title: Intradialytic exercise in hemodialysis patients: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Hemodialysis (HD) patients are more inactive, leading to poor functional capacity and quality of life; this may be reversed with intradialytic exercise training. To systematically evaluate the efficacy and safety of intradialytic exercise for HD patients, we conducted a meta-analysis of the published randomized controlled trials.
  
  
  METHODS
  Medline, Embase, and Cochrane Central Register of Controlled Trials were systematically searched up to February, 2014. The reference lists of eligible studies and relevant reviews were also checked.
  
  
  RESULTS
  24 studies of 997 patients were included. Compared with control, intradialytic exercise significantly improve Kt/V (SMD = 0.27, 95% CI 0.01-0.53), peak oxygen consumption (VO(2peak)) (SMD = 0.53, 95% CI 0.30-0.76), and physical performance of physical function of life (SMD = 0.30, 95% CI 0.04-0.55). However, no significant improvements were found in the mental function of life. There was no significant difference with respect to musculoskeletal and cardiovascular complications between the intradialytic exercise groups and control groups. Further subgroup analysis found that, when the trial duration was more than 6 months, the intervention had significant effects on VO(2peak) (SMD = 0.89, 95% CI 0.56-1.22). However, when the trial duration was less than 6 months, the change of VO(2peak) was not significant (SMD = 0.19, 95% CI -0.13 to 0.51).
  
  
  CONCLUSIONS
  Intradialytic exercise can improve Kt/V, VO(2peak), and the physical quality of life, and intradialytic exercise is safe for HD patients. Therefore, we put forward the suggestion that clinical guideline be updated to inform clinicians on the benefits of intradialytic exercise on HD patients.
authors.affiliation: Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Kaixiang
authors.initials: K
authors.lastname: Sheng
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
authors.forename: Lili
authors.initials: L
authors.lastname: Chen
authors.forename: Jun
authors.initials: J
authors.lastname: Cheng
authors.forename: Congcong
authors.initials: C
authors.lastname: Wu
authors.forename: Jianghua
authors.initials: J
authors.lastname: Chen
mesh_terms: D000203:Activities of Daily Living; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010101:Oxygen Consumption; D011788:Quality of Life; D006435:Renal Dialysis / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome