Research
Combined training is the most effective training modality to improve aerobic capacity and blood pressure control in people requiring haemodialysis for end-stage renal disease: systematic review and network meta-analysis

https://doi.org/10.1016/j.jphys.2018.11.008Get rights and content
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Abstract

Questions

Do aerobic, resistance and combined exercise training improve aerobic capacity, arterial blood pressure and haemodialysis efficiency in people requiring haemodialysis for end-stage renal disease? Is one exercise training modality better than the others for improving these outcomes?

Design

Systematic review with network meta-analysis of randomised trials.

Participants

Adults requiring haemodialysis for end-stage renal disease.

Intervention

Aerobic training, resistance training, combined training and control (no exercise or placebo).

Outcome measures

Aerobic capacity, arterial blood pressure at rest, and haemodialysis efficiency.

Results

Thirty-three trials involving 1254 participants were included. Direct meta-analyses were conducted first. Aerobic capacity improved significantly more with aerobic training (3.35 ml/kg/min, 95% CI 1.79 to 4.91) and combined training (5.00 ml/kg/min, 95% CI 3.50 to 6.50) than with control. Only combined training significantly reduced systolic (−9 mmHg, 95% CI −13 to −4) and diastolic (−5 mmHg, 95% CI −6 to −3) blood pressure compared to control. Only aerobic training was superior to control for haemodialysis efficiency (Kt/V 0.11, 95% CI 0.02 to 0.20). However, when network meta-analysis was conducted, there were some important different findings. Both aerobic training and combined training again elicited greater improvements in aerobic capacity than control. For systolic blood pressure, combined training was superior to control. For diastolic blood pressure, combined training was superior to aerobic training and control. No modality was superior to control for haemodialysis efficiency. Combined training was ranked as the most effective treatment for aerobic capacity and arterial blood pressure.

Conclusion

Combined training was the most effective modality to increase aerobic capacity and blood pressure control in people who require haemodialysis. This finding helps to fill the gap created by the lack of head-to-head comparisons of different modalities of exercise in people with end-stage renal disease.

Registration

PROSPERO CRD42015020531.

Key words

Chronic kidney failure
Renal dialysis
Exercise
Network meta-analysis
Physical therapy

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eAddenda: Figures 3, 5 and 7, and Appendices 1, 2, 3 and 4 can be found online at DOI: https://doi.org/10.1016/j.jphys.2018.11.008.

Ethics Approval: Nil.

Competing interest: Nil.

Source of support: Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) - Brazil: 467 300/2014-3, 457 581/2013-1, 307 138/2015-1; Supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Brazil: 074/2012-PVE, CsF - PveS 1170/2013.