Effectiveness of intradialytic exercise in improving physical functioning in patients with CKD

Abstract

Background: The decrease in physical functioning in patients suffering from advanced Chronic Kidney Disease (CKD) has been well documented. Although intradialytic (ID) exercise is not yet a routine part, many researchers expect it to be beneficial in improving the physical status of these patients. Research Question: “Is the implementation of intradialytic exercise effective in improving physical functioning in patients with Chronic Kidney Disease?” In relation to the PICO framework, the popula-tion (P) includes individuals suffering from CKD, the Intervention (I) is the implementation of ID exercise in comparison (C) to the absence of its execution and the desired outcome (O) is an improvement in physical functioning. Inclusion/Exclusion Criteria: Articles published in the last 10 years in English which included ≥10 male and/or female adult subjects (≥18 years) suffering from CKD and receiving haemodialysis (HD) treatment were selected. Trials including exercise that wasn’t carried out during HD were not in-cluded. Trials implementing ID exercise for <8 weeks were excluded. Studies investigating multimodal interventions whose effects interfered with distinguishing those achieved by the application of ID exercise were also excluded. Search Outcome: Five RCTs and Four Cohort Studies were eligible to the inclusion criteria. Quality Assessment: The Critical Appraisal Skills Programme tool was used to critically evaluate the methodol-ogy of each identified study. Ethical issues were also highlighted. Results: The findings of all the nine studies demonstrated an improvement in physical functioning among other outcomes following the implementation of ID exercise. Conclusions: Physical activity of an aerobic or resistive nature or a combination of both can be performed safely at any intensity during HD sessions. ID exercise is a feasible and beneficial practice which can mitigate to a significant extent the decrease in physical performance. Recommendations: Further large-scale, robustly designed controlled trials with long-term follow-up are needed to allow for more generalizability of findings. More awareness and education on the bene-fits of ID exercise for both patients and health-care professionals are needed locally and globally.