Nutrition and hydration status improve with exercise training using stationary cycling during hemodialysis (HD) in patients with end-stage renal disease (ESRD). Exercise training in patients with end-stage renal disease on hemodialysis: comparison of three rehabilitation programs. The life readiness program: a physical rehabilitation program for patients on hemodialysis. A twelve week exercise program improves the psychological status, quality of life and work capacity in hemodialysis patients. Design and methods of CYCLE-HD: improving cardiovascular health in patients with end stage renal disease using a structured programme of exercise: a randomised control trial Effect of Exercise Performed during Hemodialysis: Strength versus Aerobic Exercise training during hemodialysis improves dialysis efficacy and physical performance. Intra-dialytic electrostimulation of leg extensors may improve exercise tolerance and quality of life in hemodialyzed patients. A structured exercise programme during haemodialysis for patients with chronic kidney disease: clinical benefit and long-term adherence Haemodiafiltration, haemofiltration and haemodialysis for end-stage kidney disease. Effectiveness of intradialytic exercise on dialysis adequacy, physiological parameters, biochemical markers and quality of life - A pilot study. Five Months of Physical Exercise in Hemodialysis Patients: Effects on Aerobic Capacity, Physical Function and Self-Rated Health Complete Low-Intensity Endurance Training Programme in Haemodialysis Patients: Improving the Care of Renal Patients Cardiac effects of exercise rehabilitation in hemodialysis patients. A randomized, controlled trial of a multi-modal exercise intervention in Huntington's disease. Outcomes of long-term exercise training in dialysis patients: comparison of two training programs. The effects of resistance exercise and oral nutritional supplementation during hemodialysis on indicators of nutritional status and quality of life.
Patients with end-stage renal disease ( ESRD ) undergoing hemodialysis and peritoneal dialysis are functionally limited as a consequence of their physical , emotional , and social problems . Exercise intolerance is a major problem in chronic renal failure . Stationary cycle training during hemodialysis is recommended as safe , effective , and practical in ESRD patients treated on hemodialysis . The aim of the present study was to evaluate the effect of cycling exercises in 10 HD patients during 6-month period ( including each of dialysis sessions ) on nutrition , dialysis adequacy , and fluid parameters as measured by biochemical , and bioimpedance parameters . A significant increase in serum albumin concentration , Kt/V , and nPCR , and decrease in serum CRP have been observed after 6 months of regular stationary cycling during hemodialysis . Relative changes ( pre-post HD ) in extracellular water compartment and ECW/TBW ratio have significantly increased after 6 months of observation period Functional capacity of end-stage renal disease patients is dramatically impaired . Although exercise training programs appear to have beneficial morphological , functional and psychosocial effects in end-stage renal disease patients on hemodialysis ( HD ) , the adherence rate is high . The purpose of this study was to compare the effects of three modes of exercise training on aerobic capacity and to identify the most favourable , efficient and preferable to patients on HD with regard to functional improvements and participation rate in the programs . Fifty-eight volunteer patients were screened for low-risk status and selected from the dialysis population . The 48 patients who completed the study protocol were r and omly assigned either to one of the three training groups or to a control group .  Sixteen of them ( Group A - mean age 46.4+/-13.9 years ) completed a 6-month supervised outpatient exercise renal rehabilitation program consisting of three weekly sessions of aerobic and strengthening training on the non-dialysis days ; 10 ( Group B - mean age 48.3+/-12.1 years ) completed a 6-month exercise program during HD ; 10 ( Group C - mean age 51.4+/-12.5 years ) followed an unsupervised moderate exercise program at home , and 12 patients ( Group D-mean age 50.2+/-7.9 years ) were used as patient controls . The level of anemia , the medications and the HD prescription remained stable during the study . Fifteen sex- and age-matched sedentary individuals ( Group E - mean age 46.9+/-6.4 years ) comprised a healthy control group for baseline data . All subjects at the beginning and end of the study underwent clinical examination , laboratory tests and a treadmill exercise test to fatigue endpoints with direct measurement