Intradialytic Rehabilitation and Functional Independence in Hemodialysis Patients

Effects of Intradialytic Dynamic Lumbar Stabilization Exercises and Inspiratory Muscle Training on Functional Independence in Patients Undergoing Maintenance Hemodialysis

This study evaluated whether a rehabilitation program performed during hemodialysis sessions could improve daily functioning and mobility in adults receiving maintenance hemodialysis. Participants took part in either exercise-based rehabilitation, breathing muscle training, or usual care. The study compared changes in functional independence and mobility before and after the rehabilitation period.

Study Overview

• Status: Completed
• Conditions: Hemodialysis; Chronic Kidney Disease (Stages 4 and 5)
• Intervention / Treatment: Behavioral: Dynamic Lumbar Stabilization Exercises; Behavioral: Respiratory Muscle Training

Detailed Description

This academic clinical study was conducted in two dialysis centers in Istanbul between June 2016 and March 2017. Adults undergoing maintenance hemodialysis were allocated to one of three groups: dynamic lumbar stabilization exercises, inspiratory muscle training, or a control group receiving routine nephrological care.

Participants in the intervention groups completed a supervised intradialytic rehabilitation program three times per week for 10 weeks. Functional independence and mobility-related performance were assessed at baseline and after completion of the intervention using validated functional assessment measures. The study was conducted as part of a doctoral thesis and is being retrospectively registered for transparency.

• Study Type: Interventional
• Enrollment (Actual): 56
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adults aged 25 to 45 years.
• Diagnosis of chronic kidney disease undergoing maintenance hemodialysis.
• Receiving hemodialysis for at least 6 months.
• Hemodialysis schedule of three sessions per week, four hours per session.
• Clinically stable at the time of enrollment.
• Ability to participate in exercise and functional assessments.
• Provided written informed consent.

Exclusion Criteria:

• Acute medical conditions or unstable cardiovascular disease.
• Severe musculoskeletal, neurological, or orthopedic disorders limiting exercise participation.
• Severe cognitive impairment or inability to follow instructions.
• Uncontrolled hypertension or other conditions contraindicating exercise.
• Participation in another structured exercise or rehabilitation program during the study period.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Dynamic Lumbar Stabilization Exercise (DLSE); Participants received a supervised intradialytic dynamic lumbar stabilization exercise program three times per week for 10 weeks in addition to usual care.	Behavioral: Dynamic Lumbar Stabilization Exercises; A structured intradialytic exercise program focusing on trunk stabilization and neuromuscular control, performed under supervision during hemodialysis sessions.
Experimental: Respiratory Muscle Training (RMT); Participants received supervised respiratory muscle training during hemodialysis sessions three times per week for 10 weeks in addition to usual care.	Behavioral: Respiratory Muscle Training; Respiratory muscle training performed during hemodialysis using threshold-based breathing exercises under supervision.
No Intervention: Control Group; Participants received routine nephrological care during hemodialysis without additional exercise or rehabilitation interventions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Six-Minute Walk Test	Functional exercise capacity assessed as the distance walked in six minutes, measured according to standardized procedures.	Baseline and after 10 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Timed Up and Go Test (TUG)	Functional mobility assessed by the time required to stand up from a chair, walk three meters, turn, walk back, and sit down.	Baseline and after 10 weeks
Five Times Sit-to-Stand Test (5STS)	Lower extremity functional performance assessed as the time required to complete five consecutive sit-to-stand movements.	Baseline and after 10 weeks
Maximal Inspiratory Pressure (MIP)	Inspiratory muscle strength measured as maximal inspiratory pressure using standardized respiratory pressure measurement techniques.	Baseline and after 10 weeks
Maximal Expiratory Pressure (MEP)	Expiratory muscle strength measured as maximal expiratory pressure using standardized respiratory pressure measurement techniques.	Baseline and after 10 weeks
Forced Vital Capacity (FVC)	Pulmonary function assessed as forced vital capacity measured by spirometry according to standard guidelines.	Baseline and after 10 weeks
Forced Expiratory Volume in 1 Second (FEV1)	Pulmonary function assessed as forced expiratory volume in one second measured by spirometry according to standard guidelines.	Baseline and after 10 weeks

Collaborators and Investigators

• Sponsor: Bandırma Onyedi Eylül University
• Investigators: Principal Investigator: Serpil Çolak, PT, PhD, Bandırma Onyedi Eylül University; Study Director: Candan Z Algun, PT, PhD, Medipol University; Study Chair: Gürkan Yurteri, MD, Rentek Diyaliz Merkezi

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2016
• Primary Completion (Actual): March 1, 2017
• Study Completion (Actual): June 1, 2017

Study Registration Dates

• First Submitted: February 24, 2026
• First Submitted That Met QC Criteria: February 24, 2026
• First Posted (Actual): March 2, 2026

Study Record Updates

• Last Update Posted (Actual): March 2, 2026
• Last Update Submitted That Met QC Criteria: February 24, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: rehabilitation; mobility; inspiratory muscle training; core stabilization; functional independence; intradialytic exercise
• Additional Relevant MeSH Terms: Urogenital Diseases; Pathologic Processes; Male Urogenital Diseases; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Chronic Disease; Disease Attributes; Renal Insufficiency; Pathological Conditions, Signs and Symptoms; Renal Insufficiency, Chronic; Therapeutics; Mind-Body Therapies; Complementary Therapies; Exercise Movement Techniques; Physical Therapy Modalities; Breathing Exercises
• Other Study ID Numbers: HD-REHAB-2012

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared because the study was conducted as part of an academic thesis and no data sharing plan was included in the original ethics approval.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No