Effects of intradialytic exercise on physical and psychological outcomes in patients undergoing hemodialysis: A systematic review
https://doi.org/10.52235/lp.v7i3.815
Keywords:
hemodialysis, intradialytic exercise, physical function, psychological outcomes, quality of lifeAbstract
Background: Patients undergoing maintenance hemodialysis frequently experience physical and psychological problems, including fatigue, reduced functional capacity, muscle weakness, anxiety, stress, depression, and a decline in quality of life. These conditions are influenced by chronic kidney disease, long-term hemodialysis, limitations in physical activity, and dependence on dialysis therapy. Intradialytic exercise, defined as physical exercise performed during a hemodialysis session, is a nonpharmacological intervention with the potential to improve patients' physical and psychological conditions.
Objective: To evaluate the effectiveness of intradialytic exercise on physical and psychological outcomes in patients undergoing hemodialysis.
Methods: This systematic review was conducted in accordance with the PRISMA guidelines and was registered in PROSPERO under registration number CRD420261386106. Literature searches were conducted in PubMed, ScienceDirect, Scopus, Web of Science, and CINAHL. Articles published from 2020 to 2026 were searched, with the final search conducted in May 2026. The included studies were quantitative studies, primarily randomized controlled trials, quasi-experimental studies, or other intervention studies that evaluated exercise performed during hemodialysis and reported physical and/or psychological outcomes. Study selection, data extraction, and quality assessment were performed independently by the reviewers. A total of 18 studies met the inclusion criteria and were analyzed in this systematic review.
Results: The synthesis showed that intradialytic exercise had positive effects on physical outcomes, including improvements in functional capacity, muscle strength, activity tolerance, and physical performance, as well as reductions in fatigue. Several studies also reported improvements in psychological outcomes, including reductions in anxiety, stress, and depression and improvements in quality of life.
Conclusion: Intradialytic exercise may be an effective nonpharmacological intervention for improving physical and psychological outcomes in patients undergoing hemodialysis, while taking into account each patient's clinical condition, safety, and individual capabilities.
Downloads
References
Agustin, W. R., Safitri, W., Kurniasari, D., Setiyawan, M., Murharyati, A., & Fitriana, R. N. (2022). Intradialytic exercise on changes in blood pressure in chronic kidney failure patients during hemodialysis therapy. Open Access Macedonian Journal of Medical Sciences, 10(G), 1–5. https://doi.org/10.3889/oamjms.2022.7271
Ali, N. H., Eltokhy, H. M., Hassan, M. A., & El-Nahas, N. G. (2020). Effect of intradialytic exercise on quality of life of patients with end-stage renal disease on hemodialysis. The Scientific Journal of Al-Azhar Medical Faculty, Girls, 4, 365–372.
Anding-Rost, K., von Gersdorff, G., von Korn, P., Ihorst, G., Josef, A., Kaufmann, M., Huber, M., Bär, T., Zeißler, S., Hofling, S., Breuer, C., Gärtner, N., Haykowsky, M. J., Degenhardt, S., Wanner, C., & Halle, M. (2023). Exercise during hemodialysis in patients with chronic kidney failure. NEJM Evidence, 2(9), EVIDoa2300057. https://doi.org/10.1056/EVIDoa2300057
Baiao, V. M., Duarte, M. P., Cunha, V. A., Dourado, G. Í., Leal, D. V., Viana, J. L., Inda-Filho, A. J., Nóbrega, O. T., Ferreira, A. P., & Ribeiro, H. S. (2023). Intradialytic resistance training for short daily hemodialysis patients as part of the clinical routine: A quasi-experimental study. Frontiers in Aging, 4, 1130909. https://doi.org/10.3389/fragi.2023.1130909
Baker, L. A., March, D. S., Wilkinson, T. J., Billany, R. E., Bishop, N. C., Castle, E. M., Chilcot, J., Davies, M. D., Graham-Brown, M. P. M., Greenwood, S. A., & Smith, A. C. (2022). Clinical practice guideline exercise and lifestyle in chronic kidney disease. BMC Nephrology, 23, 75.
