International Urology and Nephrology

, Volume 50, Issue 4, pp 745–754 | Cite as

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

  • Ji-Hyung Cho
  • Ji-Yeon Lee
  • Sukyung Lee
  • Hyuntae Park
  • Seung-Wook Choi
  • Jun Chul Kim
Nephrology - Original Paper



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®/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.


End-stage renal disease Hemodialysis Exercise Sleep Accelerometry 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Ji-Hyung Cho
    • 1
  • Ji-Yeon Lee
    • 2
  • Sukyung Lee
    • 3
  • Hyuntae Park
    • 4
  • Seung-Wook Choi
    • 5
  • Jun Chul Kim
    • 1
  1. 1.Division of Nephrology and Department of Internal MedicineCHA Gumi Medical Center, CHA UniversityGumi-siSouth Korea
  2. 2.Department of Physical EducationSungshin Women’s UniversitySeoulSouth Korea
  3. 3.Department of Internal MedicineSemyung Christianity HospitalPohang-siSouth Korea
  4. 4.Department of Health Care and ScienceDong-A UniversityBusanSouth Korea
  5. 5.Department of Sports and LeisureSungshin Women’s UniversitySeoulSouth Korea

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