradialytic pedaling exercise

“…Patients treated with dialysis are less active than healthy sedentary individuals [3] and their physical inactivity is strongly associated with mortality. [4,5] Meta-analyses suggest that intradialytic exercise, which is commonly provided for patients receiving dialysis, [6] can improve hemodialysis (HD) efficacy, [7,8] exercise capacity, [7][8][9][10][11][12] blood pressure, [8] and quality of life. [7][8][9][10] The Kidney Disease Outcomes Quality Initiative guidelines for patients on dialysis recommend that "the goal for activity should be for cardiovascular exercise at a moderate intensity for 30 minutes most, if not all, days per week."…”