Effect of intradialytic exercise on daily physical activity and sleep quality in maintenance hemodialysis patients

Physical inactivity and sleep disturbance are frequently observed and relate to poor clinical outcomes in maintenance hemodialysis patients. We aimed to investigate the effect of intradialytic exercise on daily physical activity and sleep quality, measured by an accelerometer, in maintenance hemodialysis patients. This study randomly assigned ambulatory maintenance hemodialysis patients aged >= 20 years on dialysis >= 6 months, without a hospitalization history for the previous 3 months to 4 groups: aerobic exercise (AE), resistance exercise (RE), combination exercise (CE), and control. A stationary bike was used for AE and a TheraBand(A (R))/theraball for RE. A 12-week intradialytic exercise program (3 times/week) was completed in the AE (n = 11), RE (n = 10), and CE (n = 12) groups. The control group (n = 13) received only warm-up stretching. At baseline and 12-week follow-up, daily physical activity and sleep quality were measured with a triaxial accelerometer (wActiSleep-BT; ActiGraph, Pensacola, FL) during a continuous 7-day wear period. We observed a significant increase in metabolic equivalent (MET; kcal/h/kg) in the AE (1.02 +/- 0.03 vs 1.04 +/- 0.04, P = 0.04) and CE (1.06 +/- 0.05 vs 1.09 +/- 0.08, P = 0.01) groups at 12 weeks compared with baseline. When comparing between-group changes in MET, there was a significant increase in METs in the CE group (0.03 +/- 0.03 vs - 0.01 +/- 0.04, P = 0.02) compared with the control group. The total number of sedentary bouts (per week) decreased significantly in the AE (200 +/- 37 vs 174 +/- 36, P = 0.01), RE (180 +/- 31 vs 130 +/- 49, P = 0.03), and CE groups (180 +/- 45 vs 152 +/- 46, P = 0.04) at 12 weeks compared with baseline. The average sleep fragmentation index, indicating poor sleep quality, decreased significantly at 12 weeks compared with baseline in the AE (51.4 +/- 8.0 vs 44.5 +/- 9.6, P = 0.03) and RE groups (52.3 +/- 7.3 vs 40.0 +/- 15.4, P = 0.01). Intradialytic exercise appears to be clinically beneficial in improving daily physical activity and sleep quality in maintenance hemodialysis patients.