Exercise training for adults having maintenance dialysis

In this blog for people with chronic kidney disease having maintenance dialysis, Dr Rebecca Gould, Cochrane UK Fellow and Sports and Exercise Medicine Registrar, looks at recent evidence on exercise in adults having dialysis.

Take-home points

Physical activity is recommended for most people who have chronic kidney disease, including those having maintenance dialysis. Some people having maintenance haemodialysis are concerned that exercise may cause tiredness or pain and, if done during haemodialysis itself, risk damaging their fistula or intra-venous access. There is evidence that, for some people having maintenance haemodialysis, exercise programmes probably improve symptoms of depression and capacity to perform activities and tasks. They may also improve some aspects of quality of life and may reduce fatigue. Some people having dialysis may have questions about exercise, safety and how to look after their access (fistula, intra-venous or peritoneal catheter depending on the type of dialysis) during exercise. Local dialysis teams and charities are a good source of advice and support.

Physical activity is recommended for people with chronic kidney disease, including those who have dialysis. However, many people find it challenging to be active. In the UK, around 60% of the general adult population are ‘active’. That is, they meet the recommended guidelines of at least 150 minutes of moderate-intensity physical activity per week.  This number tends to be lower in people with long-term conditions. Among people with chronic kidney disease, around 6% of those having haemodialysis (HD), and 8% of those having peritoneal dialysis (PD) are thought to be active.

When people having dialysis have been asked their views of exercise, many thought it would be good for them and were interested in exercising during HD.  Their concerns included tiredness, muscle fatigue, risk of damaging their fistula or intravenous access and movement setting off the haemodialysis machine alarm.

Evidence on exercise in people having dialysis

A Cochrane Review has looked at the effect of exercise programmes in adults having maintenance dialysis compared to no or sham exercise (published January 2022). This review included eighty-nine randomised controlled trials, with over 4000 people.

Most people in the trials were having HD (often during the HD treatment itself). The exercise programmes that were included varied, were done three times a week and lasted 20 to 40 minutes. The exercise programmes lasted for at least 8 weeks. Most involved aerobic exercise alone (such as peddling on an exercise bike). Other trials included strength exercises only (such as using dumbbells or resistance bands), or a combination of the two exercise types.

Evidence on the potential benefits of exercise

When looking at all the different types of exercise programmes together, the review authors found that exercise programmes:

  • probably improve symptoms of depression, particularly if the exercise lasts for more than four months
  • probably improve functional capacity. (The ability to perform activities and tasks through an improvement in walking, and the strength and endurance of the leg muscles)
  • may also slightly improve some aspects of quality of life. (The ability to be active, go to work, or do day-to-day activities)
  • may slightly reduce fatigue and pain. It is worth noting though that a small proportion of people had pain or soreness and more fatigue.

Is it safe to exercise?

The Cochrane Review can’t tell us much about safety. This is because unwanted effects or harms of exercise were not accurately recorded in many studies. However, in 7 of the 9 studies that reported on harms, there were none.

There are a number of known safety considerations for exercise programmes:

Safety considerations for people starting haemodialysis (HD)

  • The Renal Association advise that exercise programmes should not be started within the first three months of starting HD.

Safety considerations for people with a peritoneal (PD) catheter

  • For people who have recently had a PD catheter inserted, the International Society for Peritoneal Dialysis recommends activities that increase the pressure within the tummy (for example lifting more than 5-10kg in weight, sit-ups or jumping) should be avoided for 4-6 weeks, but it is safe to start walking straight away.
  • It is also recommended that PD fluid is drained before activities which involve an increase in tummy pressure, or lots of bending forward. Some people may prefer to drain the fluid before other activities for comfort.
  • Keeping the PD catheter insertion site healthy is important; it is advised to cover the area with a water-proof dressing during water-based activity. Clean the site after it gets wet (water or sweat).
  • Using a breathable dressing (like gauze), and/or taping the catheter down during more vigorous activity, can reduce the risk of friction damage to the surrounding skin and damage to the catheter insertion.

General safety considerations

More generally, there are some medical conditions where it may be temporarily unsafe to exercise. For example, severe infection, recent heart attack or unstable angina. Uncontrolled heart failure, uncontrolled arrhythmias, very high blood pressure or severe aortic stenosis are other reasons why people may not be able to exercise until they receive treatment for these conditions.

If you’re having dialysis and are thinking about being (more) active

Speaking to a member of your dialysis team, such as a nurse, physiotherapist, or doctor, can be a good way to find out more about exercise, during or in between treatment, and discuss any worries you may have.

Speaking to other people, who have had similar experiences, can also be very useful. In addition to their helplines, some UK-based charities also have peer support schemes including Kidney Care UK’s Young Adult Kidney Group (for people aged 18 to 30) and National Kidney Federation (for home dialysis). Your local dialysis department may also have a formal peer support network.

Physical activity resources for people with chronic kidney disease

  • Kidney Care UK, Kidney Research UK and National Kidney Federation are UK-based charities that provide information on physical activity for people living with chronic kidney disease.
  • MOVE ProjectProduced by Bangor University and the Wales Kidney Research Unit, the MOVE project has produced resources, including a booklet and videos, to support people having HD to become more active.
  • We are undefeatable  a campaign from 16 leading health and social care charities, backed by Sport England, designed to inspire, and motivate people living with long-term conditions to get active in a way that’s right for them.

References (pdf)

With thanks to Holly Loughton for her input. Holly blogs about living with chronic kidney disease on her blog ‘Secondhand Life’.

Join in the conversation on Twitter with @CochraneUK and @DrRebeccaGould or leave a comment on the blog. 

Please note, we cannot give specific medical advice. We do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion. However, we ask that comments are respectful. We reserve the right to not publish any we consider offensive. Cochrane UK does not fact check – or endorse – readers’ comments, including any treatments mentioned.

Rebecca has nothing to disclose.

Exercise training for adults having maintenance dialysis by Rebecca Gould

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

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