title: Effect of intra-dialytic, low-intensity strength training on functional capacity in adult haemodialysis patients: a randomized pilot trial.
abstract: BACKGROUND
  Kidney failure is associated with muscle wasting and physical impairment. Moderate- to high-intensity strength training improves physical performance, nutritional status and quality of life in people with chronic kidney disease and in dialysis patients. However, the effect of low-intensity strength training has not been well documented, thus representing the objective of this pilot study.
  
  
  METHODS
  Fifty participants (mean +/- SD, age 69 +/- 13 years) receiving long-term haemodialysis (3.7 +/- 4.2 years) were randomized to intra-dialytic low-intensity strength training or stretching (attention-control) exercises twice weekly for a total of 48 exercise sessions. The primary study outcome was physical performance assessed by the Short Physical Performance Battery score (SPPB) after 36 sessions, if available, or carried forward from 24 sessions. Secondary outcomes included lower body strength, body composition and quality of life. Measurements were obtained at baseline and at completion of 24 (mid), 36 (post) and 48 (final) exercise sessions.
  
  
  RESULTS
  Baseline median (IQR) SPPB score was 6.0 (5.0), with 57% of the participants having SPPB scores below 7. Exercise adherence was 89 +/- 15%. The primary outcome could be computed in 44 participants. SPPB improved in the strength training group compared to the attention-control group [21.1% (43.1%) vs. 0.2% (38.4%), respectively, P = 0.03]. Similarly, strength training participants exhibited significant improvements from baseline compared to the control group in knee extensor strength, leisure-time physical activity and self-reported physical function and activities of daily living (ADL) disability; all P < 0.02. Adverse events were common but not related to study participation.
  
  
  CONCLUSIONS
  Intra-dialytic, low-intensity progressive strength training was safe and effective among maintenance dialysis patients. Further studies are needed to establish the generalizability of this strength training program in dialysis patients.
authors.affiliation: The Renal Section, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Joline L T
authors.initials: JL
authors.lastname: Chen
authors.forename: Susan
authors.initials: S
authors.lastname: Godfrey
authors.forename: Tan Tan
authors.initials: TT
authors.lastname: Ng
authors.forename: Ranjani
authors.initials: R
authors.lastname: Moorthi
authors.forename: Orfeas
authors.initials: O
authors.lastname: Liangos
authors.forename: Robin
authors.initials: R
authors.lastname: Ruthazer
authors.forename: Bertrand L
authors.initials: BL
authors.lastname: Jaber
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.forename: Carmen
authors.initials: C
authors.lastname: Castaneda-Sceppa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001823:Body Composition; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D011788:Quality of Life; D006435:Renal Dialysis; D055070:Resistance Training / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome