Table 1.

Exercise intervention studies in hemodialysis patients and predialysis patients

Study	Design	No. of Patients (Mean Age [yr]±SD or Median)	Type of Training	Intensity	Sessions Duration (min)	Frequency (times/wk)	Duration (mo)	Outcome
Study	Design	No. of Patients (Mean Age [yr]±SD or Median)	Type of Training	Intensity	Sessions Duration (min)	Frequency (times/wk)	Duration (mo)	Within Group	Between Group	%
Hemodialysis
Arterial stiffness
								AIx
Mustata et al. (27)	Uncontrolled	11 EX (55±4)	Aerobic	60%–80% heart rate peak	60	2	3	17±3 to 12.2±3^a	N/A	−28
								PWV (m/s)
Toussaint et al. (28)	Randomized crossover Bias risk: B	Group A n=10 (median age=70)	ID cycling	No target	30	3	3 EX versus	Group A: baseline versus EX	9.04±0.59 versus 10.16±0.74^b	−11
		Group B n=9 (median age=67)^c					3 non-EX	10.4±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)	RCT	15 ID EX (52±11)	ID EX: ID cycling	RPE=12–13	120	3	6	ID EX: 9.1±2.8 to 8.8±2.9 (P=NR)	NS
	Bias risk: A	15 HB EX (52±14)	HB EX: interdialytic walking	RPE=12–13	45	3		HB EX: 9.7±3.2 to 9.5±3.4 (P=NR)
	Bias risk: A	16 untrained CON (51±14)	CON: no specific intervention	RPE=12–13	45	3		CON:8.7±2.5 to 9.2±3.5 (P=NR)
Oxidative stress
Wilund et al. (56)	RCT	8 EX (61±3)	ID cycling	RPE=12–14	45	3	4	TBARS (µmol/L)
		9 CON (59±5)						EX: 9.5±1.55 to 5.9±1.05^a	^a	−38
								CON: 7.2±0.7 to 6.9±1.31 (NS)	^a	−38
								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)	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)	NS
Inflammation
Afshar et al. (64)	RCT	14 EX (51±21)	ID cycling	RPE=12–14	10–30	3	2	CRP (mg/L)
		14 CON (53±19)						EX: 5.5±2.5 to 0.9±0.7^b	NR	−83
		14 CON (53±19)						CON: 4.05±3.97 to 4.10±3.90 (NS)	NR	−83
Cheema et al. (66)	RCT	24 EX (60±15)	ID resistance	RPE=15–17		3	3	Log CRP (effect size)
		25 CON (65±13)						EX: −0.08±0.37 (P=NR)	^a	N/A
								CON: +0.24±0.37 (P=NR)	^a	N/A
Kopple et al. (65)	RCT	10 END EX (46±4)	END EX: ID cycling	50% VO₂peak	40	3	4.5	CRP (mg/L)
	Bias risk: C	15 STR EX (46±3)	STR EX: NDT resistance	80% 5 RM				END 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/STR					IL-6 (pg/ml)
		14 CON (41±3)						IL-6 (pg/ml)
		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)
EPC								e-CFU (colonies/ml)
Manfredini et al. (50)	Nonrandomized control group	14 EX (62±9)	Walking two times per day	50% maximum treadmill speed	10	7	6	EX: 0.14±0.36 to 1.93±3.52^a	^d	+1278
		8 CON (66±15)						CON: 0.75±1.75 to 0.0±0.0 (NS)	^d	+1278
								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)	NS
Predialysis
Arterial stiffness
								AIx (%)
Mustata et al. (30)	RCT	10 EX (median age=64)	Aerobic training	40%–60% of VO₂peak; RPE=12–15	5–60	2	12	EX: 29 to 27.5 (NR)	^b	−11
Stages 3–4	RCT	10 CON (median age=73)	Aerobic training	40%–60% of VO₂peak; RPE=12–15	5–60	2	12	CON: 28.5 to 28 (NR)	^b	−11
Oxidative stress
Pechter et al. (55)	Nonrandomized, self-selecting control group	17 EX (52; range=31–72)	Vertical aerobic aquatic exercise		30	2	3	LPO (ng/ml)
Stages 2–3		9 CON (48; range=35–65)						EX: 1.51±0.23 to 0.99±0.11^a	NR	−34
								CON: 0.99±0.06 to 1.35±0.15 (NS)	NR	−34
								Reduced glutathione (µM)
								EX: 751.2±46.8 to 864.2±44.5^a	NR	+15
								CON: 869.1±44.3 to 607.9±123.6 (NS)	NR	+15
Inflammation
								CRP (mg/L)
Leehey et al. (63)	RCT	7 EX	Aerobic training	Guided by VO₂peak	30–40	3	6	EX: 5.5±7.2 to 8.9±9.2 (NS)	NS
Stages 2–4	Bias risk: B	4 CON (all subjects: mean age=66)	Aerobic training	Guided by VO₂peak	30–40	3	6	CON: 17±24 to 11.7±7.1 (NS)	NS
Castaneda et al. (61)	RCT	14 EX (65±9)	Resistance training	80% 1 RM	45	3	3	EX: 7.8 to 6.1 (NR)	^a	−21
Castaneda et al. (61)	RCT	14 EX (65±9)						CON: 6.2 to 7.7 (NR)	^a	−21
Stages 3–4	Bias risk: A	12 CON (64±12)						IL-6 (pg/ml)
								EX: 11.3 to 6.9	^a	−39
								CON: 7.7 to 10.0	^a	−39
Headly et al. (62)	RCT	10 EX (58±12)	Combined aerobic and resistance	50%–60% VO₂peak	45	3	12	EX: 4.93±1.4 to 4.40±2.01 (NS)	NS
Headly et al. (62)		10 EX (58±12)						CON: 5.05±2.1 to 5.42±1.84 (NS)	NS
Stages 2–4		11 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)	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.