Table 1 Characteristics of the included studies (n = 20)
Author & Year | Method | Subjects | Therapies | ||
EG | CG | EG | CG | ||
Anding et al 2015 [10] | quantitative non-randomized study | 46 | - | Resistance training: RPE13 ~ 14, 2 times/week, 60 min/time | - |
Bae et al 2014 [11] | quantitative non-randomized study | 10 | - | Warm-up: 5 min Aerobic training: 30 min, pedaling speed at about 35 rpm, RPE10 ~ 13 Cool-down and stretching | - |
Kirkmanet al 2014 [12] | RCT | 19 | 8 | Resistance training: the maximum resistance is 200 kg, 8 ~ 10 times per group, complete 3 groups | Progressive stretching with resistance bands |
Zhang Bo et al 2019 [13] | quantitative non-randomized study | 11 | - | Resistance training: progressive resistance training using elastic bands and hand-held weights, 20 ~ 30 min, 3 times per week Aerobic exercise: Treadmill training, 30 ~ 50 min, low intensity is 25% ~ 44% VO2max, medium intensity is 45% ~ 59% VO2max | - |
Gadelhaet al 2021 [14] | RCT | 57 | 50 | Resistance training: chest compression, deep squats, rowing, knee and hip flexion and extension, shoulder compression, hip bridge, biceps curl, elbow extension, sitting leg lift; 3 times per week. Training intensity: RPE is 5–6 for the first 12 weeks and 7–8 for the last 12 weeks | Care as usual |
Myers et al 2021 [15] | RCT | 13 | 15 | Aerobic combined with resistance training, with intensity of RPE12 ~ 14, reaching 70% ~ 80% of maximum heart rate | Care as usual |
Chen Guanjie et al 2022 [16] | RCT | 28 | 28 | Resistance training: centripetal and centrifugal exercises using dumbbells, elastic bands, sandbags, weight-bearing ankle sheaths, and leg compression devices; Aerobic training: cycling in the air or using stationary bicycles, 10 to 15 times per action, total time 30 to 60 min, training intensity of 55% to 70% maximum heart rate, 2–3 times per week | Care as usual |
Lopes et al 2019 [17] | RCT | 30 | 20 | Resistance training: knee and hip flexion and extension, sitting leg lift, leg compression. 20–40 min per time, 3 times per week | Stretching training |
Zhou et al 2021 [18] | RCT | 53 | 59 | Resistance training: quadriceps stretch, deep squat, biceps curl, and pull-up. 2–3 times per set, 10 repetitions, 30 min per session. The frequency of exercise is 3 times per week, and the intensity of each training is RPE13-17 | Balance training: Stand on a balance board or plank |
Li Ming.et al 2022 [19] | quantitative non-randomized study | 42 | A:40B:38 | Personalized resistance training combined with nutrition guidance using the HAPA model | Control group A: received nutritional guidance and took 250 ml of the enteral nutrition preparation orally for nutritional supplementation Control group B: personalized resistance training based on HAPA model, including upper limb elastic ball exercise, lower limb ankle weight loading, and straight leg raising. The intensity was 60% to 80% of the maximum heart rate, 3 sets/day, 1–2 h/time, 3 times/week |
Cheema et al 2007 [20] | RCT | 20 | 19 | Resistance training: upper and lower limb exercises, 8 repetitions per group, totaling 10 groups. The intensity of each exercise is RPE15 ~ 17, and the exercise is performed three times per week | Care as usual, followed by resistance training after 12 weeks |
Geneen et al 2022 [21] | RCT | 10 | 7 | Resistance training: leg press, knee extension, hamstring flexor and calf raises. Training intensity is 80% of 1-RM. Each set contains 8 repetitions, 3 sets per session, 3 times per week | Same as the experimental group, once a week |
Fang Meng et al 2023 [22] | quantitative non-randomized study | 29 | 30 | Combined aerobic and resistance training: Aerobic training includes pedaling a bicycle at an intensity of RPE11 ~ 12, three times per week. Resistance training involves using elastic balls to perform gripping exercises ten times per group, a total of ten groups. Training involving flexion and extension of the knee and hip joints are performed using elastic straps, three times per week | Care as usual |
Pomidori et al 2016 [23] | RCT | 22 | 20 | Aerobic training: Walking training, increasing the speed when the patient can tolerate. Training twice a day for ten minutes each time | Care as usual |
