Exercise for the dialyzed - Aerobic and strength training during hemodialysis

Objective: To investigate the safety and feasibility of aerobic and strength training during hemodialysis for end-stage renal disease patients and to evaluate its impact on their cardiac fitness, muscle strength, and functional status. Design: A total of 22 patients undergoing hemodialysis for end-stage renal disease had assessment of their cardiac fitness with stress tests and walk tests, assessment of their muscle strength by one repetition maximum of knee extension, and assessment of their functional status by Medical Outcomes Study Short Form-36 before and after exercise training. Training, consisting of cycle ergometer exercise and strengthening of the knee extensors two to three times a week for 3 mo, was done during dialysis. Results: Eighteen of 22 patients completed 3 mo of training and four dropped out due to knee pain or medical complications unrelated to exercise. No patient developed major complications from the program. After training, there was a significant improvement in the mental and physical components of the Short Form-36 and one repetition maximum of knee extension. Among 14 of 18 patients who agreed and completed a follow-up fitness testing, five showed improvement on the stress tests and eight on the walk tests. Conclusions: A well designed exercise program during hemodialysis can be performed safely with proper supervision and patient education, improving muscle strength, mental and physical function, and possibly cardiac fitness.