of aerobic capacity . Group A had a higher dropout rate ( 24 % ) compared to groups B ( 17 % ) and C ( 17 % ) . Peak oxygen consumption ( VO2 peak ) increased by 43 % ( p < 0.05 ) , anaerobic threshold ( VO2AT ) by 37 % ( p < 0.05 ) and exercise time by 33 % ( p < 0.05 ) after training in Group A ; by 24 % ( p < 0.05 ) , 18 % ( p < 0.05 ) and 22 % ( p < 0.05 ) , respectively , in B ; and by 17 % ( p < 0.05 ) , 8 % ( p < 0.05 ) and 14 % ( p < 0.05 ) , respectively , in C ; while both remained almost unchanged in Group D. These results demonstrate that intense exercise training on non-dialysis days is the most effective way of training , whereas exercise during HD is also effective and preferable Patients with end-stage renal disease ( ESRD ) undergoing hemodialysis ( HD ) are typically sedentary and functionally limited as a consequence of their condition . The purpose of this study is to test the effect of a lifestyle physical rehabilitation program ( The Life Readiness Program ) on physical function in patients with ESRD undergoing HD .  Physical function was measured by the Kidney Disease Quality of Life Short Form ( KDQOL-SF ) physical function score ( range , 0 to 100 ) . Eighty-two patients were r and omly assigned to a 6-month rehabilitation program ( intervention ; n = 39 ) or to st and ard clinical management alone ( control ; n = 43 ) . The groups were frequency matched by age , sex , ethnicity , and diabetes as the cause of ESRD . General linear modeling of the change in physical function score was used for multivariate analysis . Physical function scores were not different between groups at baseline . Change in physical function score increased significantly in the intervention group compared with the control group when data were adjusted for the matching variables and adequacy of dialysis ( 3.2 , -3.6 ; P = 0.04 ) . Additionally , the control group reported more problems with work or daily functions because of emotional problems ( P : < /= 0.05 ) . In this brief 6-month intervention , The Life Readiness Program showed the therapeutic benefit of a  lifestyle rehabilitation program  on functional outcomes and health-related quality of life for patients with ESRD undergoing hemodialysis BACKGROUND Patients with chronic renal failure ( CRF ) are restricted in physical , emotional and social dimensions of life due to their treatment and their comorbid medical conditions . We aim ed to evaluate the effects of a 12-week exercise program on the functional capacity , functional mobility , walking capacity , quality of life and depression in patients with renal failure on hemodialysis ( HD ) . METHODS Twenty patients with renal failure on HD were included and 14 of them completed the study . The patients went through a 12-week exercise program of 90 min/day , 3 days a week . Exercise and walking capacity , functional mobility , psychological status and quality of life were evaluated pre- and post-training . RESULTS Following the exercise , peak oxygen consumption , exercise duration and peak workload improved significantly ( respectively , p=0.006 , p=0.002 and p=0.002 ) . There were significant improvements in the sit-to-st and -to-sit test and the 6- min walk test ( p<0.001 and p=0.002 ) . There was a significant reduction in the depression score ( p<0.001 ) . Both physical component scale ( PCS ) and mental component scale ( MCS ) of the Kidney Disease Quality of Life Short-Form 36 ( SF-36 ) question naire showed significant increases ( respectively , p=0.002 and p=0.004 ) . CONCLUSION The application of an appropriate exercise program would improve psychological status and quality of life , as well as work capacity in long-term maintenance HD patients Background There is emerging evidence that exercise training could positively impact several of the cardiovascular risk factors associated with sudden cardiac death amongst patients on haemodialysis . The primary aim of this study is to evaluate the effect of an intradialytic exercise programme on left ventricular mass . Method and design Prospect i ve , r and omised cluster open-label blinded endpoint clinical trial in 130 patients with end stage renal disease on haemodialysis . Patients will be r and omised 1:1 to either 1 ) minimum of 30 min continuous cycling thrice weekly during dialysis or 2 ) st and ard care .  