Effectiveness of Resistance Intradialytic Exercise Compared to Aerobic Intradialytic Exercise for Patients With Chronic Kidney Disease: A Randomized Controlled Clinical Trial

BACKGROUND: Patients with chronic kidney disease undergoing hemodialysis commonly experience reduced physical function, fatigue, poor sleep quality, and impaired health-related quality of life. Intradialytic exercise has been proposed as a non-pharmacological strategy to improve these outcomes. METHODS: Randomized clinical trial with 35 hemodialysis patients randomly allocated to a resistance group (RG) or aerobic group (AG). Exercises were performed during hemodialysis for 12 weeks. The primary outcome was handgrip strength (HGS). Secondary outcomes included the 30-second sit-to-stand test (30sec-STS), gait speed (GS), frailty, fatigue, sleep quality, and health-related quality of life (HRQL). RESULTS: In intragroup analyses, RG improved HGS (MD: 2.4; 95% CI: 0.3-4.5), 30sec-STS, GS, mental fatigue, and sleep quality, whereas AG improved 30sec-STS, GS, and HRQL measured by EQ-VAS. In intergroup analyses, AG was more effective than RG in reducing general fatigue (MD: 2.2; 95% CI: 0.4-4.0) and improving HRQL utility (MD: -0.04; 95% CI: -0.10 to -0.04). No significant between-group differences were observed for HGS or the other outcomes. No adverse events or harms were reported. CONCLUSIONS: Resistance and aerobic intradialytic exercise were both feasible and safe. Resistance exercise improved handgrip strength within-group; however, no significant between-group difference was observed for handgrip strength (the primary outcome). Aerobic exercise was more effective in improving general fatigue and health-related quality of life.