Exercise interventions for improving objective physical function in patients with end-stage kidney disease on dialysis: A systematic review and meta-analysis

BACKGROUND: Patients with end stage kidney disease on dialysis have increased mortality and reduced physical activity contributing to impaired physical function. While exercise programmes have demonstrated a positive effect on physiological outcomes such as cardiovascular function and strength, there is a reduced focus on physical function. The aim of this review was to determine whether exercise programmes improve objective measures of physical function indicative of activities of daily living for end stage kidney disease patients on dialysis. METHODS: A systematic search of Medline, Embase, Cochrane Central Register of Controlled Trials, and CINAHL, identified 27 randomised control trials. Only randomised control trials utilising an exercise intervention or significant muscular activation in the intervention, a usual care, non-exercising control group, and at least one objective measure of physical function was included. Participants were ≥18 years of age, with end stage kidney disease, undergoing haemo- or peritoneal dialysis. Systematic review of the literature and quality assessment of the included studies used the Cochrane Collaboration's tool for assessing risk bias. A meta-analysis was completed for the six-minute walk test. RESULTS: Data from 27 studies with 1156 participants showed exercise, regardless of modality, generally increased six-minute walk test distance, sit-to-stand time or repetitions, grip strength, as well as step and stair climb times or repetitions, dynamic mobility, and short physical performance battery scores. CONCLUSION: From the evidence available, exercise, regardless of modality, improved objective measures of physical function for end stage kidney disease patients undergoing dialysis. It is acknowledged that further well-designed RCTs are required.