The Role of Physical Activity in Patients Undergoing Hemodialysis for Chronic Kidney Disease: Implications for Clinical Outcomes and Quality of Life - A Review
DOI:
https://doi.org/10.12775/JEHS.2026.89.69905Keywords
Physical activity, Chronic kidney disease, Hemodialysis, Mental health, Quality of lifeAbstract
Introduction and purpose: End-stage kidney disease represents a major health burden and is associated with reduced physical capacity and a significant decline in patients’ quality of life. Hemodialysis, which for many individuals remains the only life-sustaining treatment option, is accompanied by numerous health-related consequences, including fatigue, muscle weakness, reduced levels of physical activity, and impaired psychological well-being. The aim of this article was to summarize the current knowledge regarding the role of physical activity in the management of patients undergoing hemodialysis and to evaluate its potential impact on clinical outcomes and quality of life.
State of Knowledge: Regular physical activity in hemodialysis patients may contribute to improvements in physical performance, muscle strength, metabolic parameters, and overall functional capacity. An increasing number of studies also indicate that exercise can positively influence health-related quality of life and reduce depressive symptoms in this population. The most favorable outcomes are typically observed in training programs of moderate intensity lasting at least several weeks.
Conclusions: Physical activity appears to be a promising adjunctive component of therapy in patients undergoing hemodialysis, providing benefits for both physical and mental health. The incorporation of appropriately designed exercise programs into standard care for patients with chronic kidney disease may improve functional capacity, quality of life, and overall prognosis. Nevertheless, further research is needed to establish standardized and safe exercise strategies tailored to this patient population.
References
Couchoud C, Bouzille G, Piveteau J, Lassalle M, Lazareth H, Hamroun A, et al. The steps of constructing and validating an algorithm to identify chronic kidney disease patients in medical administrative databases. J Epidemiol Popul Health. 2026;74(2):203370. https://doi.org/10.1016/j.jeph.2026.203370
Drabczyk N. Przewlekła niewydolność nerek [Internet]. Medycyna Praktyczna; [cited 2026 Mar 12]. Available from: https://www.mp.pl/pacjent/nefrologia/choroby/chorobyudoroslych/51919,przewlekla-niewydolnosc-nerek
Rafferty Q, Stafford LK, Vos T, Thomé FS, Aalruz H, Abate YH, et al. Global, regional, and national prevalence of kidney failure with replacement therapy and associated aetiologies, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet Glob Health. 2025;13(8):e1378-e1395. https://doi.org/10.1016/S2214-109X(25)00198-6
National Health Service. Chronic kidney disease [Internet]. NHS; 2025 [cited 2026 Mar 12]. Available from: https://www.nhs.uk/conditions/kidney-disease/
Drawz P, Rahman M. Chronic kidney disease. Ann Intern Med. 2015;162(11):ITC1-ITC16. https://doi.org/10.7326/AITC201506020
Chen TK, Knicely DH, Grams ME. Chronic kidney disease diagnosis and management. JAMA. 2019;322(13):1294-1304. https://doi.org/10.1001/jama.2019.14745
National Kidney Foundation. Kidney failure [Internet]. National Kidney Foundation; [cited 2026 Mar 12]. Available from: https://www.kidney.org/kidney-topics/kidney-failure
Grinyó JM. Why is organ transplantation clinically important? Cold Spring Harb Perspect Med. 2013;3(6):a014985. https://doi.org/10.1101/cshperspect.a014985
Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D, et al. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant. 2011;11(10):2093-2109. https://doi.org/10.1111/j.1600-6143.2011.03686.x
Flythe JE, Watnick S. Dialysis for chronic kidney failure. JAMA. 2024;332(18):1559-1560. https://doi.org/10.1001/jama.2024.16338
Hanspal I, Fathima F, Kedlaya P. Social impact of end-stage renal disease requiring hemodialysis among patients with type 2 diabetes and their caregivers in Bengaluru, Karnataka. Indian J Community Med. 2021;46(4):626-630. https://doi.org/10.4103/ijcm.ijcm_995_20
Tzanetakou IP, et al. Social life of patients undergoing haemodialysis. Int J Caring Sci. 2016;9(1):122-134. Available from: https://www.researchgate.net/publication/301200809_Social_Life_of_Patients_Undergoing_Haemodialysis
Wang AY, Sherrington C, Toyama T, Gallagher MP, Cass A, Hirakawa Y, et al. Muscle strength, mobility, quality of life and falls in patients on maintenance haemodialysis: a prospective study. Nephrology (Carlton). 2017;22(3):220-227. https://doi.org/10.1111/nep.12749
Painter P, Marcus RL. Assessing physical function and physical activity in patients with CKD. Clin J Am Soc Nephrol. 2013;8(5):861-872. https://doi.org/10.2215/CJN.06590712
Kalantar-Zadeh K, Wightman A, Liao S. Ensuring choice for people with kidney failure-dialysis, supportive care, and hope. N Engl J Med. 2020;383(2):99-101. https://doi.org/10.1056/NEJMp2001794
Wilkinson TJ, McAdams-DeMarco M, Bennett PN, Wilund K. Advances in exercise therapy in predialysis chronic kidney disease, hemodialysis, peritoneal dialysis, and kidney transplantation. Curr Opin Nephrol Hypertens. 2020;29(5):471-479. https://doi.org/10.1097/MNH.0000000000000627
Deligiannis A, D’Alessandro C, Cupisti A. Exercise training in dialysis patients: impact on cardiovascular and skeletal muscle health. Clin Kidney J. 2021;14(Suppl 2):ii25-ii33. https://doi.org/10.1093/ckj/sfaa273
Park JH, Moon JH, Kim HJ, Kong MH, Oh YH. Sedentary lifestyle: overview of updated evidence of potential health risks. Korean J Fam Med. 2020;41(6):365-373. https://doi.org/10.4082/kjfm.20.0165
Leuchtmann AB, Adak V, Dilbaz S, Handschin C. The role of the skeletal muscle secretome in mediating endurance and resistance training adaptations. Front Physiol. 2021;12:709807. https://doi.org/10.3389/fphys.2021.709807
Pourteymour S, Eckardt K, Holen T, Langleite T, Lee S, Jensen J, et al. Global mRNA sequencing of human skeletal muscle: search for novel exercise-regulated myokines. Mol Metab. 2017;6(4):352-365. https://doi.org/10.1016/j.molmet.2017.01.007
Kirk B, Feehan J, Lombardi G, Duque G. Muscle, bone, and fat crosstalk: the biological role of myokines, osteokines, and adipokines. Curr Osteoporos Rep. 2020;18(4):388-400. https://doi.org/10.1007/s11914-020-00599-y
Leal LG, Lopes MA, Batista ML. Physical exercise-induced myokines and muscle-adipose tissue crosstalk: a review of current knowledge and the implications for health and metabolic diseases. Front Physiol. 2018;9:1307. https://doi.org/10.3389/fphys.2018.01307
Xu Y, Hu T, Shen Y, Wang Y, Bao Y, Ma X. Association of skeletal muscle mass and its change with diabetes occurrence: a population-based cohort study. Diabetol Metab Syndr. 2023;15(1):53. https://doi.org/10.1186/s13098-023-01027-8
Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, Jafar TH, Heerspink HJL, Mann JF, et al. Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet. 2013;382(9889):339-352. https://doi.org/10.1016/S0140-6736(13)60595-4
Bennett PN, Breugelmans L, Barnard R, Agius M, Chan D, Fraser D, et al. Sustaining a hemodialysis exercise program: a review. Semin Dial. 2010;23(1):62-73. https://doi.org/10.1111/j.1525-139X.2009.00652.x
