The optimal exercise modality and intensity for hemodialysis patients incorporating Bayesian network meta-analysis and systematic review

Abstract

Background: Physical inactivity is highly prevalent in patients with hemodialysis, and a large body of evidence reported the positive effect of different exercise modalities on their health outcomes. However, the effective dosage of exercise for hemodialysis patients still requires verification.Objective: We aimed to determine the most effective exercise intensity and modality for improvements in physical function, blood pressure control, dialysis adequacy, and health-related quality of life for hemodialysis patients.Design: Systematic review with network meta-analysis of randomized trials.Data sources: Five electronic databases (PubMed, EMBASE, Web of Science, Cochrane CENTRAL, and Scopus) were searched for randomized controlled trials. Data extraction and quality appraisal were conducted by two authors independently. Data were analyzed by the R (version.3.6.2) and the Stata (version.15.0).Result: We included 1893 patients involving four exercise modalities and six exercise intensities. Combined training (aerobic exercise plus resistance exercise) has been the top-ranking exercise modality for improving the 6-min walk test (6MWT) (surface under the cumulative ranking curve analysis (SUCRA) score, 90.63), systolic blood pressure control (SUCRA score, 77.35), and diastolic pressure control (SUCRA score, 90.56). Moreover, the top-ranking exercise intensity was moderate–vigorous for 6MWT (SUCRA score, 82.36), systolic blood pressure (SUCRA score, 77.43), and diastolic blood pressure (SUCRA score, 83.75). Regarding dialysis adequacy and health-related quality of life, we found no exercise modality or intensity superior to the placebo.Conclusion: This network meta-analysis indicated that combined training and moderate–vigorous intensity might be the most effective interventions to improve 6MWT and blood pressure control. This finding helps further guide clinical exercise prescriptions for hemodialysis patients.Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021268535].

Combined aerobic and resistance exercise in maintenance hemodialysis patients: A meta‐analysis

“…In the present study, SBP and DBP were statistically reduced by CARE. Based on the network meta‐analysis, CARE was the most effective modality for increasing blood pressure control in people who require MHD 25 . However, the effect of CARE on blood pressure should be interpreted with caution because the usage of antihypertensive drugs was not clear in the included RCTs.…”

“…Based on the network meta-analysis, CARE was the most effective modality for increasing blood pressure control in people who require MHD. 25 However, the effect of CARE on blood pressure should be interpreted with caution because the usage of antihypertensive drugs was not clear in the included RCTs. Considering that 90% of MHD patients take at least one antihypertensive drug, it is necessary to control potential confounder (e.g., the type and quantity of antihypertensive drug) when exploring the effect of exercise on blood pressure in future studies.…”

“…The most current meta‐analysis focused on the effect of aerobic and resistance exercises. Increasing number of studies have explored the effectiveness of CARE, but their conclusions are contradicting, which limits the implementation of this exercise modality 16–18,24–26 . Some studies pooled the effectiveness of intradialytic and non‐intradialytic exercises, which may increase heterogeneity 16,24 .…”

“…Increasing number of studies have explored the effectiveness of CARE, but their conclusions are contradicting, which limits the implementation of this exercise modality. [16][17][18][24][25][26] Some studies pooled the effectiveness of intradialytic and non-intradialytic exercises, which may increase heterogeneity. 16,24 Therefore, the present study aims to assess the effectiveness of CARE on physical function, aerobic capacity, dialysis adequacy, and HRQOL in MHD patients and further explore the effect of exercise conducted in intradialytic and non-intradialytic manner.…”

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

“…In contrast, network meta-analysis (NMA) can fill these gaps by synthesizing direct and indirect comparisons to evaluate various intervention forms and determine which is the most effective [20]. To date, three NMA have been conducted to compare the effects of different exercise types or intensities on cardiorespiratory fitness, walking capacity, dialysis adequacy, and blood pressure in MHD patients [12, 21, 22]. Although these published NMA compared the effect of UC, aerobic exercise (AE), resistance exercise (RE), combined aerobic and resistance exercise (CE), and other types of exercise, they grouped intradialytic and non-intradialytic exercises together, leaving it unclear which and when exercise is more effective for this population [12, 21, 22].…”