Exercise in patients on dialysis: A multicenter, randomized clinical trial

Abstract

Previous studies have suggested the benefits of physical exercise for patients on dialysis. We conducted the Exercise Introduction to Enhance Performance in Dialysis trial, a 6-month randomized, multicenter trial to test whether a simple, personalized walking exercise program at home, managed by dialysis staff, improves functional status in adult patients on dialysis. The main study outcomes included change in physical performance at 6 months, assessed by the 6-minute walking test and the five times sit-to-stand test, and in quality of life, assessed by the Kidney Disease Quality of Life Short Form (KDQOL-SF) questionnaire. We randomized 296 patients to normal physical activity (control; n=145) or walking exercise (n=151); 227 patients (exercise n=104; control n=123) repeated the 6-month evaluations. The distance covered during the 6-minute walking test improved in the exercise group (mean distance6SD: baseline, 328696 m; 6 months, 3676113 m) but not in the control group (baseline, 3216107 m; 6 months, 3246116 m; P,0.001 between groups). Similarly, the five times sit-to-stand test time improved in the exercise group (mean time6SD: baseline, 20.566.0 seconds; 6 months, 18.265.7 seconds) but not in the control group (baseline, 20.965.8 seconds; 6 months, 20.266.4 seconds; P=0.001 between groups). The cognitive function score (P=0.04) and quality of social interaction score (P=0.01) in the kidney disease component of the KDQOL-SF improved significantly in the exercise arm compared with the control arm. Hence, a simple, personalized, home-based, low-intensity exercise program managed by dialysis staff may improve physical performance and quality of life in patients on dialysis.