Efficacy and safety of intradialytic exercise in haemodialysis patients: a systematic review and meta-analysis

Jiang Pu, Zheng Jiang, Weihua Wu, Li Li, Liling Zhang, Ying Li, Qi Liu, Santao Ou, Jiang Pu, Zheng Jiang, Weihua Wu, Li Li, Liling Zhang, Ying Li, Qi Liu, Santao Ou

Abstract

Objective: To assess the efficacy and safety of intradialytic exercise for haemodialysis patients.

Design: Systematic review and meta-analysis.

Data sources: Databases, including PubMed, Embase, the Cochrane Library, China Biology Medicine and China National Knowledge Infrastructure, were screened from inception to March 2017.

Eligibility criteria: Randomised controlled trials (RCTs) aimed at comparing the efficacy and safety of intradialytic exercise versus no exercise in adult patients on haemodialysis for at least 3 months. A minimum exercise programme period of 8 weeks.

Data extraction: Study characteristics and study quality domains were reviewed. Studies were selected, and data extracted by two reviewers.

Data analysis: The pooled risk ratios and mean differences (MDs) with 95% CIs for dichotomous data and continuous data were calculated, respectively.

Results: A total of 27 RCTs involving 1215 subjects were analysed. Compared with no exercise, intradialytic exercise increased dialysis adequacy (Kt/V) (MD 0.07, 95% CI 0.01 to 0.12, p=0.02) and maximum volume of oxygen that the body can use during physical exertion peak oxygen consumption (MD 4.11, 95% CI 2.94 to 5.27, p<0.0001), alleviated depression standardised mean difference (-1.16, 95% CI -1.86 to -0.45, p=0.001) and improved physical component summary-short form-36 (SF-36) level (MD 7.72, 95% CI 1.93 to 13.51, p=0.009). Also, intradialytic exercise could significantly reduce systolic blood pressure (MD -4.87, 95% CI -9.20 to -0.55, p=0.03) as well as diastolic blood pressure (MD -4.11, 95% CI -6.50 to -1.72, p=0.0007). However, intradialytic exercise could not improve mental component summary-SF-36 level (MD 3.05, 95% CI -1.47 to 7.57, p=0.19). There was no difference in the incidence of adverse events between the intradialytic exercise and control groups.

Conclusions: Intradialytic exercise resulted in benefits in terms of improving haemodialysis adequacy, exercise capacity, depression and quality of life for haemodialysis.

Keywords: haemodialysis; intradialytic exercise; meta-analysis; systematic review.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow diagram of studies considered for inclusion. CBM, China Biology Medicine; CNKI, China National Knowledge Infrastructure; RCT, randomised controlled trial.
Figure 2
Figure 2
Risk of bias summary.
Figure 3
Figure 3
Forest plot: effect of intradialytic exercise on Kt/V and VO2 peak. VO2 peak, peak oxygen consumption.
Figure 4
Figure 4
Forest plot: effect of intradialytic exercise on depression, PCS and MCS. MCS, mental component summary; PCS, physical component summary.
Figure 5
Figure 5
Forest plot of musculoskeletal complications.
Figure 6
Figure 6
Forest plot: effect of intradialytic exercise on Hb, Alb, cholesterol and phosphorus. Alb, albumin; Hb, haemoglobin.
Figure 7
Figure 7
Forest plot: effect of intradialytic exercise on SBP, DBP and 6MWD. DBP, diastolic blood pressure; SBP, systolic blood pressure; 6MWD, 6 min walk distance.

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