Table 1.

Exercise intervention studies in hemodialysis patients and predialysis patients

StudyDesignNo. of Patients (Mean Age [yr]±SD or Median)Type of TrainingIntensitySessions Duration (min)Frequency (times/wk)Duration (mo)Outcome
Within GroupBetween Group%
Hemodialysis
 Arterial stiffness
AIx
  Mustata et al. (27)Uncontrolled11 EX (55±4)Aerobic60%–80% heart rate peak602317±3 to 12.2±3aN/A−28
PWV (m/s)
  Toussaint et al. (28)Randomized crossover Bias risk: BGroup A n=10 (median age=70)ID cyclingNo target3033 EX versusGroup A: baseline versus EX9.04±0.59 versus 10.16±0.74b−11
Group B n=9 (median age=67)c3 non-EX10.4±3.1 versus 8.7±2.7 (NS)
Group B: EX versus non-EX
9.33±2.3 versus 10.5±3.6 (NS)
  Koh et al. (29)RCT15 ID EX (52±11)ID EX: ID cyclingRPE=12–1312036ID EX: 9.1±2.8 to 8.8±2.9 (P=NR)NS
Bias risk: A15 HB EX (52±14)HB EX: interdialytic walkingRPE=12–13453HB EX: 9.7±3.2 to 9.5±3.4 (P=NR)
16 untrained CON (51±14)CON: no specific interventionCON:8.7±2.5 to 9.2±3.5 (P=NR)
 Oxidative stress
  Wilund et al. (56)RCT8 EX (61±3)ID cyclingRPE=12–144534TBARS (µmol/L)
9 CON (59±5)EX: 9.5±1.55 to 5.9±1.05aa−38
CON: 7.2±0.7 to 6.9±1.31 (NS)
CRP (mg/L)
EX: 6.2±0.22 to 6.0±0.67 (NS)NS
CON:5.2±0.78 to 4.9±0.69 (NS)
IL-6 (pg/ml)
EX: 2.2±0.71 to 1.8±0.6 (NS)NS
CON: 2.9±0.93 to 2.5±0.44 (NS)
 Inflammation
  Afshar et al. (64)RCT14 EX (51±21)ID cyclingRPE=12–1410–3032CRP (mg/L)
14 CON (53±19)EX: 5.5±2.5 to 0.9±0.7bNR−83
CON: 4.05±3.97 to 4.10±3.90 (NS)
  Cheema et al. (66)RCT24 EX (60±15)ID resistanceRPE=15–1733Log CRP (effect size)
25 CON (65±13)EX: −0.08±0.37 (P=NR)aN/A
CON: +0.24±0.37 (P=NR)
  Kopple et al. (65)RCT10 END EX (46±4)END EX: ID cycling50% VO2peak4034.5CRP (mg/L)
Bias risk: C15 STR EX (46±3)STR EX: NDT resistance80% 5 RMEND EX: 4.5±1.5 to 2.5±0.6 (NS)NS
STR EX: 3.5±0.8 to 4.2±1.3 (NS)
COM EX: 4.6±1.4 to 5.8±2.1 (NS)
CON: 2.1±0.4 to 2.8±0.8 (NS)
Healthy CON: 2.5±0.7 to 3.6±1.4 (NS)
12 COM EX (43±4)COM EX: combined END/STRIL-6 (pg/ml)
14 CON (41±3)
20 healthy CON (42±3)END EX: 6.6±1.7 to 3.9±0.7 (NS)NS
STR EX: 5.7±1.3 to 4.7±1.2 (NS)
COM EX: 4.5±0.9 to 4.3±0.5 (NS)
CON: 3.8±0.8 to 3.6±0.8 (NS)
 EPCe-CFU (colonies/ml)
  Manfredini et al. (50)Nonrandomized control group14 EX (62±9)Walking two times per day50% maximum treadmill speed1076EX: 0.14±0.36 to 1.93±3.52ad+1278
8 CON (66±15)CON: 0.75±1.75 to 0.0±0.0 (NS)
EPC (cells/µl)
EX: 0.05±0.10 to 0.06±0.21 (NS)NS
CON: 0.0±0.0 to 0.04±0.08 (NS)
Predialysis
 Arterial stiffness
AIx (%)
  Mustata et al. (30)RCT10 EX (median age=64)Aerobic training40%–60% of VO2peak; RPE=12–155–60212EX: 29 to 27.5 (NR)b−11
  Stages 3–410 CON (median age=73)CON: 28.5 to 28 (NR)
 Oxidative stress
  Pechter et al. (55)Nonrandomized, self-selecting control group17 EX (52; range=31–72)Vertical aerobic aquatic exercise3023LPO (ng/ml)
  Stages 2–39 CON (48; range=35–65)EX: 1.51±0.23 to 0.99±0.11aNR−34
CON: 0.99±0.06 to 1.35±0.15 (NS)
Reduced glutathione (µM)
EX: 751.2±46.8 to 864.2±44.5aNR+15
CON: 869.1±44.3 to 607.9±123.6 (NS)
 Inflammation
CRP (mg/L)
  Leehey et al. (63)RCT7 EXAerobic trainingGuided by VO2peak30–4036EX: 5.5±7.2 to 8.9±9.2 (NS)NS
  Stages 2–4Bias risk: B4 CON (all subjects: mean age=66)CON: 17±24 to 11.7±7.1 (NS)
  Castaneda et al. (61)RCT14 EX (65±9)Resistance training80% 1 RM4533EX: 7.8 to 6.1 (NR)a−21
CON: 6.2 to 7.7 (NR)
  Stages 3–4Bias risk: A12 CON (64±12)IL-6 (pg/ml)
EX: 11.3 to 6.9a−39
CON: 7.7 to 10.0
  Headly et al. (62)RCT10 EX (58±12)Combined aerobic and resistance50%–60% VO2peak45312EX: 4.93±1.4 to 4.40±2.01 (NS)NS
CON: 5.05±2.1 to 5.42±1.84 (NS)
  Stages 2–411 CON (53±11)hs-CRP (mg/L)
EX: 1.74±1.61 to 1.58±1.85 (NS)NS
CON: 3.35±2.82 to 3.17±3.69 (NS)
  • Outcome is presented as within-group (pre- to postintervention unless stated otherwise) or between-group differences (EX versus CON, P value for interaction). Significant changes are presented as percentage changes versus baseline or control. For RCTs, estimations of total bias risk are presented as published in the meta-analysis by the Cochrane Collaboration (34): A, low risk; B, moderate/unclear risk; C, high risk. AIx, augmentation index; EX, exercise; N/A, not applicable; PWV, pulse wave velocity; ID, intradialytic; NS, not significant; RCT, randomized controlled trial; RPE, rating of perceived exertion; NR, not reported; HB, home based; CON, control; TBARS, thiobarbituric acid reactive substances; CRP, C-reactive protein; END, endurance; VO2peak, peak oxygen consumption; STR, strength; NDT, nondialysis time; RM, repetition maximum; COM, combined; EPC, endothelial progenitor cell; e-CFU, endothelial colony-forming unit; LPO, lipid peroxidation; hs-CRP, high-sensitivity CRP.

  • a P<0.05.

  • b P<0.01.

  • c Group A: exercise for 3 months, 1-month washout, and then no exercise for 3 months. Group B: no exercise for 3 months, 1-month washout, and then exercise for 3 months.

  • d P<0.001.