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Exercise training in haemodialysis patients: A systematic review and meta‐analysis
Author(s) -
SMART NEIL,
STEELE MICHAEL
Publication year - 2011
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.2011.01471.x
Subject(s) - medicine , confidence interval , meta analysis , physical therapy , randomized controlled trial , heart rate , blood pressure
Background We quantified baseline and observed change in peak VO 2 , 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 VO 2 values were 70% of age‐predicted values, exercise intervention patients improved post‐training peak VO 2 to 88% predicted. Exercise training produced mean 26 ± 12% improvements in eight studies that reported peak VO 2 , mean difference 5.22 mL O 2 /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 VO 2 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 VO 2 , and heart rate variability.