A structured exercise programme during haemodialysis for patients with chronic kidney disease: clinical benefit and long‐term adherence
Author, year	Anding et al., 2015 52	Duration of intervention	12 months
Participants CKD stage Age (years)	ESRD on haemodialysis 63.2 ± 16.3 (1) High adherence (HA): 19 HA, >80% of 104 training sessions within 12 months (2) Moderate adherence (MA): 12 MA, 60–80% of 104 training sessions within 12 months (3) Low adherence group (LA): 15 LA, <60% of 104 training sessions within 12 months	Sarcopenia outcomes
		Muscle mass	Muscle strength	Physical performance
		NA	At 6 months (HA, MA): ↑STS** At 12 months (HA, MA): ↑STS***	At 6 months (HA, MA): ↓TUG** ↑6MWT (NS) At 12 months (HA, MA): ↓TUG*** ↑6MWT***
Intervention description
Structured physical exercise programme (SPEP) supervised by exercise specialist: 2×/week of RE + ET for 60 min during first 2 h of haemodialysis. Intensity continuously adjusted to improvements of performance testing. Start: 5 min warm‐up Endurance training: Bed‐cycle ergometers positioned in front of patients' chairs. Participants continue until muscular fatigue. Dynamic resistance training: Weights and elastic bands used. Training of 8 muscle groups with an individual target repetition rate (R) of exercises in 2 sets of 1 min each with 1 min break. The target repetition rate was derived from the maximal repetition rate (MRR) in a maximum strength test for all 8 muscle groups; patients were asked to perform as many repetitions as possible in 1 min. Month 1: goal to achieve 50% MRR, Months 2 + 3: 65% MRR, Months 5 + 4: 70% MRR. After Month 5: MRR test repeated to set new one. Months 6–10: as 1–5 based on new MRR.

Effect of intra‐dialytic, low‐intensity strength training on functional capacity in adult haemodialysis patients: a randomized pilot trial
Author, year	Chen et al., 2010 53	Duration of intervention	6 months (48 exercise sessions)
Participants CKD stage Age (years)	ESRD on haemodialysis 69 ± 13 E1: 22 E2: 22	Sarcopenia outcomes
		Muscle mass	Muscle strength	Physical performance
		↑SMM by DXA (4.2 ± 5.6%)*** ↑ASMM by DXA (5.0 ± 7.6%)***	NA	↑SPPB (21.1%)*
Intervention description
2×/week during the 2nd hour of haemodialysis Start: 5 min warm‐up and end with 5 min cool‐down E1: Supervised progressive resistance exercise 2 sets/8 repetitions per exercise with 1–2 min rest between sets. Conditioning: first 8 exercise sessions no or little weight is used and progressed based on participants' ability to complete 2 sets/8 repetitions with proper form and rate of perceived exertion (RPE) of 2–4 (easy to somewhat easy). Next; multiple lower body seated exercises using ankle weights increasing in half‐pound increments from 0.5 to 20 lbs. Seated pelvic tilt without using free weights. Moderate intensity (somewhat hard) corresponding 6 on RPE scale. E2: Attention‐control: Stretching exercises with light resistance bands Exercises include ankles flexion, rotation, calf, hamstring and inner thigh stretch. Exercises were done in the semi recumbent position, held for 20–30 s and repeated ×2.

A pilot study investigating the effect of pedalling exercise during dialysis on 6 min walking test and hand grip and pinch strength
Author, year	Desai et al., 2019 57	Duration of intervention	4 months
Participants CKD stage Age (years)	ESRD on haemodialysis 64.0 ± 16.6 E: 13 C: 21	Sarcopenia outcomes
		Muscle mass	Muscle strength	Physical performance
		↑SMM by BIA (NS) ↓ASMM by BIA (NS)	↑Grip strength**	↑6‐MWT*
Intervention description
3×/week during haemodialysis E: Progressive sub‐maximal individualized cycling exercise with loading Exercise used bed‐cycle ergometers positioned in front of the patient's dialysis chair with exercise intensity monitored every 5 min. Warm‐up: low‐load aerobic cycling at an intensity of 8–9 on RPE scale. Conditioning: cycling with aim of 13–15 RPE (moderate intensity). Cooling down: light cycling with no load or resistance at an intensity of 8–9 RPE scale. C: Control group Received routine haemodialysis care.

