Correlation between intradialytic aerobic exercise, associated or not with neuromuscular electrical stimulation, and the quality of hemodialysis in patients with chronic kidney disease
Main Article Content
Abstract
Introduction: Individuals with Chronic Kidney Disease (CKD) on hemodialysis (HD) have impaired functional capacity. Therefore, to alleviate these complications, intradialytic exercises have been implemented. Objective: To evaluate the correlation between intradialytic aerobic exercise, associated or not with neuromuscular electrical stimulation (NMES), and the quality of HD. Methods: Randomized clinical trial that submitted individuals with CKD to an intradialytic exercise using a cycle ergometer in the lower limb and active upper limb NMES in the intervention group (IG) or placebo in the control group (CG). The outcomes evaluated were Kt/V index (an index that evaluates the adequacy of HD), number of cycles cycled, distance covered, and heart rate (HR). The groups were compared, and correlation was made between Kt/V and variables: cycles cycled, distance covered, delta HRF-I (difference between final HR and initial HR of the intervention), delta HRcycle (difference between final HR and initial HR of the cycle ergometer), and HRpeak (highest HR value during the cycle ergometer). Results: Five participants were included in the IG and 4 in the CG. During exercise, there was an increase in HR in IG and a reduction in systolic blood pressure in the CG. Furthermore, the CG performed a greater number of pedaling cycles and a greater distance covered (p<0.05). Furthermore, delta HRF-I and HRpeak were higher in the IG. There was a weak positive correlation in the IG (r=0.21; p=0.03) between delta HRcycle and Kt/V. Conclusion: Intradialytic aerobic exercise associated with NMES had a weak positive correlation between Kt/V and delta HRcycle.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY) that allows others to share and adapt the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.References
1. Heiwe S, Jacobson SH. Exercise training for adults with chronic kidney disease. Cochrane Database Syst Rev. 2011;(10): CD003236. https://doi.org/10.1002/14651858.CD003236.pub2
2. Guo J, Jiao W, Xia S, Xiang X, Zhang Y, Ge X, et al. The global, regional, and national patterns of change in the burden of chronic kidney disease from 1990 to 2021. BMC Nephrol. 2025;26(1):136. https://doi.org/10.1186/s12882-025-04028-z
3. Nerbass FB, Lima HN, Strogoff-de-Matos JP, Zawadzki B, Moura-Neto JA, Lugon JR, et al. Brazilian Dialysis Survey 2023. Braz J Nephrol. 2025;47(1):e20240081. https://doi.org/10.1590/2175-8239-JBN-2024-0081en
4. Zazzeroni L, Pasquinelli G, Nanni E, Cremonini V, Rubbi I. Comparison of Quality of Life in Patients Undergoing Hemodialysis and Peritoneal Dialysis: a Systematic Review and Meta-Analysis. Kidney Blood Press Res. 2017;42(4):717-27. https://doi.org/10.1159/000484115
5. Michou V, Davioti M, Syrakou N, Liakopoulos V, Deligiannis A, Kouidi E. Effects of a Combined Intradialytic Exercise Training Program on Functional Capacity and Body Composition in Kidney Transplant Candidates. J Funct Morphol Kinesiol. 2023;8(1):9. https://doi.org/10.3390/jfmk8010009
6. Wang XH, Mitch WE. Mechanisms of muscle wasting in chronic kidney disease. Nat Rev Nephrol. 2014;10(9):504-16.
https://doi.org/10.1038/nrneph.2014.112
7. Fahal IH. Uraemic sarcopenia: aetiology and implications. Nephrol Dial Transplant. 2014;29(9):1655-65. https://doi.org/10.1093/ndt/gft070
8. Cozzolino M, Mangano M, Stucchi A, Ciceri P, Conte F, Galassi A. Cardiovascular disease in dialysis patients. Nephrol Dial Transplant. 2018;33(suppl 3):iii28-34. https://doi.org/10.1093/ndt/gfy174
9. Bündchen DC, Sousa H, Afreixo V, Frontini R, Ribeiro O, Figueiredo D, et al. Intradialytic exercise in end-stage renal disease: An umbrella review of systematic reviews and/or meta-analytical studies. Clin Rehabil. 2021;35(6):812-28. https://doi.org/10.1177/0269215520986784
10. Araujo AM, Orcy RB, Feter N, Weymar MK, Cardoso RK, Bohlke M, et al. Effects of intradialytic exercise on functional capacity in patients with end-stage chronic kidney disease: a systematic review and meta-analysis. Res Sports Med. 2024;32(1):28-48. https://doi.org/10.1080/15438627.2022.2079983
11. Anding K, Bar T, Trojniak-Hennig J, Kuchinke S, Krause R, Rost JM, et al. A structured exercise programme during haemodialysis for patients with chronic kidney disease: clinical benefit and long-term adherence. BMJ Open. 2015;5(8):e008709. https://doi.org/10.1136/bmjopen-2015-008709
12. Desai M, Mohamed A, Davenport A. A pilot study investigating the effect of pedalling exercise during dialysis on 6-min walking test and hand grip and pinch strength. Int J Artif Organs. 2019;42(4):161-6. https://doi.org/10.1177/0391398818823761
13. Verrelli D, Sharma A, Alexiuk J, Tays Q, Rossum K, Sharma M, et al. Effect of Intradialytic Exercise on Cardiovascular Outcomes in Maintenance Hemodialysis: A Systematic Review and Meta-Analysis. Kidney360. 2024;5(3):390-413. https://doi.org/10.34067/KID.0000000000000361
14. Oliva EM, Villafañe JH, Pérez JLA, Sal AA, Carlier GM, García AQ, et al. Effect of Exercise on Inflammation in Hemodialysis Patients: A Systematic Review. J Pers Med. 2022;12(7):1188. https://doi.org/10.3390/jpm12071188
15. Chung YC, Yeh ML, Liu YM. Effects of intradialytic exercise on the physical function, depression, and quality of life for haemodialysis patients: a systematic review and meta-analysis of randomised controlled trials. J Clin Nurs. 2017;26(13-14):1801-13. https://doi.org/10.1111/jocn.13514
16. Hu H, Liu X, Chau PH, Choi EPH. Effects of intradialytic exercise on health-related quality of life in patients undergoing maintenance haemodialysis: a systematic review and meta-analysis. Qual Life Res. 2022;31(7):1915-32. https://doi.org/10.1007/s11136-021-03025-7
17. Valenzuela PL, Morales JS, Ruilope LM, la Villa P, Santos-Lozano A, Lucia A. Intradialytic neuromuscular electrical stimulation improves functional capacity and muscle strength in people receiving haemodialysis: a systematic review. J Physiother. 2020;66(2):89-96. https://doi.org/10.1016/j.jphys.2020.03.006
18. Veldman MP, Gondin J, Place N, Maffiuletti NA. Effects of Neuromuscular Electrical Stimulation Training on Endurance Performance. Front Physiol. 2016;7:544. https://doi.org/10.3389/fphys.2016.00544
19. AlSahow A, Muenz D, Al-Ghonaim MA, Al Salmi I, Hassan M, Al Aradi AH, et al. Kt/V: achievement, predictors, and relationship to mortality in hemodialysis patients in the Gulf Cooperation Council countries: results from DOPPS (2012-18). Clin Kidney J. 2020;14(3):820-30. https://doi.org/10.1093/ckj/sfz195
20. Guio BM, Gomes CP, Costa FB, Oliveira AS, Duarte MT, Leite Junior M. Efeitos benéficos da reabilitação cardiopulmonar intradialítica. J Bras Nefrol 2017;39(3):275-82. https://doi.org/10.5935/0101-2800.20170051
21. Parker K. Intradialytic exercise is medicine for hemodialysis patients. Curr Sports Med Rep. 2016;15(4):269-75. https://doi.org/10.1249/JSR.0000000000000280