Watson et al 2018 [24] | RCT | 20 | 21 | Aerobic training combined with resistance training:Aerobic training includes treadmill, cycling or rowing at an intensity of RPE12 ~ 14 for 30 min each time, three times a week; resistance training includes leg stretching and leg pressing, with the training load being 70% of the maximum single repetition, 12–15 repetitions per group, and three groups in total | The control group only performed aerobic training in the same way as the experimental group |
Han Mei et al 2023 [25] | RCT | 41 | 41 | Resistance training: Three times per week, with a training cycle of four weeks | Care as usual |
Peng Dandan et al 2023 [26] | RCT | 43 | 43 | Resistance training: lower limb ankle weight bearing and upper limb elastic ball movement, elastic ball grasping exercise. The exercise intensity starts from RPE 9 ~ 11 and gradually increases in moderate intensity RPE 12 ~ 13. Each time is 30 ~ 60 min, three times a week | Patients can choose to walk (80 ~ 90 steps/minute), jog (7 ~ 8 km/h), go up and down stairs (10 ~ 20 steps/minute) |
He Tonglin et al 2019 [27] | RCT | 21 | 21 | Resistance training: The initial training intensity is 15-25RM, gradually increasing to 6 ~ 12RM, 60 min per time, 2–3 times per week | Walking, jogging, going up and down stairs. Perform muscle stretching after training |
He Huixia et al 2022 [28] | RCT | 90 | 90 | Resistance training: Start with a physical load of 15–25 RM and gradually increase to 6 ~ 12RM, 40 min per session, 2–3 times per week Aerobic training: Warm-up and cool-down exercises, each performed for 10 min | Conduct non-resistance training such as walking (average 80–100 steps per minute), jogging (7–8 km/h), and walking up and down stairs (15–20 steps per minute). Exercise for a total of 1 h, 2–3 times per week |
Wu Qian et al 2021 [29] | quantitative non-randomized study | 58 | 57 | Aerobic training: Perform Baduanjin training before hemodialysis, 20–30 min each time, 3 times a week | Care as usual |
Intervention Duration | Outcome Measures & Measurement Tools | Main Results | |||
12Â months | Physical Performance:6MWT Patient-Reported Outcomes:QoL | High and moderate adherence groups showed notable enhancements in exercise capacity, strength, and several quality of life subscales | |||
12 weeks | Physical Performance:6MWT, Resting metabolic rate, Lactate threshold Body composition:Weight, Muscle mass, Body fat mass, Fat percentage, Body mass index Skeletal Muscle Status:Skeletal Muscle Mass Index, Right knee extension and flexion, Left knee extension and flexion Patient-Reported Outcomes:Quality of Life Questionnaire Pulmonary function:VO2max | After 12 weeks of aerobic training, chronic kidney disease patients undergoing hemodialysis experienced a significant increase in the distance covered in the six-minute walk test (P< 0.05) | |||
12Â weeks | Physical Performance: 6MWT, Sit to stand, 8-ft get up and go Skeletal Muscle Status:Muscle volume, Knee extensor strength | A 12-week high-intensity progressive resistance exercise training (PRET) regimen significantly increased thigh muscle volume and strength in hemodialysis patients | |||
12 weeks | Physical Performance:6MWT, Seat forward test, Eye-opening one-legged standing balance test Skeletal Muscle Status:Appendicular skeletal muscle mass, Grip strength Index Laboratory examination:Albumin, Renal profile , Urine albumin High-Density Lipoprotein and Low-Density Lipoprotein Pulmonary function:VO2 max | Structured exercise training significantly improves muscle mass, muscle strength, and motor function, as evidenced by improved ASMI, grip strength index, 6-m walk speed, VO2peak, one-leg standing time, and reach in seat distance (P < 0.05), highlighting the potential of exercise interventions in this population | |||
24 weeks | Physical Performance:Time up-and-go, 6MWT Body composition:Body mass, BMI, Free fat mass,Body fat Skeletal Muscle Status:Handgrip Laboratory examination: Albumin, Potassium, Phosphorous,Calcium Patient-Reported Outcomes:Pain perception | Findings revealed that resistance training before dialysis sessions significantly improved iron status, reduced ferritin and hepcidin levels, and favorably modulated inflammatory markers (TNFα, IL-6 decrease; IL-10 increase) | |||
