A BERNIER-JEAN1, N A BERUNI2, N P BONDONNO3,4, G WILLIAMS1, A TEIXEIRA-PINTO1, J CRAIG5, G WONG1
1School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia, 2Resident Support Unit, Western Sydney Local Health District, Westmead, Australia, 3The University of Western Australia, Royal Perth Hospital, Perth, Australia, 4School of Medical and Health Sciences, Edith Cowan University, Perth, Australia, 5College of Medicine and Public Health, Flinders University, Adelaide, Australia
Aim: To assess the potential for exercise training to improve outcomes in adults undergoing dialysis.
Background: Uncertainties exist in the relevance and sustainable benefits of exercise training for adults undergoing dialysis.
Methods: We conducted a systematic search of the Cochrane Kidney and Transplant Specialised Register for randomised controlled trials of structured exercise programs of eight weeks or more in adults undergoing maintenance dialysis (hemodialysis or peritoneal dialysis) compared to no exercise or sham exercise. Two authors independently assessed the trials for eligibility, extracted the data and assessed the risk of bias. We conducted random-effects meta-analyses.
Results: We identified 93 studies involving 4634 participants. The interventions lasted from 8 weeks to 2 years and most often took place thrice weekly during hemodialysis treatments. Overall, the quality of the included studies was low.
In adults undergoing dialysis, compared with no or sham exercise, exercise training may improve fatigue, the physical component of health-related quality of life (HR-QoL)(MD=4.5, 95% CI 2.2 to 6.8 points/100: low certainty evidence), depression (SMD=0.73, 95% CI 0.39 to 1.07: moderate certainty evidence), pain (MD=6.1 95% CI 0.5 to 11.7 points on a 100-points scale: low certainty evidence), functional capacity on the 6 Minutes-Walk Test (MD=49.9 meters, 95% CI 37.2 to 62.6; moderate certainty evidence) and the Sit-To-Stand test (MD=2.4 cycles, 95% CI 1.8 to 3.1; moderate certainty evidence).
We could not conclude for mortality, cardiovascular events, the mental component of HR-QoL, blood pressure and the safety of exercise training for adults undergoing dialysis.
Conclusions: In adults undergoing maintenance dialysis, exercise training is likely to improve depressive symptoms and functional capacity and may improve fatigue, the physical component of quality of life and pain.
Amelie Bernier-Jean is a Canadian nephrologist with a Master of Clinical Epidemiology from the University of Sydney. She is soon to complete a PhD on the epidemiology of lifestyle factors in chronic kidney disease at the Sydney School of Public Health, for which she was awarded an NHMRC Post-Graduate Scholarship.