Effect of intra-dialytic pedaling exercise on dialysis adequacy: A randomized controlled trial

Clinical Snapshot

Key Findings

• P Value: Weight change p=0.25, BUN p=1.52, Kt/V p=0.11

• Effect Size: Weight change: t=0.80, BUN: t=0.13, Kt/V: t=1.62

• Primary Outcome: No significant differences in dialysis adequacy measures between groups

• Nnt Or Sensitivity: Not applicable - no significant benefit demonstrated

• Confidence Interval: Not reported

Clinical Application

Pedaling exercise during dialysis appears feasible but requires equipment and staff supervision Limited relevance to Australian practice without demonstration of efficacy; would require local validation studies before implementation Limited applicability due to single-centre Iranian study with baseline group imbalances

Abstract

BACKGROUND: In patients with chronic kidney disease undergoing hemodialysis, physical activity and rehabilitation are crucial for preventing declines in muscle strength and functional capacity. This study aimed to assess the impact of physical activity during hemodialysis on dialysis adequacy in patients undergoing hemodialysis. METHODS: This randomized controlled trial (RCT) investigated the impact of pedaling exercise on dialysis effectiveness in 84 hemodialysis patients at hospitals in Bushehr. Participants were randomly assigned to either an experimental group (n = 42) that performed 30 minutes of pedaling exercise during their 4-hour dialysis sessions or a control group (n = 42) that received routine hemodialysis. Dialysis adequacy was assessed by comparing pre- and post-dialysis blood samples obtained from the arterial line. A conservative intradialytic exercise protocol, blood samples, and patient weight were measured using a calibrated digital scale. Data analysis was performed using SPSS version 24 software. RESULTS: The experimental and control groups were similar in demographic characteristics, except for age (X2 = -3.84, p = 0.001) and education levels (X2 = 10.100, p = 0.006). While there was no significant difference in weight between the groups before and after the intervention (t = 0.223, p = 0.82 before; t = 0.203, p = 0.84 after), both groups showed a substantial weight reduction overall (p < 0.0001). There were no statistically significant differences in weight change (t = 0.80, p = 0.25), BUN (t = 0.13, p = 1.52), or Kt/V (t = 1.62, p = 0.11) between the experimental and control groups. CONCLUSION: This study found that incorporating pedaling exercise during hemodialysis did not significantly improve dialysis effectiveness, as measured by weight change, BUN levels, or Kt/V. While both groups showed weight loss, there were no statistically significant differences between them. However, the study was limited by its small sample size and the specific exercise protocol employed. Further research with larger cohorts and a broader range of physical activities is needed to determine whether physical activity during hemodialysis can improve dialysis adequacy and overall patient outcomes. TRIAL REGISTRATION: IRCT code number 20150529022466N15 and trial Code of Ethics IR.BPUMS.REC.1398.130E.

References

1. 1.Mohamadizadeh, M., Sharifi, S., Motamed, N., Shadman, M. A., & Pouladi, S. (2026). Effect of intra-dialytic pedaling exercise on dialysis adequacy: A randomized controlled trial. *PLoS One*. https://doi.org/10.1371/journal.pone.0348063