The primary outcome is change in left ventricular mass at 6 months , assessed by cardiac MRI ( CMR ) . In order to detect a difference in LV mass of 15 g between groups at 80 % power , a sample size of 65 patients per group is required . Secondary outcome measures include abnormalities of cardiac rhythm , left ventricular volumes and ejection fraction , physical function measures , anthropometric measures , quality of life and markers of inflammation , with interim assessment for some measures at 3 months . Discussion This study will test the hypothesis that an intradialytic programme of exercise leads to a regression in left ventricular mass , an important non-traditional cardiovascular risk factor in end stage renal disease . For the first time this will be assessed using CMR . We will also evaluate the efficacy , feasibility and safety of an intradialytic exercise programme using a number of secondary end-points . We anticipate that a positive outcome will lead to both an increased patient uptake into established intradialytic programmes and the development of new programmes nationally and internationally . Trial registration numberIS RCT N11299707 ( registration date 5th March 2015 ) Rational : Patients under regular dialysis can also present alterations in the cardiovascular , musculoskeletal , and metabolic systems . Objectives : The aim of this study is to compare the effects of strength and aerobic exercises performed during  hemodialysis ( HD ) in individuals with chronic renal disease . Material s and Methods : R and omized clinical trial . It was developed as a program of exercises three times a week , in the first 2 h of HD for 8 weeks . The patients were divided into three groups : control ( Group 1 , n : 11 ) , strength ( Group 2 , n : 11 ) , and aerobic ( Group 3 , n : 10 ) . G1 has not developed any type of physical training ; G2 utilized a training load of 40 % of one repetition maximum ( 1RM ) with anklets , and developed three series of 15 repetitions . G3 pedaled seated in the dialysis seat , during 20 min , in an ergometric bicycle , with intensity regulated by the perceived effort scale . Before and after 8 weeks , the following variables were evaluated : respiratory muscular strength , pulmonary function , functional capacity , blood biochemistry , and quality of life . Main Findings : In the pre- and post-training comparison , there was statistically significant improvement ( p < 0.05 ) in the maximal inspiratory pressure ( MIP ) , number of steps achieved ( NSA ) , and quality of life ( QoL ) in the trained groups , as compared to the non-exercised group ( G1 ) . Conclusions : The strength and aerobic exercises developed during HD can improve the respiratory muscular strength , functional performance , and quality of life , when compared to individuals presenting the disease who have not developed any type of physical training OBJECTIVE To determine the impact of a 20-week intradialytic exercise program , consisting of 60 minutes of cumulative duration , low-intensity exercise during the first 2 hours of dialysis , on dialysis efficacy , physical performance , and quality of life in self-care hemodialysis ( HD ) patients . DESIGN One-group repeated measures . SETTING Satellite HD units affiliated with a Canadian teaching hospital . PARTICIPANTS A convenience sample of 13 self-care HD patients who were stable on dialysis for a minimum of 6 months and were medically screened for significant cardiac , pulmonary , and /or musculoskeletal pathology that would preclude exercise . INTERVENTION A 5-month intradialytic exercise program in which subjects exercised 3 times a week ( cycle ergometer , mini-stepper ) for 30 minutes in each of the first 2 hours of HD . MAIN OUTCOME MEASURES Dialysis efficacy ( in single-pool model of urea kinetics [ spKt/V ] ) was assessed prior to and at the end of each month of the exercise program . Physical function ( 6-minute walk test [ 6MWT ] ) , and quality of life . ( Kidney Disease Quality of Life-Short Form [ KDQOL ] ) were determined at baseline and at weeks 10 and 20 of the exercise program . RESULTS SpKt/V increased 11 % at the end of the first month of the program ( P<.05 ) and remained elevated for the duration of the program ( 18%-19 % ) . Distance walked on the 6MWT increased by 14 % at both weeks 10 and 20 ( P<.05 ) . No changes were noted in KDQOL scores . CONCLUSIONS A low-intensity intradialytic exercise program is a viable adjunctive therapy , which improves HD efficacy and physical function in HD patients Hemodialyzed ( HD ) patients with end-stage renal disease ( ESRD ) exhibit lower fitness as a consequence of chronic uremic changes that trigger various structural , metabolic , and functional abnormalities in skeletal muscles . The aim of this r and omized study was to compare the effect of rehabilitation ( RHB ) training on a bicycle ergometer and electromyostimulation ( EMS ) of leg extensors in HD patients with ESRD . Thirty-two HD patients ( 18 men/14 women ; mean age 61.1 ± 8.8 years ) were r and omized into three groups : ( i ) exercise training ( ET ; n = 11 ) on bicycle ergometer 2 × 20 min ; ( ii ) EMS ( n = 11 ) where stimulation ( 10 Hz ) of leg extensors was applied for 60 min ; and ( iii ) controls ( CON ; n = 10 ) without exercise . Exercising was performed between the 2nd and the 3rd hour of HD , three times a week , 20 weeks in total . Ergometric test was performed in order to evaluate peak workload ( W(peak ) ) , 6-min corridor walking test ( CWT ) to evaluate the distance walked , and dynamometry of leg extensors to assess muscle power ( F(max ) ) . Urea clearance was monitored and expressed as st and ard parameters : spKt/V , spKt/V equilibrated ( spKt/V-e ) , and the urea removal ratio ( URR ) . Quality of life ( QoL ) was assessed by the question naire SF-36 . A significant increase of F(max ) ( P = 0.040 in group ET ; P = 0.032 in group EMS ) , of 6-min CWT ( P < 0.001 in ET group ; P = 0.042 in EMS group ) , and of W(peak ) ( P = 0.041 in ET group ) was observed . In both exercising groups , significant increase of spKt/V , spKt/V-e , and URR was found as compared with initial values ( P < 0.05 ) . In both exercising groups , highly significant changes in summarized mental functions were found ( P = 0.001 ) ; in summarized physical components , significant improvement was observed in the ET group ( P = 0.006 ) . Intradialytic RHB showed comparable positive effects on functional parameters , urea clearance , and QoL. Intradialytic EMS might represent wide therapeutic possibility in the near future Objective Long-term studies regarding the effect of a structured physical exercise programme ( SPEP )  during haemodialysis ( HD ) assessing compliance and clinical benefit are scarce . Study design A single-centre clinical trial , non-r and omised , investigating 46 patients with HD ( 63.2±16.3 years , male/female 24/22 , dialysis vintage 4.4 years ) performing an SPEP over 5 years . The SPEP ( twice/week for 60 min during haemodialysis ) consisted of a combined resistance ( 8 muscle groups ) and endurance ( supine bicycle ergometry ) training . Exercise intensity was continuously adjusted to improvements of performance testing . Changes in endurance and resistance capacity , physical functioning and quality of life ( QoL ) were analysed over 1 year in addition to long-term adherence and economics of the programme over 5 years . Average power per training session , maximal strength tests ( maximal exercise repetitions/min ) , three performance-based tests for physical function , SF36 for QoL were assessed in the beginning and every 6 months thereafter . Results 78 % of the patients completed the programme after 1 year and 43 % after 5 years . Participants were divided — according to adherence to the programme — into three groups : ( 1 ) high adherence group ( HA , > 80 % of 104 training sessions within 12 months ) , ( 2 ) moderate adherence ( MA , 60–80 % ) , and 3 . Low adherence group ( LA , < 60 % ) ) with HA and MA evaluated quantitatively . One-year follow-up data revealed significant ( p<0.05 ) improvement for both groups in all measured parameters : exercise capacity ( HA : 55 % , MA : 45 % ) , strength ( HA : > 120 % , MA : 40–50 % ) , QoL in three scores of SF36 subscales and physical function in the three tests taken between 11 % and 31 % . Moreover , a quantitative correlation analysis revealed a close association ( r=0.8 ) between large improvement of endurance capacity and weak physical condition ( HA ) . Conclusions The exercise programme described improves physical function significantly and can be integrated into a HD routine with a high long-term adherence Background Convective dialysis modalities ( haemofiltration ( HF ) , haemodiafiltration ( HDF ) , and acetate-free biofiltration ( AFB ) ) removed excess body fluid across the dialysis membrane with positive pressure and accumulated middle- and larger-size accumulated solutes more efficiently than haemodialysis ( HD ) . This increased larger solute removal combined with use of ultra-pure dialysis fluid in convective dialysis is hypothesised to reduce the frequency and severity of symptoms during dialysis as well as improve clinical outcomes . Convective dialysis therapies ( HDF and HF ) are associated with lower mortality compared to diffusive therapy ( HD ) in observational studies . This is an up date of a review first published in 2006 . Objectives To compare convective ( HF , HDF , or AFB ) with diffusive ( HD ) dialysis modalities on clinical outcomes ( mortality , major cardiovascular events , hospitalisation and treatment-related adverse events ) in men and women with end-stage kidney disease ( ESKD ) . Search methods We search ed the Cochrane Renal Group 's Specialised Register ( to 18 February 2015 ) through contact with a