22. Bogataj Š, Pajek M, Pajek J, Ponikvar JB, Paravlic AH. Exercise-Based Interventions in Hemodialysis Patients: A Systematic Review with a Meta-Analysis of Randomized Controlled Trials. J Clin Med. 2019;9(1):43. https://doi.org/10.3390/jcm9010043
23. Kanbay M, Ertuglu LA, Afsar B, Ozdogan E, Siriopol D, Covic A, et al. An update review of intradialytic hypotension: concept, risk factors, clinical implications and management. Clin Kidney J. 2020;13(6):981-93. https://doi.org/10.1093/ckj/sfaa078
24. Thompson S, Klarenbach S, Molzahn A, Lloyd A, Gabrys I, Haykowsky M, et al. Randomised factorial mixed method pilot study of aerobic and resistance exercise in haemodialysis patients: 20 Dialy-size!. BMJ Open. 2016;6(9):e012085. https://doi.org/10.1136/bmjopen-2016-012085
25. van de Vegte YJ, Tegegne BS, Verweij N, Snieder H, van der Harst P. Genetics and the heart rate response to exercise. Cell Mol Life Sci. 2019;76(12):2391-409. https://doi.org/10.1007/s00018-019-03079-4
26. Wonisch M, Hofmann P, Fruhwald FM, Kraxner W, Hodl R, Pokan R, et al. Influence of beta-blocker use on percentage of target heart rate exercise prescription. Eur J Cardiovasc Prev Rehabil. 2003;10(4):296-301. https://doi.org/10.1097/00149831-200308000-00013
27. Cheng JC, Chiu CY, Su TJ. Training and Evaluation of Human Cardiorespiratory Endurance Based on a Fuzzy Algorithm. Int J Environ Res Public Health. 2019;16(13):2390. https://doi.org/10.3390/ijerph16132390
28. Hu H, Wu C, Kwok JYY, Ho MH, Chau PH, Lok KYW, et al. Effects of Different Exercises on Physical Function, Dialysis Adequacy, and Health-Related Quality of Life in Maintenance Hemodialysis Patients: A Systematic Review and Network Meta-Analysis. Am J Nephrol. 2023;54(9-10):379-90. https://doi.org/10.1159/000532109
29. Ferrari F, Andrade FP, Teixeira MS, Ziegelmann PK, Carvalho G, Bittencourt ESS, et al. Efficacy of six exercise-based interventions for individuals undergoing hemodialysis: a network meta-analysis of randomized clinical trials. Nephrol Dial Transplant. 2023;38(10):2389-406. https://doi.org/10.1093/ndt/gfad083
30. Parsons TL, Toffelmire EB, King-VanVlack CE. Exercise training during hemodialysis improves dialysis efficacy and physical performance. Arch Phys Med Rehabil. 2006;87(5):680-87. https://doi.org/10.1016/j.apmr.2005.12.044
31. Maheshwari V, Samavedham L, Rangaiah GP, Loy Y, Ling LH, Sethi S, et al. Comparison of toxin removal outcomes in online hemodiafiltration and intra-dialytic exercise in high-flux hemodialysis: a prospective randomized open-label clinical study protocol. BMC Nephrol. 2012;13:156. https://doi.org/10.1186/1471-2369-13-156
32. Figoni SF. Exercise responses and quadriplegia. Med Sci Sports Exerc. 1993;25(4):433-41.
33. Kirkman DL, Roberts LD, Kelm M, Wagner J, Jibani MM, Macdonald JH. Interaction between Intradialytic Exercise and Hemodialysis Adequacy. Am J Nephrol. 2014;38(6):475-82. https://doi.org/10.1159/000356340
34. Pu J, Jiang Z, Wu W, Li L, Zhang L, Li Y, et al. Efficacy and safety of intradialytic exercise in haemodialysis patients: a systematic review and meta-analysis. BMJ Open. 2019;9(1):e020633. https://doi.org/10.1136/bmjopen-2017-020633
35. Banerjee P, Clark A, Witte K, Crowe L, Caulfield B. Electrical stimulation of unloaded muscles causes cardiovascular exercise by increasing oxygen demand. Eur J Cardiovasc Prev Rehabil. 2005;12(5):503-8. https://doi.org/10.1097/01.hjr.0000169188.84184.23
36. Harris S, LeMaitre JP, Mackenzie G, Fox KA, Denvir MA. A randomized study of home-based electrical stimulation of the legs and conventional bicycle exercise training for patients with chronic heart failure. Eur Heart J. 2003;24(9):871-8. https://doi.org/10.1016/S0195-668X(02)00822-9
37. Dobsak P, Novakova M, Fiser B, Siegelova J, Balcarkova P, Spinarova L, et al. Electrical stimulation of skeletal muscles. An alternative to aerobic exercise training in patients with chronic heart failure? Int Heart J. 2006;47(3):441-53. https://doi.org/10.1536/ihj.47.441