Effect of intradialytic exercise on bone profile in hemodialysis patients

Abstract

Background: Chronic kidney disease increases the risk of fractures and altered bone and mineral metabolism. Exercise training could be a non-pharmacological therapeutic intervention. The aim of this work is to evaluate the effect of intradialytic exercise training on bone markers in hemodialysis (HD) patients. Results: Forty adult patients on regular HD participated in the study. Twenty of which completed 3 months supervised intradialytic cycling exercise program and 20 served as controls. At baseline, there was no difference between both groups regarding age, sex, physical performance, and laboratory studies performed. After 3 months, the exercise group showed significant improvement in short performance battery test (SPBT) total score (P<0.001) associated with significant decrease in serum parathormone (PTH) (P=0.01) and increase in serum alkaline phosphatase (ALP) and bone specific alkaline phosphatase (BALP) (P<0.05 and P<0.001 respectively). Controls did not show similar change in SPBT or laboratory studies. There was no significant change in serum calcium or phosphorus in both groups. A significant positive correlation was observed between SPBT scores post-exercise and both BALP and ALP levels (r=0.432, P=0.01 and r=0.645, P<0.01 respectively). Also, an inverse relation was observed between SPBT and PTH (r=−0.503, P=0.01). Conclusion: Intradialytic cycling exercise program resulted in significant increase in physical performance associated with decrease in serum PTH and increase in BALP and ALP in HD patients. This indicates the positive influence of exercise not only on physical performance in dialysis patients but also on bone metabolism.