Exercise During Dialysis: A Game-Changer for Heart Health
"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.
Cardiovascular Evidence
A 2024 systematic review and meta-analysis evaluated intradialytic aerobic and/or resistance exercise in adults with kidney failure receiving maintenance hemodialysis. It reported clinically meaningful improvement in pulse wave velocity, a component of arterial resistance, along with improvements in diastolic blood pressure, left ventricular ejection fraction, and heart rate variability. A separate systematic review and meta-analysis, with searches through January 2026, evaluated cardiovascular structural and functional parameters in patients receiving maintenance hemodialysis, showing that this remains an actively developing evidence base.
Current Practice
Exercise during dialysis is generally considered a supervised approach that may include aerobic activity, resistance work, or both. Its practical advantage is that it occurs during scheduled treatment, but implementation can depend on patient tolerance, clinical safety, staffing, and available equipment. Because protocols and patient circumstances vary, the most appropriate program is not necessarily the same for everyone, and evidence should be interpreted with appropriate caution.
From Efficacy to Implementation
Early efficacy studies established the potential benefits of intradialytic exercise, while later work identified a physiological reason to study it more closely: hemodialysis can cause acute left ventricular myocardial wall-motion abnormalities, known as myocardial stunning, through segmental hypoperfusion. A 2023 study examined whether exercise during dialysis could favorably affect central hemodynamics and blood-pressure stability, factors considered relevant to dialysis-induced myocardial stunning. More recent research has shifted toward a controlled nationwide effectiveness-implementation study evaluating intradialytic exercise as routine practice, including safety, physical function, and body composition.
How Does Intradialytic Exercise Protect the 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.
- 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.
Acute Cardiac Effects
A review published in November 2025 examined the acute effect of a single intradialytic aerobic exercise session on cardiac stunning. It compared exercise sessions with hemodialysis without exercise in patients with chronic kidney disease undergoing hemodialysis. The review included non-randomized intervention studies, crossover trials, and randomized controlled trials, reflecting multiple study designs rather than one uniform type of evidence.
Important Limitations
Cardiovascular disease is the leading cause of death among people with kidney failure receiving hemodialysis, making cardiovascular protection an important research priority. Intradialytic myocardial stunning is common and is associated with adverse cardiovascular events. These facts underline the clinical need for exercise research, but they also show why promising findings should not be treated as proof that every exercise program prevents cardiovascular events.
Intradialytic Versus Home Exercise
Research has compared intradialytic exercise with exercise performed outside the clinic, including home-based programs. Intradialytic exercise can involve cycling or resistance training, while home-based exercise offers a different setting and delivery model. Reviews and pilot studies have examined feasibility and effects on cardiovascular health, muscle mass, strength, physical function, and vascular parameters, but the available protocols are not identical enough to make every outcome directly interchangeable.
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.
A Promising Adjunct
Exercise during dialysis appears to be a promising adjunct to routine hemodialysis care rather than a universal replacement for other cardiovascular strategies. Its potential value lies in combining a scheduled treatment period with supervised physical activity. Decisions about starting or adjusting exercise should remain individualized and clinically supervised, particularly because patients differ in health status, tolerance, and treatment response.
From Trials to Practice
Future research will likely need to clarify which exercise formats, intensities, and schedules are most useful for different dialysis populations. Larger and more consistent studies could help distinguish short-term physiological responses from durable cardiovascular benefits. Real-world implementation research may also show how exercise programs can be integrated safely and consistently into routine dialysis services.
Implementation Matters
The broader challenge is not simply demonstrating that exercise can be beneficial, but making suitable programs accessible during routine dialysis care. Factors such as staffing, equipment, supervision, patient health, and clinic workflows may affect whether a program can be delivered consistently. These practical issues mean that research findings may not automatically translate into identical results across all dialysis settings.
Nationwide Real-World Care
A controlled nationwide effectiveness-implementation study evaluated a real-world clinical implementation of an intradialytic exercise program. Its focus was not only whether the intervention could work under study conditions, but how it functioned when introduced into routine practice. This real-world perspective is important because safety, participation, and usefulness depend on how exercise fits into patients’ actual dialysis experience.