Exercise training in haemodialysis patients: A systematic review and meta-analysis

Fifteen studies, yielding 565 patients were included. Baseline, peak VO₂ values were 70% of age-predicted values, exercise intervention patients improved post-training peak VO₂ to 88% predicted. Exercise training produced mean 26 ± 12% improvements in eight studies that reported peak VO₂, mean difference 5.22 mL O₂/kg per min (95% confidence interval 3.86, 6.59, P < 0.00001). Equivocal results for change in short-form 36 health questionnaire scores were reported post-training. Heart rate variability was improved after exercise training of normal to normal interval, mean difference 1634 milliseconds (95% confidence interval 8.3, 24.3, P < 0.0001). Significant improvements in lean body mass, quadriceps muscle area, knee extension, hip abduction and flexion strength were also reported (all P < 0.0001). Exercise training appears safe, with no deaths directly associated with exercise in 28 400 patient-hours and no differences in withdrawal rates between exercise and control participants, P = 0.98. Exercise training for 6 months or more conveyed larger improvements in peak VO₂ than shorter programmes. Data indicate about 25% of patients were excluded from exercise training studies for medical reasons.