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Am Fam Physician. 2022;106(2):135-136

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Clinical Question

What are the benefits of regular exercise for adults undergoing maintenance dialysis?

Evidence-Based Answer

Regular exercise probably improves functional capacity for adults undergoing maintenance dialysis and might be associated with small improvements in pain, depression, and quality of life; it is uncertain whether any effect on risk of death or cardiovascular outcomes occurs.1 (Strength of Recommendation: B, systematic review and meta-analysis of lower-quality clinical trials.)

Practice Pointers

For patients with end-stage renal disease, peritoneal dialysis and hemodialysis can prolong life compared with conservative management. However, dialysis is also associated with a considerable commitment of time, and patients are at risk of discomfort and complications. Up to 60% of patients who initiate dialysis later regret the decision.2 A previous Cochrane review found that regular exercise could improve fitness, walking capacity, and health-related quality of life among patients with all stages of chronic kidney disease.3 The authors of this review sought to evaluate the effects of regular structured exercise training on death, cardiovascular events, fatigue, depression, functional capacity, and pain for adults with end-stage renal disease who were undergoing dialysis.

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These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at

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