Impact of intradialytic physical activity in patients on chronic hemodialysis: a systematic review

Sergio Pereira, Servicio de Nefrología, CASMU, Hospital de Clínicas, Facultad de Medicina, Universidad de la República. Montevideo, Uruguay
Ricardo Silvariño, Unidad Académica de Nefrología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República. Montevideo, Uruguay

Chronic kidney disease and hemodialysis are strongly associated with sedentary behavior, muscle loss, and functional decline, all of which increase frailty, cardiovascular risk, and mortality. Intradialytic exercise has emerged as a promising strategy to counteract this deconditioning. This systematic review analyzed studies published between 2000 and 2024 that compared exercise programs performed during hemodialysis sessions with non-intervention controls. A total of 34 studies involving 1,110 patients were identified. Overall, aerobic, resistance, combined, and other exercise modalities consistently improved lower-limb strength, physical performance measured by the Short Physical Performance Battery, and distance covered in the Six-Minute Walk Test. Several studies also reported increases in muscle mass, improvements in nutritional markers such as albumin and hematologic parameters, and reductions in inflammatory markers. Intradialytic exercise was safe, well tolerated, and associated with high adherence, with no serious adverse events reported. Although methodological heterogeneity limits direct comparisons across studies, the global evidence is robust and coherent: intradialytic exercise is both effective and feasible, providing functional, nutritional, inflammatory, and cardiovascular benefits. It should be integrated into standard hemodialysis care, while future research should define optimal exercise dosing and clarify its impact on hard clinical outcomes.

Keywords: Chronic kidney disease. Chronic hemodialysis. Intradialytic exercise. Muscle strength. Quality of life.