Exercise for Dialysis

Overseen By Jarrin Penny, PhD, RN, CNeph (C)

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's

Disqualifiers: Vigorous exercise, Coronary syndrome, Arrhythmia, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

Duration: 3 weeks

15 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how different exercise intensities during hemodialysis (HD) can protect the heart from dialysis-induced stress. The researchers aim to determine whether high-intensity exercise is more effective than moderate-intensity exercise in maintaining heart health for those on regular HD. Participants will engage in various exercise levels, specifically through intradialytic cycling (exercise performed during dialysis), to identify the most beneficial approach. Individuals who have been on HD for at least three months and do not already engage in intense exercise may qualify for this study. As an unphased trial, this study offers a unique opportunity to contribute to groundbreaking research that could enhance heart health for dialysis patients.

Do I have to stop taking my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that intradialytic cycling is safe for hemodialysis patients?

Research has shown that exercising during dialysis, known as intradialytic cycling, is generally safe. Most patients do not encounter problems during these sessions. However, some minor issues have been reported. For example, leg pain occurred in about 8.77% of sessions, and low blood pressure in about 2.63% of cases. Hospital visits were very rare, occurring in just 0.8% of sessions.

Overall, while risks like muscle pain or low blood pressure exist, the benefits of exercising during dialysis, such as faster recovery and improved survival rates, often outweigh these concerns. Following guidelines and regularly consulting healthcare providers is important to ensure safety. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the trial of intradialytic cycling for dialysis patients because it explores the potential benefits of exercising during dialysis sessions. Unlike the standard care, which typically involves medication and dietary adjustments, this approach integrates physical activity directly into the dialysis routine. This method could enhance patient well-being, improve physical fitness, and potentially lead to better overall health outcomes. By varying the exercise intensity—ranging from no exercise to moderate and high intensity—researchers aim to discover the optimal level of activity that provides the maximum benefit without additional strain on patients.

What evidence suggests that intradialytic cycling might be an effective treatment for cardiovascular health in dialysis patients?

Research shows that cycling during dialysis, which participants in this trial will experience through intradialytic cycling, can benefit patients. Studies have found it improves quality of life and speeds recovery after dialysis. Evidence also indicates it strengthens muscles over time. Patients who engage in this exercise often feel less tired. Additionally, it can help with frailty by boosting strength and endurance. While more research is needed, these findings suggest cycling during dialysis could improve heart health. ^{1 6 7 8 9}

Who Is on the Research Team?

Chris McIntyre, MBBS DM

Principal Investigator

London Health Sciences Centre

Are You a Good Fit for This Trial?

This trial is for patients who are regularly undergoing hemodialysis treatments due to kidney failure. Participants should be interested in exercising during their dialysis sessions and have no health conditions that would restrict them from engaging in physical activity.

Inclusion Criteria

I have been on hemodialysis for at least 3 months.

Willing and able to provide informed consent

I am 18 years old or older.

Exclusion Criteria

I have a thickened heart muscle.

Unable or deemed unsafe to exercise for any reason

I have severe high blood pressure in the lungs.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo randomized exercise interventions during hemodialysis sessions, including high intensity, moderate intensity, and control (no exercise) conditions over three weeks.

3 weeks

3 visits (in-person, during dialysis sessions)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Intradialytic Cycling

Trial Overview The study is testing the effects of intradialytic cycling, which is exercise done while receiving hemodialysis. It aims to determine if high-intensity cycling can better protect patients' hearts from damage caused by the dialysis process itself.

How Is the Trial Designed?

Group I: Randomization Order 2 Experimental Treatment 1 Intervention

Participants will be randomized into one of the three conditions indicating the order in which they will receive the exercise intervention. Randomization Order 2 will receive moderate intensity exercise week one. Week 2 the participant will have high intensity exercise and week three the participant will have control (no exercise). All sessions (i.e. HD-Cont, HD-Mod and HD-High) will be performed on one of the patient's three days of weekly dialysis. Each patient will consistently perform all sessions on the same day of dialysis throughout the study. The three sessions will be separate by at least one week to avoid potential carryover effects.