Effects of intradialytic resistance exercise on systemic inflammation in maintenance haemodialysis patients with sarcopenia: a randomized controlled trial
Author, year	Dong et al., 2019 43	Duration of intervention	12 weeks
Participants CKD stage Age (years)	ESRD on haemodialysis 60 (43–68) E: 21 C: 20	Sarcopenia outcomes
		Muscle mass	Muscle strength	Physical performance
		↔SMM by BIA (NS)	↑Grip strength (23.54%)**	↑6‐MWT (15.94%)*
Intervention description
3×/week during haemodialysis E: progressive resistance exercise Start: 5 min warm‐up. 10 sets/10 repetitions of all exercises maximally maintained for 3–5 s per cycle and then release completing 1–2 h of RE during haemodialysis. 1st week: low intensity RE with no weights using quadriceps training board for assistance. 2–12 weeks: moderate to high intensity adding + 0.5 kg (single foot)/week to ankle to reach + 5 kg maximum Progression was done according to patient's tolerance with the angle of the training board reduced gradually (150°–90°) until it was removed. Upper limb exercises: non‐treated hand with elastic resistance ball. C: Control group Received routine haemodialysis care.

Aerobic or resistance training and pulse wave velocity in kidney transplant recipients: a 12 week pilot randomized controlled trial [the Exercise in Renal Transplant (ExeRT) Trial]
Author, year	Greenwood, et al., 2015 62	Duration of intervention	12 weeks
Participants CKD stage Age (years)	Kidney transplanted 54 ± 10.6 RE:13 AE:13 UC:20	Sarcopenia outcomes
		Muscle mass	Muscle strength	Physical performance
		NA	↑STS* (within RE and within AE) ↑STS (RE/UC)** ↑STS (AE/UC) (NS)	NA
Intervention description
2×/week free supervised structured aerobic exercise classes in a gym or hospital setting and 1×/week home‐based resistance exercise. Prior to start: all received 40 min individual behaviour modification session to discuss exercise and personal goals using motivational interviewing. Participants were instructed how to use an RPE scale to rate perception of effort at the prescribed exercise intensity RE: Home‐based resistance exercise 60 min once per week Resistance bands and ankle weights were provided. Prescription: warm‐up and cool‐down period of 5 min on a stationary exercise cycle, RPE of 11, followed by gentle stretching. RE of high‐intensity at 80% one‐repetition maximum, the maximum amount of weight can be lifted or pressed once but not twice, for upper and lower body muscle groups (bench press, latissimus pull down, bicep curl, triceps pull down, leg press, knee extension, hamstring curl, and calf raises). Duration of all 8 exercises to be completed within 60 min session. Progression: start with 1–2 sets and 10 repetitions (based on 80% one‐repetition maximum and on tolerance) with the aim of slowly and progressively increasing to 3 sets and 8–10 repetitions. Reporting and Monitoring: each patient completed an exercise diary after home exercise sessions. Weekly calls to increase motivation and assess rate of RPE. The 1‐repetition maximum was reassessed monthly, and the programme was adjusted accordingly. AE: Supervised aerobic exercise gym or hospital based 60 min twice per week Heart rate monitor and aerobic‐based home exercise programme provided. Prescription: warm‐up and cool‐down period of 5 min on a stationary exercise cycle, RPE of 11, followed by gentle stretching. Individually tailored on recumbent stationary exercise cycles, a treadmill, and elliptical trainer switching every 10 min, with 3 min rest. Intensity set to 80% heart rate reserve as derived from the incremental exercise testing with RPE training target was 13–15 (somewhat hard to hard). C: Control usual care group Seen routinely in the transplantation clinic but not referred for formal exercise.