John SG, Sigrist MK, Taal MW, McIntyre CW. Natural history of skeletal muscle mass changes in chronic kidney disease stage 4 and 5 patients: an observational study. PLoS One. 2013;8(5):e65372. https://doi.org/10.1371/journal.pone.0065372
Cheema BSB, O’Sullivan AJ, Chan M, Patwardhan A, Kelly J, Gillin A, et al. Progressive resistance training during hemodialysis: rationale and method of a randomized controlled trial. Hemodial Int. 2006;10(3):303-310. https://doi.org/10.1111/j.1542-4758.2006.00112.x
Othman RB, Balti A, Boukhris S, Ceylan HI, Jamoussi H, Muntean RI, et al. Sarcopenia in hemodialysis patients: prevalence, independent risk factors, and functional implications-A multicenter cross-sectional study. J Clin Med. 2025;14(19):6893. https://doi.org/10.3390/jcm14196893
Chung Y, Yeh M, Liu Y. Effects of intradialytic exercise on the physical function, depression and quality of life for haemodialysis patients: a systematic review and meta-analysis of randomized controlled trials. J Clin Nurs. 2017;26(13-14):1801-1813. https://doi.org/10.1111/jocn.13514
Lee CL, Wang PC, Chen YL, Chen ZY, Uen CC, Lai HY, et al. Comparisons of intradialytic exercise versus home-based exercise in hemodialysis patients: a narrative review. Biomedicines. 2024;12(10):2364. https://doi.org/10.3390/biomedicines12102364
De Araújo TB, De Luca Corrêa H, De Deus LA, Neves RVP, Reis AL, Honorato FS, et al. The effects of home-based progressive resistance training in chronic kidney disease patients. Exp Gerontol. 2023;171:112030. https://doi.org/10.1016/j.exger.2022.112030
Halle M, Manfredini F, Floege J, Zoccali C. Physical exercise in haemodialysis patients: which type of exercise is more convenient? Clin Kidney J. 2024;17(7):sfae165. https://doi.org/10.1093/ckj/sfae165
Ferrari F, Andrade FP, Teixeira MS, Ziegelmann PK, Carvalho G, Bittencourt ESS, et al. Efficacy of six exercise-based interventions for individuals undergoing hemodialysis: a network meta-analysis of randomized clinical trials. Nephrol Dial Transplant. 2023;38(10):2389-2406. https://doi.org/10.1093/ndt/gfad083
Jung TD, Park SH. Intradialytic exercise programs for hemodialysis patients. Chonnam Med J. 2011;47(2):61-65. https://doi.org/10.4068/cmj.2011.47.2.61
Mohseni R, Zeydi AE, Ilali E, Adib-Hajbaghery M, Makhlough A. The effect of intradialytic aerobic exercise on dialysis efficacy in hemodialysis patients: a randomized controlled trial. Oman Med J. 2013;28(5):345-349. https://doi.org/10.5001/omj.2013.99
Wahida AZ, Rumahorbo H, Murtiningsih. The effectiveness of intradialytic exercise in ameliorating fatigue symptoms in patients with chronic kidney failure undergoing hemodialysis: a systematic literature review and meta-analysis. J Taibah Univ Med Sci. 2023;18(3):512-525. https://doi.org/10.1016/j.jtumed.2022.11.004
Nakoui N, Ilbeigi S, Ahmadi MM, Saber A. Comparison of the effect of aerobic and resistance training on fatigue, quality of life and biochemical factors in hemodialysis patients. Sci Rep. 2025;15(1):10052. https://doi.org/10.1038/s41598-025-94257-x
Raj VSV, Mangalvedhe PV, Shetty MS, Balakrishnan DC. Impact of exercise on fatigue in patients undergoing dialysis in a tertiary care hospital. Cureus. 2023;15(2):e35004. https://doi.org/10.7759/cureus.35004
Kong CH, Tattersall JE, Greenwood RN, Farrington K. The effect of exercise during haemodialysis on solute removal. Nephrol Dial Transplant. 1999;14(12):2927-2931. https://doi.org/10.1093/ndt/14.12.2927
Segura-Ortí E, Kouidi E, Lisón JF. Effect of resistance exercise during hemodialysis on physical function and quality of life: randomized controlled trial. Clin Nephrol. 2009;71(5):527-537. https://doi.org/10.5414/cnp71527
