Intradialytic exercise in chronic kidney disease

Heidi Agnor Bunæs-Næss, spesialfysioterapeut, Cand Mag., Oslo universitetssykehus HF, Medisinsk klinikk, Seksjon for fysioterapi, Ullevål. uxbunh@ous-hf.no.  

Aud-Eldrid Stenehjem, avdelingsoverlege, PhD, Oslo universitetssykehus HF, Medisinsk klinikk, Nyremedisinsk Avdeling, Ullevål. 

Birgitta Blakstad Nilsson, seniorforsker, Oslo universitetssykehus HF, Medisinsk klinikk, seksjon for fysioterapi, og førsteamanuensis, Høgskolen i Bergen, Institutt for ergoterapi, fysioterapi og radiografi.

Abstract

Introduction: Patients with chronic renal failure on hemodialysis (HD) develop complications that affect almost every organsystem in the body. Muscle loss and especially proximal muscle weakness is common in patients with chronic renal failure in dialysis (stage 5). Patients in HD experience significantly lower health-related quality of life, compared with healthy individuals. The benefits of exercise training in patients in HD have been frequently reported, but few studies have evaluated the effect of exercise during dialysis (intradialytic exercise).

Purpose: This article aims to discuss the current knowledge related to training of patients with chronic renal failure (stage 5) and summarise the evidence based knowledge related to effects on physical performance and health related quality of life of intradialytic exercise.

Content: Strength exercise, or a combination of aerobic and strength exercise training are the most frequent design used in clinical studies. The exercise programs are difficult to compare and the descriptions are somewhat imprecise. Aerobic training are conducted during the second hour of HD either on a stationary ergometer bicycle or lying in the dialysis chair exercising on special designed bicycles.

Conclusion: The evidence for intradialytic exercise is limited. We believe that larger randomized controlled trials which compare different exercise modalities is needed to recommend the exercise training for chronic kidney disease patients in HD. Physiotherapists have an important role in organizing and training of renal patients and may play a significant role in the future treatment of dialysis patients.

Keywords: intradialytic exercise, hemodialysis, chronic renal failure.

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