Safety and Feasibility of Intradialytic Exercise Including Upper Limb Neuromuscular Electrical Stimulation in Adults With Chronic Kidney Disease: A Randomized Controlled Pilot Clinical Trial.

Abstract

Purpose: To assess the safety and feasibility of an intradialytic exercise protocol, including unilateral upper limb neuromuscular electrical stimulation (NMES) superimposed on a voluntary contraction combined with leg cycle ergometer exercise, in adults with chronic kidney disease (CKD).

Methods: This was a pilot randomized clinical trial in which patients with CKD underwent an intradialytic exercise protocol using a cycle ergometer and active upper limb NMES in the intervention group (IG) or cycle ergometer and SHAM in the control group (CG). Safety was assessed by monitoring blood pressure, heart rate (HR), peripheral oxygen saturation, and any abnormal signs or adverse events. Feasibility was evaluated based on the rate of adherence to the protocol, number of dropouts, and protocol acceptability by patients and healthcare teams.

Results: HR increased in both groups during exercise, but there was no difference between the groups. The post-exercise HR remained higher than the initial HR only in the IG (p = 0.04), and the post-exercise systolic blood pressure (SBP) was lower than the initial SBP only in the CG (p = 0.05); however, these variables remained within the safety values. The adherence rate was 87.5% in the IG and 82.29% in the CG, with no reported adverse events, and the majority expressed interest in continuing exercise after the end of the study, with positive acceptance from the healthcare staff at the HD center.

Conclusion: This intradialytic exercise protocol, including active upper limb NMES, seems to be safe and feasible, suggesting that NMES may be incorporated into intradialytic protocols.

Trial registration: ClinicalTrials.gov identifier: NCT05374863.