title: Exercise training in haemodialysis patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  We quantified baseline and observed change in peak VO(2) , quality of life, cardiac function, strength and energy intake following exercise training in haemodialysis patients and optimal exercise delivery for producing greatest adherence, safety and patient improvements.
  
  
  METHODS
  A systematic literature search was completed in August 2010 to identify randomized, controlled trials of exercise training studies in haemodialysis patients. A subsequent meta-analysis was conducted and the search repeated in December 2010.
  
  
  RESULTS
  Fifteen studies, yielding 565 patients were included. Baseline, peak VO(2) values were 70% of age-predicted values, exercise intervention patients improved post-training peak VO(2) to 88% predicted. Exercise training produced mean 26 ± 12% improvements in eight studies that reported peak VO(2) , mean difference 5.22 mL O(2) /kg per min (95% confidence interval 3.86, 6.59, P < 0.00001). Equivocal results for change in short-form 36 health questionnaire scores were reported post-training. Heart rate variability was improved after exercise training of normal to normal interval, mean difference 1634 milliseconds (95% confidence interval 8.3, 24.3, P < 0.0001). Significant improvements in lean body mass, quadriceps muscle area, knee extension, hip abduction and flexion strength were also reported (all P < 0.0001). Exercise training appears safe, with no deaths directly associated with exercise in 28 400 patient-hours and no differences in withdrawal rates between exercise and control participants, P = 0.98. Exercise training for 6 months or more conveyed larger improvements in peak VO(2) than shorter programmes. Data indicate about 25% of patients were excluded from exercise training studies for medical reasons.
  
  
  CONCLUSIONS
  Exercise training is safe and imparts large improvements in peak VO(2) , and heart rate variability.
authors.affiliation: Department of Exercise Science, University of New England, Armidale, Queensland, Australia. nsmart2@une.edu.au
authors.forename: Neil
authors.initials: N
authors.lastname: Smart
authors.forename: Michael
authors.initials: M
authors.lastname: Steele
mesh_terms: D002149:Energy Intake; D005081:Exercise Therapy / Q000009:adverse effects; D017079:Exercise Tolerance; D006339:Heart Rate; D006801:Humans; D007674:Kidney Diseases / Q000503:physiopathology / Q000628:therapy*; D053580:Muscle Strength; D010101:Oxygen Consumption; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left