Randomized controlled trial of exercise in CKD—the RENEXC study
Author, year	Hellberg et al., 2019 51	Duration of intervention	12 months
Participants CKD stage Age (years)	CKD—non‐dialysis Stages 3–5 66 ± 14 E1: 76 E2: 75	Sarcopenia outcomes
		Muscle mass	Muscle strength	Physical performance
		NA	Between groups: ∆Grip strength (NS) ∆STS (NS) Within Group E1: ↑Grip strength (NS) ↑STS*** Within Group E2: ↔Grip strength (NS) ↑STS**	Between groups: ∆6‐MWT (NS) Within Group E1: ↑6‐MWT*** Within Group E2: ↑6‐MWT***
Intervention description
Self‐administered exercise of 150 min/week distributed in 3–5 sessions/week starting with 10 min warm‐up followed by: 60 min of endurance training + 90 min/week of either strength or balance training. Both groups: Before starting, a bank of predefined exercises was created and explained in detail by the physiotherapist and individual training plan was provided. Training setting at home or at a nearby gym, depending on individual preference. Each patient was advised to evaluate training performance according to RPE and provide a report by mailing in the training diary. Endurance training to be performed for at least 60 min (2 sessions of 30 min)/week at an RPE of 13–15 includes walking, jogging, cycling, etc. and adjusted by increasing speed or distance, or by interval training. Reporting and monitoring: weekly phone calls by physiotherapist during first 3 months, followed by every second week in months 4 to 12, were provided to check progress, encourage patients, and adjust training plan to maintain desired level of exertion. E1: Strength + endurance training 90 min (3 sessions of 30 min)/week with a target of 13–17 RPE per exercise set. In all, 4–6 different exercises (e.g. quadriceps extension, squats, biceps curls, pull‐ups, etc.) were performed as 2–3 sets of 10 repetitions and adjusted by increasing the weights or the difficulty of the exercises (e.g. adjusting body position regarding angle or leverage). E2: Balance + endurance training 90 min (3 sessions of 30 min)/week at 13–17 RPE per exercise set. In all, 4–6 different exercises (e.g. standing with feet together, on one leg, on balance board or planking, etc.) were performed as 2–3 sets of 10 repetitions and adjusted by increasing the difficulty (e.g. adding arm movements, closing eyes, or changing body position).

Effects of home‐based exercise on pre‐dialysis chronic kidney disease patients: a randomized pilot and feasibility trial
Author, year	Hiraki et al., 2017 59	Duration of intervention	12 months
Participants CKD stage Age (years)	CKD—non‐dialysis Stages 3–4 68.7 ± 6.8 E: 14 C: 14	Sarcopenia outcomes
		Muscle mass	Muscle strength	Physical performance
		NA	↑Grip strength (17.0 ± 16.1%)*	NA
Intervention description
E: Home‐based therapy of combined aerobic and resistance exercise Exercise instructions were given in first visit included AE: brisk walking for 30 min a day or completing 8000–10 000 steps per day. RE minimum 3×/week: upper limbs using handgrip‐strengthening device provided and mid‐level load exercises such as squats and calf raises for exercising the lower limbs (20–30 repetitions per exercise). Record keeping: exercise record sheet used to report adherence to RE, the implementation rate and exercise details. Number of steps (steps/day), amount of exercise performed (total amount of calories burnt through exercise: kcal/day), and time spent on performing mid‐level load exercises (min/day) were collected from accelerometer pedometers worn continuously for 1 year and removed only when bathing or sleeping. No direct supervision for a period of 1 year. Exercises performed were collected from patients during outpatient visits every 2–3 months, and feedback was provided at each visit. Both the AE and the RE used RPE scale aiming to mid‐level load strength. C: Control group Given accelerometer pedometers for a period of 1 year. No exercise instructions were given and asked to carry out daily activities as usual. Record keeping: number of steps recorded during follow‐up visits, without additional information related to exercise.

