Person cycling during dialysis with a glowing heart.

Exercise During Dialysis: A Game-Changer for Heart Health

Mira Elwood in Health & Wellness December 2025 • 4 min read.

"Discover how intradialytic exercise can protect your heart during hemodialysis, reduce myocardial stunning, and improve your overall well-being."

For individuals undergoing hemodialysis, each session places significant stress on the circulatory system. This stress can lead to acute ischemia, a condition characterized by reduced blood flow to the heart, resulting in recurrent and cumulative cardiac injury, often referred to as myocardial stunning. Addressing this critical issue is key to improving the long-term health outcomes for dialysis patients.

Intradialytic exercise (IDE), which involves physical activity performed during dialysis, has emerged as a promising strategy to enhance functional status in individuals receiving hemodialysis. The goal of a recent exploratory study was to determine whether IDE could serve as a preconditioning intervention, and if so, whether it could reduce the myocardial stunning often associated with hemodialysis.

The research investigated the impact of IDE on heart health during hemodialysis, providing new insights into how exercise can protect the heart in this vulnerable population. By understanding the benefits and mechanisms of IDE, patients and healthcare providers can make informed decisions about integrating exercise into dialysis treatments.

How Does Intradialytic Exercise Protect the Heart?

Person cycling during dialysis with a glowing heart.

The study, detailed in Nephrology Dialysis Transplantation, involved a single-center cross-sectional analysis of adults with chronic kidney disease participating in a clinical IDE program. Participants underwent two hemodialysis sessions within the same week: a control visit (no exercise) and an exposure visit (usual intradialytic cycling). Echocardiography was performed at three time points during each session to evaluate cardiac stunning. Regional wall motion abnormalities (RWMAs), indicative of myocardial stunning, were assessed using speckle-tracking software to measure longitudinal strain in 12 left ventricular segments.

Researchers defined RWMAs as a ≥20% reduction in strain, with myocardial stunning indicated by two or more RWMAs. This meticulous approach allowed them to quantify the impact of exercise on cardiac function during hemodialysis. Nineteen patients were analyzed, with a mean age of 57.2 years and a median dialysis vintage of 3.8 years. The results provided compelling evidence of the cardioprotective effects of IDE.

Reduced RWMAs: The mean number of RWMAs during the control visit was 4.5 ± 2.6, decreasing to 3.6 ± 2.7 during the IDE session.
Peak Stress Reduction: At peak HD stress, the mean number of RWMAs was 5.8 ± 2.7 in the control visit versus 4.0 ± 1.8 during the exposure visit (p = 0.01).
Significant Reduction in Cardiac Injury: IDE is associated with a significant reduction in HD-induced acute cardiac injury.

These findings demonstrated that IDE could significantly reduce myocardial stunning during hemodialysis, offering a protective effect against acute cardiac injury. The study highlighted the potential of exercise as an accessible and effective intervention for improving cardiac health in dialysis patients.

The Future of Intradialytic Exercise

The study's findings suggest that incorporating exercise into dialysis treatments could offer substantial benefits for heart health. As research continues, future studies may explore the optimal duration, intensity, and frequency of IDE to maximize its protective effects. By refining and expanding the application of IDE, healthcare providers can offer more effective, holistic care for dialysis patients, improving their quality of life and cardiovascular outcomes.

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This article is based on research published under:

DOI-LINK: 10.1093/ndt/gfy376, Alternate LINK

Title: Intradialytic Exercise Preconditioning: An Exploratory Study On The Effect On Myocardial Stunning

Subject: Transplantation

Journal: Nephrology Dialysis Transplantation

Publisher: Oxford University Press (OUP)

Authors: Jarrin D Penny, Fabio R Salerno, Ranveer Brar, Eric Garcia, Krista Rossum, Christopher W Mcintyre, Clara J Bohm

Published: 2018-12-22

Everything You Need To Know

What is intradialytic exercise (IDE) and why is it important for individuals undergoing hemodialysis?

Intradialytic exercise (IDE) refers to physical activity performed during hemodialysis. It's important because hemodialysis sessions can place significant stress on the circulatory system, leading to acute ischemia and recurrent cardiac injury, known as myocardial stunning. IDE has emerged as a strategy to reduce myocardial stunning and enhance functional status in these individuals. Further research is needed to determine optimal duration, intensity, and frequency to maximize the protective effects of IDE.

How does intradialytic exercise (IDE) help protect the heart during hemodialysis?

Intradialytic exercise (IDE) helps protect the heart by serving as a preconditioning intervention that can reduce myocardial stunning often associated with hemodialysis. A study found that IDE is associated with a reduction in regional wall motion abnormalities (RWMAs), which are indicative of myocardial stunning. By reducing RWMAs, IDE can protect against acute cardiac injury. Future studies may explore the optimal parameters of IDE to maximize protective effects.

What are regional wall motion abnormalities (RWMAs), and how are they measured in the context of intradialytic exercise (IDE) studies?

Regional wall motion abnormalities (RWMAs) are indicative of myocardial stunning, which is cardiac injury resulting from reduced blood flow to the heart. In intradialytic exercise (IDE) studies, RWMAs are assessed using echocardiography and speckle-tracking software to measure longitudinal strain in left ventricular segments. A ≥20% reduction in strain defines RWMAs, and myocardial stunning is indicated by two or more RWMAs. This approach quantifies the impact of exercise on cardiac function during hemodialysis, offering insights into how IDE might mitigate cardiac stress.

What did the Nephrology Dialysis Transplantation study reveal about the impact of intradialytic exercise (IDE) on cardiac health during hemodialysis?

The *Nephrology Dialysis Transplantation* study revealed that intradialytic exercise (IDE) is associated with a significant reduction in hemodialysis-induced acute cardiac injury. Specifically, it found a reduction in regional wall motion abnormalities (RWMAs) during IDE sessions compared to control visits without exercise. At peak hemodialysis stress, the mean number of RWMAs was significantly lower during the exposure visit with IDE (4.0 ± 1.8) versus the control visit (5.8 ± 2.7), demonstrating the cardioprotective effects of IDE. Further research is required to explore optimal duration, intensity, and frequency of IDE to maximize its protective effects.

Given that intradialytic exercise (IDE) shows promise in reducing myocardial stunning, what are the potential implications for the long-term care and quality of life for hemodialysis patients?

Since intradialytic exercise (IDE) helps reduce myocardial stunning, incorporating IDE into dialysis treatments has the potential to offer substantial benefits for heart health. The reduction in myocardial stunning can lead to improved cardiovascular outcomes, enhancing the overall well-being and quality of life for hemodialysis patients. This approach offers a more effective and holistic care model. Moreover, reducing regional wall motion abnormalities (RWMAs) can improve the long-term prognosis for patients. However, optimizing the duration, intensity, and frequency of IDE remains an area for future exploration.