EXERCISE IN HEMODIALYSIS

César Castaños Cuevas
Sep 28
4 min read

#minefroHD #minefroExerciseHD #hemodialysis

Many people on hemodialysis think exercise is impossible or dangerous. However, a growing body of research shows that movement and exercise have significant benefits , as long as they are done carefully and under medical supervision.

Below is a video of some clinic patients exercising:

What types of exercise are there?

Exercise during dialysis (intradialysis)
- It can be done on an adapted stationary bike or with bands while the patient is connected.
- Make the most of your session time.
- Most patients manage to do this with good consistency.
Exercise between dialysis sessions (interdialysis)
- It is performed at home or in a rehabilitation center.
- It can be walking, dancing, cycling, breathing exercises or strength training with light weights.
- It has greater benefits for the heart and lungs, but fewer patients are able to maintain it.

Proven benefits ✅

Scientific studies have found that exercise in hemodialysis patients:

Improves muscle strength and the ability to walk or climb stairs.
Helps maintain a healthy weight and reduce inflammation in the body.
It increases the quality of life, especially in the physical aspect.
It allows for greater independence: some patients have gone from needing a walker to being able to walk alone or go shopping.

Some studies also suggest that exercise may:

Protect the heart 🫀 by preventing it from growing too large or hardening.
Reduce the formation of cholesterol plaques in the arteries.

Is exercise harmful? 🚫

The scientific evidence is clear: no significant harm has been found when used with proper care. Care depends on:

The age of the patient .
Your nutritional status .
The type of vascular access (temporary catheter, permanent catheter, or fistula).

Therefore, it is always recommended that exercise be prescribed or supervised by a nephrologist or a physiotherapist specializing in kidney patients .

BEFORE STARTING TO READ THE TOPIC, YOU SHOULD HAVE NOTIONS ABOUT THE GENERALITIES OF HEMODIALYSIS (TO READ, CLICK HERE)

It's a somewhat controversial topic; for many unit-based dialysis patients, these achievements may seem like a fantasy, but there are multiple examples in the literature and data on the effects of exercise on multiple aspects of health for hemodialysis patients.

For patients treated with hemodialysis, "exercise" comes in many forms. Exercise during dialysis (intradialytic exercise), often on a modified bicycle, has the advantages of being convenient, making use of time otherwise lost, and having good adherence rates.

However, the potential cardiovascular adaptations may not be as impressive as when exercise is delivered between dialysis sessions (intradialytic exercise), potentially resulting in greater cardiopulmonary adaptations, but (as expected) adherence to such programs is poorer .

So, is there data that exercise improves things for hemodialysis patients? Well, yes, there is data, and some of it is quite good. Data from adequately powered randomized trials have shown us that a structured resistance training program improves strength, physical functioning, body weight and body composition, and reduces systemic inflammation in dialysis patients.

Furthermore, aerobic training between dialysis sessions significantly improves functional capacity. Systematic reviews have also suggested that exercise improves the physical component of quality of life for many patients, although this may not be true for all forms of exercise. These are all good things, and for me, they are sufficient on their own to encourage and support dialysis patients to participate in regular exercise programs and to support the delivery of exercise programs in dialysis units.

Questions remain, however. Does exercise improve cardiovascular health? Does it make you live longer? The answer to both questions is maybe. There are small studies suggesting that exercise during dialysis improves heart function, slows heart growth, and slows the formation of cholesterol plaque in the arteries, but these studies are small and, as the authors point out, underpowered to detect the differences they describe.

There is also no convincing data that exercise interventions improve mortality in dialysis patients. Importantly, none of the research on exercise in dialysis patients (in any form) has identified potential harm. SO IT DOESN'T HARM! WITH NECESSARY CARE, WHICH WILL DEPEND ON AGE, NUTRITIONAL STATUS, AND TYPE OF HEMODIALYSIS ACCESS (TEMPORARY OR PERMANENT CATHETER OR FISTULA).

What is clear to me (full disclosure, I have worked on a large randomized trial of exercise in dialysis patients for the past 4 years) is that for some patients, a structured exercise program is life-changing, and for some patients it is not. There are stories of people who were unable to climb stairs and patients who needed walkers to get from the car to the dialysis unit who were randomized to the exercise intervention in our study , and upon completing the program, are now able to go out and do their own shopping, take walks with their grandchildren, and walk their children to school.

These are powerful stories when heard firsthand, and in the absence of evidence to the contrary, they are, in and of themselves, sufficient for me to defend "exercise" as "good for dialysis patients." As in the general population (and even among nephrologists!), there are a number of patients who are simply not interested in participating in exercise, even when we tell them earnestly that it might be helpful. While there are definitely evidence gaps that need to be filled in this field overall, understanding and working through this—the human factor—is perhaps the most important of all.

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Conclusion

Exercising during hemodialysis is worth it : it improves strength, independence, and quality of life. Not all patients will be equally motivated to do it, but those who do have very positive stories: walking with their grandchildren, going to the store, or no longer relying on a walker.

Bottom line: Exercise doesn't hurt, it helps, and it can change the lives of many hemodialysis patients.