12Â weeks | Physical Performance:1-min sit-to-stand test, 6MWT Body composition:Total leg mass,Total body mass,Total body fat Skeletal Muscle Status:Hand grip, Upper body strength, Lower body strength Pulmonary function: Forced Vital Capacity, Forced Expiratory Volume in One Second | Findings revealed that the 12-week home-based exercise program significantly improved physical function, exercise capacity, and certain aspects of health-related quality of life (HRQL) among elderly patients undergoing maintenance hemodialysis | |||
12–18 weeks | Physical Performance:6MWT Body composition:BMI Skeletal Muscle Status:Hand grip, upper arm muscular circumference, calf circumference Patient-Reported Outcomes: Short Physical Performance Battery | The study found that implementing an exercise program during dialysis significantly reduced the prevalence of sarcopenia in the experimental group compared to the control group (P = 0.014). Improvements were observed in grip strength, usual gait speed, calf circumference, and Short Physical Performance Battery (SPPB) scores (P < 0.05 for all) | |||
12Â weeks | Body composition:Body mass, Lean mass, Fat mass Laboratory examination:IL-6, IL-10, TNF-a Skeletal Muscle Status:Hand grip Patient-Reported Outcomes: Short Physical Performance Battery | The study observed that a 12-week home-based exercise regimen led to modest enhancements in physical function, exercise capacity, responses to exercise, pulmonary function, and health-related quality of life | |||
12 months | Physical Performance: 6MWT, Functional reach Body composition: BMI,Arm lean mass, Leg lean mass, Trunk lean mass Skeletal Muscle Status: Hand grip, isometric quadriceps strength Laboratory examination: mGFR Patient-Reported Outcomes: Berg’s balance test | The findings indicate that exercise training effectively prevents sarcopenia and maintains muscle mass. Despite significant increases in plasma myostatin levels in both exercise groups, these changes were not negatively associated with muscle mass or physical performance outcomes | |||
6Â months | Physical Performance: Time up-and-go, stand up and sit test Skeletal Muscle Status:Hand grip Laboratory examination:Albumin, Transferrin, Hemoglobin Patient-Reported Outcomes:SARC-F, Barthel Index | The findings demonstrated that the combination of nutritional guidance and personalized resistance exercise significantly enhanced serum nutritional parameters and quality of survival in MHD patients with sarcopenia. The intervention led to improvements in serum hemoglobin, prealbumin, and transferrin levels | |||
24Â weeks | Physical Performance: 6MWT Body composition: Body weight Skeletal Muscle Status: Muscle cross-sectional area, Muscle attenuation,Knee extension strength, Hip abduction strength,Triceps strength, Specific tension Laboratory examination:Log C-reactive protein | The study found that prolonged intradialytic PRT led to an increase in muscle cross-sectional area and improvements in muscular strength and exercise capacity | |||
12Â weeks | Physical Performance:6MWT, stand up and sit test, Physical Activity Recall Body composition: Weight, BMI, Fat mass Skeletal Muscle Status: Knee extension peak force 45, Leg press peak force,Total muscle depth, anatomical cross-sectional area Patient-Reported Outcomes: Leicester Uraemic Symptom Score | The study revealed that both low (once a week) and higher frequency (three times a week) resistance training over 12Â weeks significantly improved vastus lateralis cross-sectional area, pennation angle, muscle strength, and physical function in stage-3 CKD patients. The higher frequency group showed greater anatomical and physiological muscle adaptations, yet improvements in strength and function were comparable between frequencies | |||
