Abstract: FR-PO799

Effects of Intradialytic Cycling on Exercise Capacity, Quality of Life, and Physical and Cardiovascular Function: A Systematic Review and Meta-Analysis

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Young, Hannah ML, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, LEICESTER, United Kingdom
  • Brile, Chris, University of Lincoln , Lincoln, United Kingdom
  • Burton, James, University of Leicester, Leicester, United Kingdom
  • March, Daniel Scott, University of Leicester, Leicester, United Kingdom
  • Graham-Brown, Matthew P.M., University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, LEICESTER, United Kingdom
  • Jones, Arwel W, University of Lincoln , Lincoln, United Kingdom
  • Curtis, Ffion, University of Lincoln , Lincoln, United Kingdom
  • Grantham, Charlotte E., University of Leicester, Leicester, United Kingdom
  • Highton, Patrick J., Loughborough University, Leicester, United Kingdom
  • Smith, Alice C., University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, LEICESTER, United Kingdom
  • Singh, Sally Jane, University Hospitals of Leicester NHS FT, Leicester, United Kingdom
Background

There is growing interest in intradialytic cycling (IDC), to address a range of health & wellbeing issues associated with haemodialysis (HD). The aim of this systematic review was to identify & synthesise the available evidence on the effects of IDC on exercise capacity, quality of life (QOL), physical & cardiovascular function.

Methods

Databases of published, unpublished & ongoing studies (Medline, EMBASE, CINAHL, LiLACS, Web of Science, Sports Discus, PsycINFO, PEDRO, AMED, Cochrane, PROSPERO, DARE, BIOSIS previews, Index to Scientific & Technical Proceedings, Conference Papers Index, CENTRAL, ClinicalTrials.gov, Current Controlled Trials) were searched for randomised controlled trials (RCTs) of prevalent adult HD patients, comparing cycle training during HD to usual care. Sources were searched until March 2017 & supplemented by internet, hand searching & consultation with experts. No limits were placed upon publication language.

Results

Fourteen RCTs were eligible,but 5 did not provide data interpretable for use in meta-analyses. The remaining 9 RCTs included 187 participants and the length of IDC interventions ranged from 8-26 weeks. Most studies had an overall high risk of bias. Meta-analysis of available evidence indicated no significant change in VO2 peak (MD 1.84, 95% CI -0.90 to 4.59 p=0.19), physical (mean change -0.06, -0.69 to 0.58 p=0.86) or mental component (mean change 1.68, -6.30 to 9.65 p=0.68) scores of the SF36, or pulse wave velocity (MD -0.36, -1.54 to 0.43, p=0.38) following IDC. IDC did lead to a mean improvement of 85m (25 to 144, p=0.005) on the six-minute walk test.The limited number of studies in the meta-analyses precluded planned sensitivity & subgroup analyses & assessment of publication bias.

Conclusion

There is insufficient evidence to support the use of IDC to influence exercise capacity, QOL, cardiac or physical function in practice. The point estimates of the meta-analyses on the 6MWT are greater than the smallest clinically important difference, but the imprecision of the individual study estimates means further RCTs are needed. The strength of the evidence could be greatly enhanced via transparent reporting & consensus on validated measures.

Funding

  • Government Support - Non-U.S.