| Objective: Maintenance hemodialysis(MHD)patients is growing rapidly around the world.With the progress made in hemodialysis technology,the life expectancy of patients on MHD has dramatically increased.However,the overall mortality and quality of life in this population are far from satisfaction.Besides,the level of physical activity is very low in MHD patients,which could increase the risk of death in MHD patients.Kinesitherapy referred to improving the physical function of MHD patients through training,and studies have suggested that intradialytic exercise can improve the physical function and psychological condition,and even reduce the mortality of MHD patients,but the role remains controversial.We aimed to systematically review the efficacy and safety of intradialytic exercise for hemodialysis patients.Methods:We searched databases including CNKI,China Biology Medicine,Pubmed,Embase,The Cochrane library(March,2017).The eligibility criteria is randomized controlled trials(RCTs)aiming at comparing the efficacy and safety of intradialytic exercise versus no exercise in adult patients on hemodialysis.Two reviewers screened the literature independently according to eligibility criteria.Data concerning the literature of year,country and author,articipant characteristic,exercise protocol,outcomes,adverse events and study design were extracted.Cochrane risk of bias summary and improved Jadad Scale were used respectively to evaluate the bias risk and quality of the literature.Statistical analyses were calculated by Review Manager 5.3.Heterogeneity of studies was assessed by I 2and P,which was the basis that we select random effects model or fixed effect model.Sensitivity analysis was conducted for all outcomes.Results:Twenty seven randomized controlled trials(RCTs)with 1215 patients were included,including exercise group 636 and control group 579.Compared with no exercise,intradialytic exercise increased KT/V [MD=0.07,95%CI(0.01,0.12),P=0.02] and VO2 peak [MD=4.11,95%CI(2.94,5.27),P<0.0001],relieved depression[SMD=-1.16,95%CI(-1.86,-0.45),P=0.001] and improved physical component summary-SF-36 level [MD=7.72,95%CI(1.93,13.51),P=0.009].Moreover,intradialytic exercise could significantly reduce systolic blood pressure [MD=-4.87,95%CI(-9.20,-0.55),P=0.03] and diastolic blood pressure [MD=-4.11,95%CI(-6.50,-1.72),P=0.0007].Aslo,intradialytic exercise advanced 6-min walk distance [MD=61.81,95%CI(34.97,88.65),P<0.00001].However,intradialytic exercise could not improve mental component summary-SF-36 level[MD=3.05,95%CI(-1.47,7.57),P=0.19],hemoglobin level [MD=0.01,95%CI(-0.13,0.16),P=0.88],albumin level [SMD=0.01,95%CI(-0.29,0.31),P=0.95],serum phosphorus [SMD=-0.03,95%CI(-0.26,0.21),P=0.82] and cholesterol [SMD=-0.13,95%CI(-0.39,0.13),P=0.33].There was no difference in the incidence of adverse events between two groups.All the results was conducted for sensitivity analysis,and there was no difference.Conclusion:Intradialytic exercise exhibited benefits in improving hemodialysis adequacy,exercise capacity,blood pressure,depression and quality of life for hemodialysis patients with a good tolerance.Since the limitation of quality of included studies,high quality and large scale RCTs are conducted for further verification. |
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