12Â weeks | Body composition: BMI, visceral adipose tissue area Skeletal Muscle Status: Total Muscle Mass, Hand grip Laboratory examination: Albumin, Log C-reactive protein, Hemoglobin | The study demonstrated that aerobic combined with resistance exercises significantly improved muscle strength, nutritional status, and quality of life in elderly patients undergoing maintenance hemodialysis with obesity-related sarcopenia. These interventions led to significant reductions in body fat percentage and visceral fat area, alongside notable increases in grip strength, serum albumin levels, and overall life quality scores | |||
6Â months | Physical Performance: 6MWT Pulmonary function: Forced Expiratory Volume in One Second, Vital Capacity, Maximum Voluntary Ventilation, Maximal Inspiratory Pressure | The study investigated the impact of a 6-month moderate-intensity exercise program on respiratory muscle strength in dialysis patients, comparing trained versus untrained groups. The results indicated that the exercise program improved physical capacity and preserved respiratory muscle function in the trained group, contrasting with the deterioration observed in the untrained group | |||
12Â weeks | Physical Performance: Incremental shuttle walk test Skeletal Muscle Status: Muscle volume Body composition: Weight Pulmonary function: VO2max | The study revealed that combining aerobic and resistance exercise for 12Â weeks produced greater increases in muscle mass and strength compared to aerobic exercise alone in patients with chronic kidney disease not on dialysis. Significant improvements were observed in knee extensor strength and quadriceps volume | |||
12Â weeks | Skeletal Muscle Status: MRC muscle strength scoring system Patient-Reported Outcomes: Sarcopenia quality of life, SarQoL | The study found that implementing periodic resistance training alongside a reasonable diet significantly enhanced muscle strength and overall quality of life in hemodialysis patients suffering from sarcopenia. This intervention showed notable improvements in both upper and lower limb muscle strength grading scores and scores across various domains of the Sarcopenia Quality of Life (SarQoL) questionnaire | |||
12Â weeks | Physical Performance: 6MWT Skeletal Muscle Status: Hand grip, skeletal muscle mass index, Upper arm muscular circumference, calf circumference Patient-Reported Outcomes: Short Physical Performance Battery | The study found that implementing a 12-week progressive resistance exercise (PRE) program significantly improved handgrip strength (HGS), daily walking speed, and SPPB (Short Physical Performance Battery) scores. Moreover, skeletal muscle mass index (SMI), arm circumference, and calf circumference were significantly higher in the PRE group compared to the control group | |||
8–12 weeks | Skeletal Muscle Status: Skeleton appendiculare Patient-Reported Outcomes: Activities of Daily Living | The study demonstrated that exercise rehabilitation therapy significantly improved muscle mass and strength in patients with uremic sarcopenia, thereby offering notable therapeutic and preventive benefits for uremic sarcopenia. The therapy led to statistically significant increases in skeletal muscle mass at 8 and 12 weeks, as well as higher activities of daily living (ADL) scores in the treatment group compared to the control group | |||
12Â months | Skeletal Muscle Status: Skeleton appendiculare Patient-Reported Outcomes: Activities of Daily Living | The study demonstrated that exercise rehabilitation therapy significantly improved skeletal muscle mass and the ability to perform activities of daily living (ADL) in patients with uremic sarcopenia. Notably, both male and female patients in the intervention group showed significant increases in skeletal muscle mass and ADL scores after 6 and 12Â months of rehabilitation, compared to the control group | |||
12Â weeks | Physical Performance: 6MWT Skeletal Muscle Status: Hand grip, Skeletal muscle mass index Patient-Reported Outcomes: International physical activity questionnaire short form | The study found that practicing Baduanjin exercise prior to hemodialysis sessions significantly improved hand grip strength, daily walking speed, and physical activity levels, while reducing fatigue as measured by the revised Piper Fatigue Scale (RPFS), compared to a control group receiving standard care and exercise guidance | |||