Systematic Review of Exercise Training and Musculoskeletal Health in Dialysis Patients

Abstract Background Exercise is often recommended for dialysis patients, but uncertainty remains regarding its benefit on musculoskeletal and nutritional outcomes. Methods We conducted a systematic review and random-effects meta-analysis of randomized controlled trials (RCTs) comparing structured exercise (aerobic, resistance, or combined) with usual care, sham, or placebo in dialysis patients. Searches of PubMed, Scopus, and Embase were performed in May 2025 without language or date limits. Primary outcomes included muscle mass, muscle strength (handgrip strength [HGS]), and physical performance (6-minute walk test [6MWT], sit-to-stand test [STS], Short Physical Performance Battery [SPPB], timed up and go test [TUG]). Secondary outcomes were nutritional indicators (serum albumin, body mass index [BMI], cholesterol), and health-related quality of life (SF-36 score). Results Thirty-one RCTs including 2,535 patients were analyzed. Exercise significantly improved muscle strength and physical performance (HGS +2.21 kg; 6MWT +48.2 m; 60sSTS +4.96 repetitions), exceeding minimal clinically important differences. Gains were consistent across SPPB, TUG, STS-5, and STS-10. However, no significant effects were observed on muscle mass or nutritional markers (serum albumin, BMI, cholesterol). Quality of life improved in physical domains but not consistently in the SF-36 mental component score. No publication bias was detected except for the SF-36 domain. Conclusion Exercise training in dialysis patients significantly improves strength, functional capacity, and physical quality of life but does not increase muscle mass or alter nutritional markers. These findings reinforce structured exercise as an evidence-based adjunct to dialysis care and highlight the need for complementary nutritional and anti-inflammatory strategies to more effectively target sarcopenia