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

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 summarySF- 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.