Trials ' Search Co-ordinator using search terms relevant to this review . Selection criteria We included r and omised controlled trials comparing convective therapy ( HF , HDF , AFB ) with another convective therapy or diffusive therapy ( HD ) for treatment of ESKD . Data collection and analysis Two independent authors identified studies , extracted data and assessed study risk of bias . We summarised treatment effects using the r and om effects model . We reported results as a risk ratio ( RR ) for dichotomous outcomes and mean difference ( MD ) for continuous data together with 95 % confidence intervals ( CI ) . We assessed for heterogeneity using the Chi2 test and explored the amount of variation in treatment estimates beyond that expected by chance using the I2 statistic . Main results Twenty studies comprising 667 participants were included in the 2006 review . In that review , there was insufficient evidence of treatment effects on major clinical outcomes to draw clinical ly meaningful conclusions . Search ing to February 2015 identified 40 eligible studies comprising 3483 participants overall . In total , 35 studies ( 4039 participants ) compared HF , HDF or AFB with HD , three studies ( 54 participants ) compared AFB with HDF , and three studies ( 129 participants ) compared HDF with HF . Risks of bias in all studies were generally high result ing in low confidence in estimated treatment effects . Convective dialysis had no significant effect on all-cause mortality ( 11 studies , 3396 participants : RR 0.87 , 95 % CI 0.72 to 1.05 ; I2 = 34 % ) , but significantly reduced cardiovascular mortality ( 6 studies , 2889 participants : RR 0.75 , 95 % CI 0.61 to 0.92 ; I2 = 0 % ) . One study reported no significant effect on rates of nonfatal cardiovascular events ( 714 participants : RR 1.14 , 95 % CI 0.86 to 1.50 ) and two studies showed no significant difference in hospitalisation ( 2 studies , 1688 participants : RR 1.23 , 95 % CI 0.93 to 1.63 ; I2 = 0 % ) . One study reported rates of hypotension during dialysis were significantly reduced with convective therapy ( 906 participants : RR 0.72 , 95 % CI 0.66 to 0.80 ) . Adverse events were not systematic ally evaluated in most studies and data for health-related quality of life were sparse . Convective therapies significantly reduced predialysis levels of B2 microglobulin ( 12 studies , 1813 participants : MD -5.55 mg/dL , 95 % CI -9.11 to -1.98 ; I2 = 94 % ) and increased dialysis dose ( Kt/V urea ) ( 14 studies , 2022 participants : MD 0.07 , 95 % CI -0.00 to 0.14 ; I2 = 90 % ) compared to diffusive therapy , but results across studies were very heterogeneous . Sensitivity analyses limited to studies comparing HDF with HD showed very similar results . Directly comparative data for differing types of convective dialysis were insufficient to draw conclusions . Studies had important risks of bias leading to low confidence in the summary estimates and were generally limited to patients who had adequate dialysis vascular access . Authors ' conclusions Convective dialysis may reduce cardiovascular but not all-cause mortality and effects on nonfatal cardiovascular events and hospitalisation are inconclusive . However , any treatment benefits of convective dialysis on all patient outcomes including cardiovascular death are unreliable due to limitations in study methods and reporting . Future studies which assess treatment effects of convection dose on patient outcomes including mortality and cardiovascular events would be informative End-stage renal disease is emerging as a major public health problem in the developing countries . It must be treated with renal replacement therapy and hemodialysis ( HD ) is the most widely used therapy and the only maintenance treatment if kidney transplant is not feasible . This study aim ed to determine the effectiveness of intradialytic exercise on dialysis efficacy , physiological parameters , biochemical markers , and quality of life among patients on HD . Experimental research design was adopted to conduct the study with 20 patients in our HD unit who met the inclusion criteria and patients were r and omly allocated into experimental group and control group . The experimental group received intradialytic exercise during the first 2 h of HD besides receiving routine care compared to the control group . Data were tabulated and analyzed using the SPSS package . The finding of the present pilot study reveals that the prescribed intradialytic exercise intervention result ed in significant improvement in Kt/V , serum creatinine , blood urea , serum potassium , phosphorous , and quality of life . Based on the findings of the present study , it can be concluded that intradialytic