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

Background: We quantified baseline and observed change in peak VO2, quality of life, cardiac function, strength and energy intake following exercise training in haemodialysis patients and optimal exercise delivery for producing greatest adherence, safety and patient improvements. Methods: A systematic literature search was completed in August 2010 to identify randomized, controlled trials of exercise training studies in haemodialysis patients. A subsequent meta-analysis was conducted and the search repeated in December 2010. Results: 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. Conclusion: Exercise training is safe and imparts large improvements in peak VO2, and heart rate variability.