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D.C. Bündchen1, H. Sousa2, D. Figueiredo2, E.M.d.S. Costa3
1Federal University of Santa Catarina, Department of Health Sciences, Araranguá, Brazil, 2Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro, Aveiro, Portugal, 3UCIBIO/REQUIMTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing, University of Porto, Porto, Portugal
Background: Intradialytic exercise (IDE) has been proposed as a viable strategy to increase physical activity in patients with end-stage renal disease (ESRD). Recent research has suggested that it can be an effective complementary therapy for patients with ESRD, as it increases dialysis adequacy and other clinically relevant outcomes such as functional capacity and quality of life. Most of these studies have assessed the effectiveness of aerobic exercise or resistance training. However, a detailed examination of the evidence indicates that the data may not be as robust as often stated and that the effects of different modalities should be studied more carefully. In addition, new interventions have been proposed, namely neuromuscular electrical stimulation (NMES) and inspiratory muscle training (IMT), and little is known about its effectiveness, clinical benefits, and risks for this population. Overall, results about the effects of IDE are still frailty and, a time, conflicting.
Purpose: To understand the clinical benefits and risks associated with different modalities of IDE in patients with ESRD.
Methods: Data Sources: The search was performed until September 10, 2020 on Scopus, Web of Science (all databases included), the Cochrane Database, CINAHL, and PubMed.
Methods: This study was conducted in accordance with the PRISMA guideline statement. The methodological quality of the studies was assessed with the AMSTAR-2. Standardized mean differences with 95% confidence intervals were estimated. The I2 statistic was used to assess heterogeneity and the Eggers’ test to measure asymmetry and small-study effects.
Methods: This study was conducted in accordance with the PRISMA guideline statement. The methodological quality of the studies was assessed with the AMSTAR-2. Standardized mean differences with 95% confidence intervals were estimated. The I2 statistic was used to assess heterogeneity and the Eggers’ test to measure asymmetry and small-study effects.
Results: Ten studies were included and 48 unique meta-analyses were examined. Nine were supported by suggestive evidence (p<0.05, small heterogeneity, absence of small-study effects, and excess significance bias. Clinical benefits were found for functional capacity associated with aerobic exercise (d=0.81; k=6), resistance training (d=0.58; k=6), NMES (d=0.70; k=5), and IMT (d=1.13; k=2), measured by the distance covered in the 6-minutes walking test (6-MWT). This outcome was also associated with aerobic exercise (d=0.28; k=7) and combined exercise, measured by VO2peak (d =1.01; k=5) and by the duration of the cardiopulmonary test (d=1.07; k=4). Isometric quadriceps muscle strength improved with neuromuscular electrical stimulation (d=1.19; k=7) while patients’ perception of vitality improved with combined exercise (d=0.60; k=3).
Conclusion(s): Suggestive evidence was found for the associations between various modalities of IDE and functional capacity. Combined exercise is beneficial for patients’ levels of vitality while NMES improves muscle performance. Few or no adverse events were reported.
Implications: This Umbrella review shows that there is no ideal exercise prescription for this population since several associations were found between the various exercise modalities and the different clinical benefits examined, with little or no adverse events. This finding raises the possibility that different forms of intervention can be applied according to patients’ needs and motivations while considering the possibilities of each dialysis unit (e.g., the available equipment and the qualifications of health professionals responsible for delivering the intervention). Overall, this can improve patients’ adherence to IDE and contribute to behavioral changes and the consolidation of a healthier and more active lifestyle.
Funding, acknowledgements: N/A
Keywords: haemodialysis, exercise training, meta-analysis
Topic: Disability & rehabilitation
Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: Meta-analysis and systematic reviews are not considered research involving humans and does not need the approval of the Ethics Committee.
All authors, affiliations and abstracts have been published as submitted.
