Background. To date, the impact of home-based exercise on physical performance and quality of life (QoL) in patients with end-stage kidney disease (ESKD) on maintenance dialysis have not been fully established. Methods. We searched four large electronic databases (up to August 13, 2022) to identify randomized controlled trials (RCTs) reporting the impact of home-based exercise interventions vs. usual care or intradialytic exercise interventions, on physical performance and QoL in ESKD patients on hemodialysis or peritoneal dialysis. The meta-analysis was performed using fixed effects modeling. Results. We included 12 unique RCTs involving a total of 791 individuals of various ages with ESKD on maintenance dialysis. Compared to usual care or intradialytic exercise interventions, home-based exercise interventions were associated with an improvement of walking speed at the 6 Minutes Walking Test (6MWT; 9 RCTs; pooled weighted mean differences [WMD]: 33.7 meters, 95% confidence interval [CI] 22.8 - 44.5; p<0.001; I2=0%) and in aerobic capacity as assessed by the peak oxygen consumption (VO2 peak; 3 RCTs; pooled WMD: 2.04 ml/kg/min, 95% CI 0.25 – 3.83; p=0.03; I2=0%). Home-based exercise interventions were also associated with improved QoL, as assessed by the Short Form (36) Health (SF-36) score. Stratifying the RCTs by control groups, no significant difference was found between home-based exercise and intradialytic exercise interventions. Funnel plots did not reveal any significant publication bias. Conclusions. The findings of this systematic review and meta-analysis showed that home-based exercise interventions from three to six months were associated with significant improvements in physical performance and QoL in patients on maintenance dialysis. Therefore, further randomized control studied wih a long follow-up should be conducted to assess the safety, the adherence, the feasibility, and the effect on QoL of home-based exercise programs in dialysis patients
Home-based exercise in patients on maintenance dialysis: a systematic review and meta-analysis of randomized clinical trials
YURI BATTAGLIA;Alessandro Mantovani;
2023-01-01
Abstract
Background. To date, the impact of home-based exercise on physical performance and quality of life (QoL) in patients with end-stage kidney disease (ESKD) on maintenance dialysis have not been fully established. Methods. We searched four large electronic databases (up to August 13, 2022) to identify randomized controlled trials (RCTs) reporting the impact of home-based exercise interventions vs. usual care or intradialytic exercise interventions, on physical performance and QoL in ESKD patients on hemodialysis or peritoneal dialysis. The meta-analysis was performed using fixed effects modeling. Results. We included 12 unique RCTs involving a total of 791 individuals of various ages with ESKD on maintenance dialysis. Compared to usual care or intradialytic exercise interventions, home-based exercise interventions were associated with an improvement of walking speed at the 6 Minutes Walking Test (6MWT; 9 RCTs; pooled weighted mean differences [WMD]: 33.7 meters, 95% confidence interval [CI] 22.8 - 44.5; p<0.001; I2=0%) and in aerobic capacity as assessed by the peak oxygen consumption (VO2 peak; 3 RCTs; pooled WMD: 2.04 ml/kg/min, 95% CI 0.25 – 3.83; p=0.03; I2=0%). Home-based exercise interventions were also associated with improved QoL, as assessed by the Short Form (36) Health (SF-36) score. Stratifying the RCTs by control groups, no significant difference was found between home-based exercise and intradialytic exercise interventions. Funnel plots did not reveal any significant publication bias. Conclusions. The findings of this systematic review and meta-analysis showed that home-based exercise interventions from three to six months were associated with significant improvements in physical performance and QoL in patients on maintenance dialysis. Therefore, further randomized control studied wih a long follow-up should be conducted to assess the safety, the adherence, the feasibility, and the effect on QoL of home-based exercise programs in dialysis patients
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