# The effect of intradialytic resistance exercise on physical function and dialysis adequacy in patients on maintenance hemodialysis

## TL;DR

This study shows that resistance exercise during hemodialysis improves physical function, cardiovascular health, and dialysis effectiveness in patients.

## Contribution

The study demonstrates the safety and effectiveness of intradialytic resistance training in improving multiple health outcomes for hemodialysis patients.

## Key findings

- Six-minute walk test distance improved significantly by 26.4 meters after three months of intradialytic resistance exercise.
- Blood pressure decreased during dialysis, and dialysis adequacy markers like creatinine and urea reduction ratios increased significantly.
- Nutritional status improved, with fewer patients at risk of malnutrition and healthier BMI ranges observed.

## Abstract

Chronic kidney disease poses a growing global health concern and is linked to several complications with higher prevalence and intensity in the hemodialysis (HD) population. These complications contribute to high morbidity and mortality and are associated with poor physical function, and poor quality of life. Intradialytic exercise has emerged as a promising strategy to improve HD patients’ clinically relevant outcomes.

Assess the effect of intradialytic exercise on the functional and metabolic status of patients undergoing HD, and on their physical performance and evaluate its safety and feasibility.

This was a pre-experimental clinical trial conducted between February and August 2024, including adult patients on maintenance HD at Sahloul University Hospital. Patients underwent a supervised intradialytic resistance training twice or three times a week, over a period of 12 weeks.. Dialysis adequacy parameters, physical function, cardiovascular parameters, as well as patients’ nutritional status were assessed before and after the intervention.

Our study included 21 patient with a female predominance (76.2%). The population’s mean age was 44.5 ± 10.4 years. A total of five patients (23.8%) received hemodialysis twice a week, while the remaining 16 patients underwent dialysis three times a week. Over the three-month intervention, the six minutes walk test distance improved significantly with a mean paired difference of 26.4 m (p = 0.007). As for cardiovascular parameters we noted that intradialytic blood pressure decreased from 121.7 mmHg to 112 mmHg (p = 0.03). Dialysis adequacy markers also showed significant increases in creatinine reduction ratio (p = 0.04) and Urea Reduction Ratio (p = 0.04). Furthermore nutritional status showed fewer patients at risk of malnutrition and BMI shifted toward healthier ranges.

Our study results suggest that three months of intradialytic resistance exercise safely improved HD patients’ care including cardiovascular state, physical function and adequacy parameters. Further research especially combining resistance and aerobic exercise is needed to expand and generalize these results.

The trial was retrospectively registered with the Pan African Clinical Trial Registry (PACTR202506776186443).