exercise program is a safe complementary intervention and does not need an extra time of the patient and showed improvement in patients ' outcome Background : The number of chronic renal failure patients treated by hemodialysis ( HD )  is continuously increasing . Most patients have reduced physical capacity and have a high risk of cardiac and vascular diseases . The aim of this study was to determine the effects of 5 months physical exercise of HD patients ’ physical capacity , self-rated health and risk factors for cardiovascular disease . Methods : 33 HD patients were included in the study . Inclusion criteria : HD for more than 3 months , age > 18 years . Exclusion criteria : Diabetes mellitus , symptomatic cardiovascular disease , musculoskeletal limitations , severe peripheral polyneuropathy , inability to speak Danish or English , dementia or other mental disorders . The patients were r and omly assigned to an exercise group ( EG , n = 22 ) or a control group ( CG , n = 11 ) . Prior to r and omization , baseline testing was performed . The effects were measured by aerobic capacity , ‘ 2-min stair climbing ’ , ‘ squat test ’ , self-rated health ( SF36 ) , blood pressure and lipids . All tests were carried out by blinded testers . The intervention consisted of 1 h of physical exercise twice a week for 5 months . Results : 20 patients completed the intervention .  Attendance was 74 % of all sessions . There were no dropouts caused by complications related to the intervention . The EG had a significant increase in aerobic capacity , ‘ squat test ’ and Physical Function and Physical Component Scale ( SF36 ) . No significant changes were observed in any of the parameters in the CG . Conclusion : Physical exercise twice a week for 5 months increases physical function and aerobic capacity in HD patients . An exercise program with only two exercise sessions per week seems easy to implement in clinical practice with high attendance among participants . Further investigation is needed to determine the effects on blood pressure and lipids . There were no medical complications related to the exercise program Background : Patients on haemodialysis ( HD ) have a decreased physical and functional capacity . Several studies have reported the beneficial effects of exercise on the physical , functional and psychological functioning of HD patients . Despite these results , exercise programmes on HD are not commonplace . Objective : To analyse the effect of an intradialysis endurance training programme on muscular strength and functional capacity in our HD patients . Material and Methods : A 6-month single-centre prospect i ve study . HD patients were non-r and omly assigned to an exercise group  ( group E ) or a control group ( group C ) . Exercise training included complete endurance training using balls , weights and elastic b and s in the first 2 h of an HD session ; group C received st and ard HD care . Analysed data : ( 1 ) biochemical parameters ; ( 2 ) biceps and quadriceps muscle tone , maximum quadriceps length strength ( MQLS ) and dominant h and grip ( HG ) ; ( 3 ) functional capacity tests : sit-to-st and -to-sit ( STS10 ) and 6-min walking test ( 6MWT ) . Results : Forty patients were included , 55 % were men ; their mean age was 68.4 years ; the patients were 61.6 months on HD ; 16 patients were in group E and 24 in group C. In group E , muscular strength showed a significant improvement in MQLS ( 15.6 ± 10.7 vs. 17.7 ± 12.5 kg , p < 0.05 ) and HG ( 22.1 ± 13.2 vs. 24.1 ± 15.8 kg , p < 0.05 ) at the end of the programme , while a global decrease was reported in group C ( MQLS 20.9 ± 9.3 vs. 16.2 ± 8.4 kg , p < 0.05 ; HG 25.1 ± 10.3 vs. 24.1 ± 11.1 kg ) . 6MWT significantly improved in group E ( 20 % , 293.1 vs. 368 m , p < 0.001 ) and decreased in group C ( 10 % , 350 vs. 315 m , p < 0.004 ) . At the end of the programme , STS10 time was reduced in group E ( 2.1 ± 18.5 vs. 28.7 ± 20.6 s ) , while it rose in group C ( 31.5 ± 17.9 vs. 36.4 ± 19.8 s ) , though significant differences were not found . Conclusions : ( 1 ) The intradialysis training programme  improved muscular strength and functional capacity in our HD patients . ( 2 ) These results support the benefits of exercise training for HD patients . ( 3 ) Nephrologists should consider exercise training as a st and ard practice for the care of HD patients Exercise training has well documented beneficial effects in a variety of cardiac disorders . End stage renal disease patients present many cardiovascular complications and suffer from impaired exercise capacity . No study to date has adequately examined the cardiac responses to exercise training in renal patients on hemodialysis ( HD ) . To determine