Effects of intradialytic exercise on frailty in maintenance hemodialysis patients: a systematic review and meta-analysis

Abstract

Background: The pooled prevalence of frailty in maintenance hemodialysis patients is increasing, and research on the effects of intradialytic exercise to improve frailty remains limited. Objectives: To analyze the effects of intradialytic exercise on frailty in maintenance hemodialysis patients through randomized clinical trials and quasi-experimental studies. Methods: We performed a comprehensive literature search in PubMed, Embase, Web of Science, and Cochrane Library, and English-language publications were indexed from January 2010 to August 2024. Statistical analyses were performed using Review Manager V.5.3 and STATA 15.0. Statistical heterogeneity among studies was quantified using the Chi-square and I-square tests, and publication bias was evaluated using Egger’s test and funnel plots. Results: 31 studies involving 1,365 maintenance hemodialysis patients were included. The data from the meta-analysis showed that intradialytic exercise significantly reduced frailty score (MD = −0.98, 95%CI: 1.90 to −0.06, p = 0.04) and fatigue (SMD = −0.47, 95%CI: 0.72 to −0.23, p = 0.0001). Also, intradialytic exercise significantly increased grip strength (MD = 2.42, 95%CI:0.78 to 4.06, p = 0.004), 6-min walking distance (MD = 36.65, 95%CI:24.90 to 48.39, p < 0.0001), and step counts (SMD = 0.32, 95%CI:0.04 to 0.60, p = 0.03). However, no significant effects were found in body weight (MD = 0.71, 95%CI: 1.28 to 2.69, p = 0.48). Conclusion: Intradialytic exercise can significantly improve overall frailty and frailty indicators such as grip strength, 6-min walking distance, step counts, and fatigue. Thus, intradialytic exercises might be a viable strategy for frailty in maintenance hemodialysis patients. Systematic Review registration: CRD42024576582.