Exercise training in CKD: efficacy, adherence, and safety
Author, year	Howden et al., 2015 60	Duration of intervention	8 weeks supervised followed by 10 months home‐based exercise
Participants CKD stage Age (years)	CKD—non‐dialysis Stages 3–4 E: 36 60.2 ± 9.7 C:36 62.0 ± 8.4	Sarcopenia outcomes
		Muscle mass	Muscle strength	Physical performance
		NA	At 6 months follow‐up: ↔Grip strength* At 12 months Follow‐up: ↔Grip strength*	At 6 months follow‐up: ↑6‐MWT* ↔TUG (NS) (Prevented decline observed in control group) At 12 months follow‐up: ↑6‐MWT*** ↔TUG (NS) (Prevented decline observed in control group)
Intervention description
E: Exercise training and lifestyle intervention Usual care plus assistance from a multidisciplinary team (nurse practitioner, exercise physiologist, dietitian, psychologist, diabetes educator, and social worker). Education about safety, hydration and signs and symptoms of abnormal response to exercise especially those with angina, severe arthritis, and diabetes was given. Individualized prescription aimed to complete 150 min/week of moderate intensity AE and RE, starting with 8 weeks of supervised training followed by 10 months of home‐based training. Initial supervised phase: AE for 30 min: walking or jogging, cycling, or rowing at an exercise intensity of RPE of 13–15. RE: 3 sets/10–15 repetitions of 6–8 functional RE, using hand weights or resistant bands focusing on whole‐body, including wall squats; bench press; lunges; wall push‐ups; seated row, bicep, and triceps extension; ‘supermans’; and bridge holds. Follow‐up with the nurse practitioner was scheduled at Week 4. Home‐based maintenance phase: Encouragement to continue to perform a combination of AE and RE. All participants were provided with resistance bands, Swiss ball, and RE booklet with examples of strength training workouts. Home‐based AE consisted predominantly of walking or stationary cycling. Regular contact to monitor adherence to training. If issues identified with adherence, they were encouraged to attend the gym for a refresher visit or alternative strategies were discussed to reach the required exercise levels. C: Control group Received usual care according to best practice guidelines including attending a consultation with a nephrologist and lifestyle modification recommendation with no detailed information, education, or referral to an allied health practitioner.

Anabolic exercise in haemodialysis patients: a randomized controlled pilot study
Author, year	Kirkman et al., 2014 58	Duration of intervention	12 weeks
Participants CKD stage Age (years)	ESRD on haemodialysis RE: 9 48 ± 18 Sham E:10 58 ± 15	Sarcopenia outcomes
		Muscle mass	Muscle strength	Physical performance
		↑ASMM by MRI**	↑STS (NS)	↑6‐MWT (NS) ↓TUG (NS)
Intervention description
3×/week during haemodialysis E: progressive resistance exercise training (PRET) Each session: included leg press exercise using equipment fit to dialysis chair with series of resistance bands providing a maximum resistance equivalent to 200 kg. Exercise included 3 sets/8–10 repetitions with 2 min rest between sets at 80% of patients predicted 1‐RM. If 10–12 repetitions could be completed at a rating of RPE below 15 (hard), 1‐RM was re‐determined and the training load increased accordingly. Weekly training volume was calculated as kg per lift × lifts per session × sessions per week. SHAM E group: Un‐progressive stretches using an ultra‐light band.

Effect of resistance exercises on the indicators of muscle reserves and handgrip strength in adult patients on haemodialysis
Author, year	Olvera‐Soto et al., 2015 54	Duration of intervention	12 weeks (24 sessions in total)
Participants CKD stage Age (years)	ESRD on haemodialysis 29 (21–39) E: 30 C: 31	Sarcopenia outcomes
		Muscle mass	Muscle strength	Physical performance
		NA	↑Grip strength (9.82%)**	NA
Intervention description
2×/week during haemodialysis E: Progressive resistance exercise First 2 sessions; familiarization with exercises. 3rd session; 500‐g weight belts were attached to each ankle 4 sets/30 repetitions were performed for each 4 exercises: A: arm extension with moderate resistance bands in the non‐arteriovenous fistula arm whereas patients with catheters both arms exercised B: lower leg extension C: straight leg extension D: seated marching Duration per session: 50 min. C: Control group No exercises, education, or equipment to perform resistance exercises or any type of exercises were given.