Battaglia, Y., Cozzolino, M., & Cupisti, A. (2024). Exercise and rehabilitation in chronic kidney disease patients undergoing hemodialysis. Journal of Nephrology, 37(2), 245–258. https://doi.org/10.1007/s40620-024-02049-9
Bogataj, Š., Pajek, M., Pajek, J., & Kovačič, T. (2024). Randomized controlled trial of intradialytic cognitive and physical training in patients undergoing hemodialysis. Kidney Medicine. https://doi.org/10.1016/j.xkme.2024.100934
Boukadida, R., Saadaoui, M., Thabet, N., Olfa, M., Asma, F., Nouir, S., Sahtout, W., Ben Aicha, N., Azzabi, A., Guedri, Y., Laatiri, I., Mrabet, S., & Zellama, D. (2026). The effect of intradialytic resistance exercise on physical function and dialysis adequacy in patients on maintenance hemodialysis. PLOS ONE, 21(3), e0337910. https://doi.org/10.1371/journal.pone.0337910
Chung, Y. C., Yeh, M. L., & Liu, Y. M. (2017). Effects of intradialytic exercise on the physical function, depression and quality of life for haemodialysis patients: A systematic review and meta-analysis of randomised controlled trials. Journal of Clinical Nursing, 26(13–14), 1801–1813.
Elghoneimy, H. A., El-Deeb, A. E., Younis, G. A. E.-L., Abd El-Kader, M. M., & El-Wakil, H. S. (2022). The effect of intradialytic aerobic training on physical performance and quality of life among hemodialysis patients. Journal of the Egyptian Society of Nephrology and Transplantation, 22, 86–96.
Feng, X., Sun, J., Wang, Z., Zhang, N., Liu, Y., Wang, Z., Wang, N., Jian, G., Cheng, D., Sheng, X., & Ma, Y. (2025). The impact of intradialytic elastic band exercise on physical and cognitive abilities in patients on maintenance hemodialysis: A randomized controlled trial. Renal Failure, 47(1), 2482124. https://doi.org/10.1080/0886022X.2025.2482124
Garritty, C., Gartlehner, G., Nussbaumer-Streit, B., King, V. J., Hamel, C., Kamel, C., Affengruber, L., & Stevens, A. (2021). Cochrane Rapid Reviews methods group offers evidence-informed guidance to conduct rapid reviews. Journal of Clinical Epidemiology, 130, 13–22.
Honda, Y., Uchida, S., & Shibagaki, Y. (2026). Duration-stratified effects of exercise therapy on health-related quality of life in patients undergoing hemodialysis: A systematic review and meta-analysis. Renal Replacement Therapy.
Jiang, H., Wang, Y., Peng, J., Wu, S., & Wu, C. (2025). The efficacy of different types of intradialytic exercise for patients undergoing hemodialysis: A systematic review and network meta-analysis of randomized controlled trials. BMC Nephrology, 26, 450. doi:10.1186/s12882-025-04381-z.
KDIGO CKD Work Group. (2024). KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International, 105(4S), S117–S314. https://doi.org/10.1016/j.kint.2023.10.018
Kim, S., Park, H.-J., & Yang, D.-H. (2022). An intradialytic aerobic exercise program ameliorates frailty and improves dialysis adequacy and quality of life among hemodialysis patients: A randomized controlled trial. Kidney Research and Clinical Practice, 41(4), 462–472. https://doi.org/10.23876/j.krcp.21.284
Kimmel, P. L. (2007). Quality of life in chronic kidney disease: CKD, ESRD, anemia and erythropoietin. Seminars in Nephrology, 26(1), 68–79.
Lakshmi, Y., Sasikala, D., & Varughese, S. (2024). The effect of intradialytic aerobic exercise on dialysis parameters and fatigue in hemodialysis patients: A non-randomized interventional study. Cureus, 16(6), e62498. https://doi.org/10.7759/cureus.62498
Li, J., Li, Y., Shi, W., Guo, Q., Yang, Q., & Chu, Z. (2026). Effects of exercise training on depression, anxiety, and physical health-related quality of life in end-stage renal disease patients receiving maintenance hemodialysis: A systematic review and meta-analysis of randomized controlled trials. Frontiers in Public Health, 14, 1788845. doi:10.3389/fpubh.2026.1788845.
Li, X., Liu, Y., Zhang, H., Chen, J., & Wang, L. (2025). Intradialytic exercise interventions to enhance physical activity levels in hemodialysis patients: A systematic review and meta-analysis. American Journal of Nephrology. doi:10.1159/000548114.
Lin, C. H., Hsu, Y. H., & Chen, H. J. (2022). Effects of intradialytic exercise on physical function, dialysis adequacy, and quality of life in hemodialysis patients. Healthcare, 10(4), 667.
Lin, C. Y., Hsu, Y. H., & Chen, H. J. (2022). Exercise interventions and psychological outcomes in patients with chronic kidney disease: A systematic review. International Journal of Environmental Research and Public Health, 19(12), 7321. https://doi.org/10.3390/ijerph19127321
Mavrommatis, A., Papageorgiou, D., & Theodorou, G. (2025). The effect of intradialytic exercise on cognition in renal patients undergoing hemodialysis: A systematic review. Healthcare, 13(23), 3016.