De Moura Reboredo M, Henrique DMN, De Souza Faria R, Chaoubah A, Bastos MG, De Paula RB. Exercise training during hemodialysis reduces blood pressure and increases physical functioning and quality of life. Artif Organs. 2010;34(7):586-593. https://doi.org/10.1111/j.1525-1594.2009.00929.x
Von Gersdorff G, Von Korn P, Duvinage A, Ihorst G, Josef A, Kaufmann M, et al. Cluster randomized controlled trial on the effects of 12 months of combined exercise training during hemodialysis in patients with chronic kidney disease-study protocol of the Dialysis Training Therapy (DiaTT) trial. Methods Protoc. 2021;4(3):60. https://doi.org/10.3390/mps4030060
Hargrove N, Tobgy NE, Zhou O, Pinder M, Plant B, Askin N, et al. Effect of aerobic exercise on dialysis-related symptoms in individuals undergoing maintenance hemodialysis. Clin J Am Soc Nephrol. 2021;16(4):560-574. https://doi.org/10.2215/CJN.15080920
Flynn MG, McFarlin BK, Markofski MM. The anti-inflammatory actions of exercise training. Am J Lifestyle Med. 2007;1(3):220-235. https://doi.org/10.1177/1559827607300283
Fakhrpour R, Hamid TK, Ebrahim K. Effect of sixteen weeks combined training on FGF-23, Klotho, and Fetuin-A levels in patients on maintenance hemodialysis. Iran J Kidney Dis. 2020;14(3):212-218.
Mahindru A, Patil P, Agrawal V. Role of physical activity on mental health and well-being: a review. Cureus. 2023;15(1):e33475. https://doi.org/10.7759/cureus.33475
Tsai YC, Chen HM, Hsiao SM, Chen CS, Lin MY, Chiu YW, et al. Association of physical activity with cardiovascular and renal outcomes and quality of life in chronic kidney disease. PLoS One. 2017;12(8):e0183642. https://doi.org/10.1371/journal.pone.0183642
Martins P, Marques EA, Leal DV, Ferreira A, Wilund KR, Viana JL. Association between physical activity and mortality in end-stage kidney disease: a systematic review of observational studies. BMC Nephrol. 2021;22(1):227. https://doi.org/10.1186/s12882-021-02407-w
LEKsykon. HRQoL - health-related quality of life [Internet]. Available from: https://leksykon.com.pl/tag/hrqol/
Hu H, Liu X, Chau PH, Choi EPH. Effects of intradialytic exercise on health-related quality of life in patients undergoing maintenance haemodialysis: a systematic review and meta-analysis. Qual Life Res. 2022;31(7):1915-1932. https://doi.org/10.1007/s11136-021-03025-7
Yuenyongchaiwat K, Namdang P, Vasinsarunkul P, Phongsukree P, Chaturattanachaiyaporn K, Pairojkittrakul S, et al. Effectiveness of inspiratory muscle training on respiratory fitness and breathlessness in chronic renal failure: a randomized controlled trial. Physiother Res Int. 2021;26(1):e1879. https://doi.org/10.1002/pri.1879
Ouzouni S, Kouidi E, Sioulis A, Grekas D, Deligiannis A. Effects of intradialytic exercise training on health-related quality of life indices in haemodialysis patients. Clin Rehabil. 2009;23(1):53-63. https://doi.org/10.1177/0269215508096760
Yu H, Huang M, Tao Y, Li S, Wang J, Li P, et al. The effects of exercise training interventions on depression in hemodialysis patients. Front Psychiatry. 2024;14:1321413. https://doi.org/10.3389/fpsyt.2023.1321413
Lowrie EG, Curtin RB, LePain N, Schatell D. Medical outcomes study short form-36: a consistent and powerful predictor of morbidity and mortality in dialysis patients. Am J Kidney Dis. 2003;41(6):1286-1292. https://doi.org/10.1016/S0272-6386(03)00361-5
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Tomasz Wołoszczuk, Zofia Graca, Jakub Kołodziej, Aleksandra Skowronek, Julia Jeziorna, Elżbieta Siudmak, Agnieszka Sawina, Adam Iwanicki, Maciej Łabuś, Aleksandra Skawińska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 86
Number of citations: 0