Group II: Randomization Order 1 Experimental Treatment 1 Intervention

Participants will be randomized into one of the three conditions indicating the order in which they will receive the exercise intervention. Randomization Order 1 will receive control (no exercise) week one. Week 2 the participant will have a moderate intensity exercise treatment and week three the participant will have a high intensity exercise treatment. All sessions (i.e. HD-Cont, HD-Mod and HD-High) will be performed on one of the patient's three days of weekly dialysis. Each patient will consistently perform all sessions on the same day of dialysis throughout the study. The three sessions will be separate by at least one week to avoid potential carryover effects.

Group III: Randomization 3 Experimental Treatment 1 Intervention

Participants will be randomized into one of the three conditions indicating the order in which they will receive the exercise intervention. Randomization Order 3 will receive high intensity exercise week one. Week 2 the participant will have control (no exercise) and week three the participant will have a moderate intensity exercise treatment. All sessions (i.e. HD-Cont, HD-Mod and HD-High) will be performed on one of the patient's three days of weekly dialysis. Each patient will consistently perform all sessions on the same day of dialysis throughout the study. The three sessions will be separate by at least one week to avoid potential carryover effects.

Who Is Running the Clinical Trial?

London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's

Lead Sponsor

Trials

678

Recruited

421,000+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12341117/

The efficacy of different types of intradialytic exercise for ... Current evidence is insufficient to conclude that any specific type of intradialytic exercise significantly improves dialysis adequacy.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9854908/

Evaluating the effect of intradialytic cycling exercise on ... CONCLUSION. Shor-term intradialytic cycling exercise is found to improve hemodialysis patients' QOL and dialysis recovery time. As a result, intradialytic ...

3. jrenendo.com jrenendo.com/PDF/jre-10-e25164.pdf

Effect of intradialytic aerobic exercise on dialysis adequacy ... The results showed a significant increase in muscle strength at the end of 6 months in the exercise group. In conclusion, intradialytic exercise ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S1658361222002165

The effectiveness of intradialytic exercise in ameliorating ... Intradialytic exercise was effective in decreasing fatigue in dialysis patients with t count values (12.71 and 24.45), larger than the t table value (t39 = 1.69) ...

5. frontiersin.org frontiersin.org/journals/physiology/articles/10.3389/fphys.2025.1600219/full

Effects of intradialytic exercise on frailty in maintenance ... In conclusion, our study found that intradialytic exercise can significantly improve overall frailty and frailty indicators such as grip ...

6. sciencedirect.com sciencedirect.com/science/article/pii/S2013251421001255

Impact and safety outcomes of an intradialytic physical ... In 100% of the cases, it was shown that carrying out a physical exercise regimen during dialysis was safe since there were no complications, neither during nor ...

7. bmcnephrol.biomedcentral.com bmcnephrol.biomedcentral.com/articles/10.1186/s12882-023-03158-6

The effect of intradialytic exercise on dialysis patient survival Intradialytic exercise performed for at least 60 min during thrice weekly dialysis sessions improves survival in adult patients receiving HD.

8. academic.oup.com academic.oup.com/ndt/article/33/suppl_1/i482/4998367

SP402 ADVERSE EVENTS RELATE TO INTRADIALYTIC ... However, intradialytic exercise has a few potential risks, including hypotension, muscle and joint pain, and laceration.

9. journals.lww.com journals.lww.com/jasn/fulltext/2025/10001/short_term_efficacy_and_safety_of_intradialytic.1833.aspx

Short-Term Efficacy and Safety of Intradialytic Exercise:... Adverse events occurred in 12.28% of sessions, most frequently leg pain (8.77%), followed by intradialytic hypotension (2.63%) and hospitalizations (0.8%). No ...