Michou, V., Davioti, M., Syrakou, N., Liakopoulos, V., Deligiannis, A., & Kouidi, E. (2023). Effects of a combined intradialytic exercise training program on functional capacity and body composition in kidney transplant candidates. Journal of Functional Morphology and Kinesiology, 8(1), 9. https://doi.org/10.3390/jfmk8010009
Moeinzadeh, F., Shahidi, S., & Shahzeidi, S. (2022). Evaluating the effect of intradialytic cycling exercise on quality of life and recovery time in hemodialysis patients: A randomized clinical trial. Journal of Research in Medical Sciences, 27, 84.
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71.
Pu, J., Jiang, Z., Wu, W., Li, L., Zhang, L., Li, Y., Liu, Q., & Ou, S. (2019). Efficacy and safety of intradialytic exercise in haemodialysis patients: A systematic review and meta-analysis. BMJ Open, 9(1), e020633.
Rossum, K., Hancock, E., Thompson, S., Brar, R., Riehl-Tonn, V., Garcia, E., Leon, S. J., Sharma, M., Ford, E., Komenda, P., Rigatto, C., Tangri, N., MacRae, J. M., & Bohm, C. (2023). A randomized trial examining the impact of timing of intradialytic cycling on intradialytic hypotension. Kidney International Reports, 8(5), 1002–1012. https://doi.org/10.1016/j.ekir.2023.02.1074
Sefidgaran, A., Mehrad-Majd, H., Taravati, H., Dolatabadian, N., & Hami, M. (2024). Effect of intradialytic aerobic exercise on dialysis adequacy, inflammatory, biochemical markers and quality of life: A double-blind randomized clinical trial study. Journal of Renal Endocrinology, 10, e25164. https://doi.org/10.34172/jre.2024.25164
Shehata, A. M., Zaki, W. E., Ali, H. A., & Weheida, S. M. (2026). Effect of nurse-led intradialytic stretching exercises on muscle cramp burden among patients undergoing maintenance hemodialysis: A randomized controlled trial. BMC Nursing, 25, 333. https://doi.org/10.1186/s12912-026-04430-4
Shrivastava, A., & Sakhardande, V. (2022). A quasi-experimental study to assess the effectiveness of intradialytic aerobic exercises on muscle cramps among patients undergoing haemodialysis. International Journal of Health Sciences, 6(S5), 5971–5975. https://doi.org/10.53730/ijhs.v6nS5.10014
Tabibi, M. A., Cheema, B., Salimian, N., Corrêa, H. de L., & Ahmadi, S. (2023). The effect of intradialytic exercise on dialysis patient survival: A randomized controlled trial. BMC Nephrology, 24, 100. https://doi.org/10.1186/s12882-023-03158-6
Takahashi, R., Yabe, H., Ishikawa, H., Hibino, T., Suzumura, A., & Yamada, T. (2025). The impact of intradialytic exercise on activities of daily living and physical function in hospitalized hemodialysis patients: A study of efficacy and safety. Journal of UOEH, 47(1), 1–12.
Uchida, D., Honda, H., & Kato, S. (2026). Potential effects of intradialytic exercise therapy on physical performance in hemodialysis patients based on the intervention period: A systematic review and meta-analysis. Renal Replacement Therapy.
Wahida, A. Z., Rumahorbo, H., & Murtiningsih. (2023). The effectiveness of intradialytic exercise in ameliorating fatigue symptoms in patients with chronic kidney failure undergoing hemodialysis: A systematic literature review and meta-analysis. Journal of Taibah University Medical Sciences, 18(3), 512–525. https://doi.org/10.1016/j.jtumed.2022.11.004
Yabe, H., Kono, K., Yamaguchi, T., Ishikawa, Y., Yamaguchi, Y., & Azekura, H. (2021). Effects of intradialytic exercise for advanced-age patients undergoing hemodialysis: A randomized controlled trial. PLOS ONE, 16(10), e0257918. https://doi.org/10.1371/journal.pone.0257918
Zou, Z. H., Zhang, J. Q., Yi, Z. H., Chen, X., & Qing, W. (2025). Effects of intradialytic exercise on frailty in maintenance hemodialysis patients: A systematic review and meta-analysis. Frontiers in Physiology, 16, 1600219. https://doi.org/10.3389/fphys.2025.1600219
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Indra Frana Jaya KK, Novi Yanti S, Ayu Prawesti Priambodo
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
