From gains to decline: effects of structured pre-dialytic exercise training and detraining on physical fitness, quality of life, and inflammation in haemodialysis patients.

OBJECTIVE: Pre-dialysis exercise training may benefit haemodialysis patients, but the effects of structured aerobic and resistance training remain unclear. This study evaluated the effects of a 6-month training performed 1-2 h before haemodialysis on muscle strength, cardiorespiratory fitness, quality of life, and systemic inflammation. DESIGN: A 3-phase self-controlled design: 3-month control, 6-month aerobic and resistance training (72 sessions) and nutrition counselling, and 3-month follow-up. PATIENTS: Haemodialysis patients > 3 months. METHODS: Assessments were performed every 3 months at 5 time points. Outcomes included physical fitness (dual-energy X-ray absorptiometry, isokinetic dynamometry, and cardiopulmonary exercise testing), Kidney Disease QOL questionnaire, International Physical Activity Questionnaire, nutrition, and plasma pro- and anti-inflammatory cytokines. RESULTS: Of 118 patients screened, 29 entered training and 22 completed 72 sessions (92% compliance). Pre-dialysis exercise training improved muscle mass, cardiorespiratory fitness, quadriceps strength, physical and mental components, and disease-specific quality of life; cardiorespiratory fitness and strength declined at 3-month follow-up, but muscle mass remained. Cytokine levels were unchanged, suggesting minimal pro- or anti-inflammatory effects. CONCLUSION: A 6-month pre-dialysis exercise programme improved cardiorespiratory fitness, strength, muscle mass, and quality of life with high compliance. It may be viable for haemodialysis patients, though maintenance is needed to sustain benefits. CLINICALTRIALS: gov ID: NCT05649657.