the effects of an exercise rehabilitation program on the left ventricular function at rest and during submaximal effort , 38 end-stage renal disease patients on maintenance HD were r and omised into three groups . Sixteen of them ( group A -- mean age 46.4+/-13.9 years ) , without clinical features of heart failure , participated in a 6-month supervised exercise renal rehabilitation program consisting of three weekly sessions of aerobic training , 10 ( group B -- mean age 51.4+/-12.5 years ) followed a moderate exercise program at home , and the other 12 ( group C -- mean age 50.2+/-7.9 years ) were not trained and remained as controls . The level of anemia and the HD prescription remained constant during the study . Fifteen sex- and age-matched sedentary individuals ( group D -- mean age 46.9+/-6.4 years ) were the healthy controls . All subjects at the start and end of the program underwent physical examination , laboratory tests , treadmill exercise testing , M-mode and 2-D echocardiograms performed at rest and at peak of supine bicycle exercise .  Left ventricular volumes ( EDV , ESV ) and mass ( LVM ) were measured and ejection fraction ( EF ) , stroke volume index ( SVI ) and cardiac output index ( COI ) were calculated by st and ard formulae . The maximal oxygen consumption increased by 43 % ( P<0.001 ) and the exercise time by 33 % ( P<0.001 ) after training in group A , by 17 % ( P<0.001 ) and 14 % ( P<0.01 ) , respectively , in B , and both remained unchanged in group C. Training in group A was also associated with an increase in LVIDd ( from 52.1+/-6.4 to 54.0+/-6.1 mm , P<0.001 ) and LVM ( 226+/-67 to 240+/-84 g , P<0.05 ) at rest with no change noted in groups B and C. Following a 6-month exercise training in group A an increase was also found in the resting EF by 5 % ( P<0.01 ) and SVI by 14 % ( P<0.001 ) . There was no change found in groups B and C. Supine bicycle exercise after training in group A was associated with an improvement in EF by 14 % compared to the pre-training change ( P<0.001 ) , SVI by 14 % ( P<0.001 ) and COI by 73 % ( P<0.001 ) . These changes from rest to submaximal exercise were less pronounced in group B following training at home . The untrained patients demonstrated no changes in LV systolic function over the 6-month period . These results demonstrate that intense exercise training improves LV systolic function at rest in HD patients ; both intense and moderate physical training leads to enhanced cardiac performance during supine submaximal exercise INTRODUCTION This study aim ed to evaluate the feasibility and benefit of a structured exercise intervention in people with Huntington 's Disease ( HD ) . METHODS This study was conducted at 6 sites , and participants were r and omized into either exercise or control ( usual care ) groups , and were assessed at baseline , 13 and 26 weeks . The intervention was a 12 week , three times per week progressive exercise program , including aerobic ( stationary cycling ) and upper and lower body strengthening exercise with tapered 1:1 support for 20 of 36 sessions . RESULTS 314 adults were assessed for eligibility : 248 did not meet inclusion criteria , 34 declined , and 32 were recruited and r and omized . Three individuals in the intervention group were withdrawn within the first month due to concomitant medical conditions , result ing in 14 participants in intervention and 15 in control groups . There were two AEs in the intervention group , both related to previous medical conditions , and there were two SAEs , both in the control group . The intervention group had better fitness ( predicted VO2 max difference : 492.3 ml min-1 , 95 % CI : [ 97.1 , 887.6 ] ) , lower UHDRS mMS ( difference 2.9 points , 95 % [ -5.42 , -0.32 ] ) and lower weight at Week 13 ( difference 2.25 kg , 95 % CI : [ -4.47 , -0.03 ] ) . CONCLUSION This study demonstrates that a short-term exercise intervention  is safe and feasible . Individuals with HD may benefit from structured exercise , and intensity , monitoring and support may be key factors in optimizing response . Larger scale trials are now required to fully eluci date the extended clinical potential of exercise in HD . TRIAL REGISTRATION Current Controlled Trials IS RCT N11392629 BACKGROUND Exercise training has been shown to improve the low functional capacity and quality of life in dialysis ( HD ) patients . However , there are no data about the outcome of long-term exercise training and , also , the adherence of HD patients in such long-term renal rehabilitation programs . Therefore , the aim of this study was to evaluate the effects of 2 modes of long-term physical training on HD patients ' physical fitness , perception of health and