The Effect of Exercise Therapy on Physical Function, Biochemistry and Dialysis Adequacy in Haemodialysis Patients: A Systematic Review and Meta-Analysis — Oak Academic Publishing
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The Effect of Exercise Therapy on Physical Function, Biochemistry and Dialysis Adequacy in Haemodialysis Patients: A Systematic Review and Meta-Analysis
Department of Exercise Science, University of New England, Armidale, Australia.
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Department of Exercise Science, University of New England, Armidale, Australia.
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Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium.
1 Department of Exercise Science, University of New England, Armidale, Australia.
2 Department of Exercise Science, University of New England, Armidale, Australia.
3 Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium.
Background : Patients undergoing dialysis have high mortality rate s and a unique risk factor profile. Som e improvements elicited by exercise training have been shown in dialysis populations, here we aimed to further explore the bene-fits of exercise. As well as changes in physical fitness we quantified cardiac function, depression, serum biochemistry, dialysis adequacy and energy intake following exercise training in people with chronic kidney disease (CKD) under taking dialysis. Methods : A systematic literature search was completed in December 2012 identifying randomized, controlled trials of exercise training studies in haemodialysis (HD) patients. A subsequent meta-analysis was conducted. Results : Twenty four studies were included, totalling 879 patients. Exercise training produced significant improve ments in physical fitness: peak VO 2 5.03 mlO 2 · kg -1 · min -1 (95% CI 3.73, 6.33, p < 0 .0001), Knee extensor strength 2.99 kg (95% CI 0.46, 5.52, p = 0.02) and 6 minute walk distance 60.7 metres (95% CI 18.9, 103, p = 0.004). Significant increases in energy intake MD 238 Kcal · day - 1 (95% CI 94, 383, p = 0.001), serum Interleukin-6 MD- 0.58 pg · ml - 1 (95% CI- 1.01, - 0.15, p = 0.008) and Creactive protein MD 0.92 mg/L - 1 (95% CI 0.29, 1.56, p = 0.004), but not Albu min or BMI, were reported. Improved Beck Depression scores were reported MD-6.9 (95% CI-9.7,-4.1, p < 0.00001). D ialysis adequacy was reduced MD-0.2 3 (95% CI -0. 29 , -0.17, p < 0.00001), while serum potassium was higher MD 0.14 mmol · L -1 (95% CI 0.01, 0.27, p = 0.04). Moreover exercise training appeared safe, with no direct exercise- associated deaths in over 30,000 patient-hours. Conclusions: Our pooled analyses confirmed improvements in physical fitness following exercise training and suggested additional improvements in dialysis efficiency (kt/v), serum potassium, inflammation and depression in HD patients.
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