overall life situation . PATIENTS AND METHODS Forty-eight HD patients , free of any other systemic disease , who followed 2 modes of exercise training for 4 years , were studied . Half of them ( group A ) were r and omly assigned to participate in a supervised outpatient exercise training program ( 3/weekly ) on the non-dialysis days , while the other half ( group B ) followed a training program with stationary bicycles during their HD sessions ( 3/weekly ) . The measured domains of physical fitness and well-being every year were : aerobic capacity , as estimated from a modified Bruce treadmill exercise test and spiroergometric study , the patients ' perception of health , the overall life situation and the employment status . RESULTS During the 4-year study , there were 8 drop-outs in group A and 5 in B. No adverse effects of the exercise programs were reported . The 1 year of exercise training result ed in 38 % in group A ( 16 patients , who remained in the study ) and 31 % in group B ( 18 patients ) improvement of exercise time , and a 47 % increase in group A of peak oxygen consumption ( VO2peak ) and a 36 % in group B in comparison to baseline value . After 3 additional years of training , significant improvements were also noted in exercise time ( by 53 % in group A and by 43 % in B ) and VO2peak ( by 70 % in group A and by 50 % in group B ) , as well as in other gas exchange variables in comparison to baseline values . However , the improvements in group A were more pronounced than in B. Interestingly , the gains in exercise capacity were more enhanced in the first year of training in both groups . After 4-year training , significantly more patients in both groups perceived their health and overall life situation as well , compared to baseline . In addition , perception of improved health was higher in group A. The increase in the proportion of patients working was also higher in group A than B after the 4-year training . CONCLUSION HD patients can adhere to long-term physical training programs on the non-dialysis days , as well as during hemodialysis with considerable improvements in physical fitness and health . Although training out of HD seems to result in better outcomes , the drop out rate was higher BACKGROUND Protein-energy wasting ( PEW ) is common in patients undergoing hemodialysis ( HD ) . Studies have assessed the positive effect of oral nutritional supplementation ( ONS ) or resistance exercise ( RE ) on nutritional status ( NS ) markers in patients undergoing HD . METHODS The aim of this study was to assess the effect of ONS and RE on NS and the quality of life ( QOL ) of 36 patients undergoing HD . In a r and omized clinical trial , patients were divided into the following two groups : a control group ( ONS ) that received a can of ONS during their HD sessions and an intervention group ( ONS + RE ) that received a can of ONS and underwent a 40-min session of RE during their HD sessions . Both interventions lasted 12 weeks . The patients ' anthropometric , biochemical , dietetic and bioelectrical impedance measurements as well as their QOL , evaluated using the Kidney Disease Quality of Life Short Form , were recorded . RESULTS At baseline , 55.5 % of patients presented with PEW according to International Society of Renal Nutrition and Metabolism criteria ( 20 patients ) . We found statistically significant changes from baseline in both groups , such as increases in body weight , body mass index , midarm circumference , midarm muscle circumference , triceps skinfold thickness , fat mass percentage , h and grip strength , phase angle and serum albumin . A decrease in the prevalence of PEW was observed in both groups at the end of the intervention . A delta comparison between groups showed no statistically significant differences in the anthropometric and biochemical parameters . No significant improvement was observed in QOL and body composition measured by bioimpedance vector analysis . Dietary energy and protein intake increased significantly during the study period for all patients . CONCLUSION Oral nutritional supplementation during HD improves NS . The addition of RE during HD does not seem to augment the acute anabolic effects of intradialytic ONS on NS
Conclusions : Compared to age-matched population s , people with ESKD/HD had significantly slower GS and reduced walk distances ; with intervention , the change in the distance walked was significant .
Background : People with end-stage kidney disease ( ESKD ) on hemodialysis ( HD )  commonly have functional impairments .
The purpose of this systematic review was to evaluate the effect of HD on spatio-temporal characteristics of gait , and effect of exercise on these parameters .