Effect of continuous progressive resistance training during haemodialysis on body composition, physical function and quality of life in end‐stage renal disease patients: a randomized controlled trial
Author, year	Rosa et al., 2018 55	Duration of intervention	12 weeks
Participants CKD stage Age (years)	ESRD on haemodialysis 55.7 ± 14.03 E: 28 C:24	Sarcopenia outcomes
		Muscle mass	Muscle strength	Physical performance
		Between groups: ∆ASMM by DXA* Within group (E): ↑ASMM by DXA*	Between groups: ∆Grip strength (NS) ∆STS* Within group (E): ↔Grip strength (NS) ↑STS*	Between groups: ∆6‐MWT (NS) Within group (E): ↑6‐MWT*
Intervention description
3×/week with each session divided to 2 segments; Upper limb exercises prior to haemodialysis in waiting room and lower limb exercises during haemodialysis. Clinical exercise physiologist supervised all exercise sessions in both groups. E: Progressive resistance exercise 6 sessions of familiarization exercises held 2 weeks prior to training with no/low loads at 2 sets/10 repetitions. Post 2 weeks: start 2 sets of 15–20 repetitions of 11 exercises progressively increased until momentary failure occurred. If repetitions performed beyond the above, weight was increased to return the number of repetitions within the maximum training zone (15–12 repetitions). Rest between sets and exercises was individualized according to patients' needs. Post exercise; passive stretching of lower limbs performed to facilitate recovery. Duration per session: 40–50 min. C: Sham exercise Active mobilization of the arms and legs without load and progression, circumduction of the cervical and scapular girdle, and a breathing exercise. 2 sets of 3–5 repetitions only and no stretching exercises. Duration per session 5–10 min.

Effects of a renal rehabilitation exercise programme in patients with CKD: a randomized, controlled trial
Author, year	Rossi et al., 2014 61	Duration of intervention	12 Weeks (24 sessions)
Participants CKD stage Age (years)	CKD—non‐dialysis Stages 3–4 E: 48 67.7 ± 12.4 C: 46 69.2 ± 12.4	Sarcopenia outcomes
		Muscle mass	Muscle strength	Physical performance
		NA	↑STS (29%)***	↑6MWT (19%)*** ↔Gait speed (NS)
Intervention description
2×/week at selected physical therapy or cardiac rehabilitation facilities E: renal rehabilitation exercise programme (RRE) 60 min individual or group sessions guided by exercise physiologist or physical therapist who assessed cardiovascular and strength capabilities at the initial session according to the perceived level of exertion (PLE) scale. Intervention limited to PLE 11 corresponding to 60–65% predicted maximal heart rate. Cardiovascular exercises (AE): Treadmill walking and/or stationary cycling with increase of duration by 2–3 min/session, increase bicycle freewheel tension or treadmill speed or elevation. Self‐administered 5000–10 000 steps/day monitored by pedometers. Weight training (RE): Upper and lower extremity extensions and flexions with free weights. 1 set/10 repetitions of each exercise using 1 to 10 lb weights (according to tolerance) and increased to 3 sets of 15 repetitions, after which time weight was further increased. C: Control group Received usual care.

Effects of progressive resistance training on body composition, physical fitness and quality of life of patients on haemodialysis
Author, year	Song et al., 2012 56	Duration of intervention	12 weeks
Participants CKD stage Age (years)	ESRD on haemodialysis E: 20 52.1 ± 12.4 C: 20 54.6 ± 10.1	Sarcopenia outcomes
		Muscle mass	Muscle strength	Physical performance
		↑SMM by BIA**	↑Grip strength (NS) ↑STS (NS)	NA
Intervention description
3×/week during haemodialysis E: Progressive resistance training (PRT) 3 sets of 10–15 repetition with intensity of 11–15 RPE (‘moderate’ to ‘hard’). 10 PRT exercises in 30 min/PRT session including 5 min warm up prior to PRT and 5 min cool down post PRT. 20 min PRT included 6 upper body exercises using elastic bands and 6 lower body exercises using sand bags. Elastic bands tensile strength was progressively increased to all participants. 4th week of PRT, 1–3 kg sand bags added around each of ankles. 8th week of PRT, +1 kg was added to previous sand bag worn. C: Control group Usual care without any instructions to exercises or access to exercise equipment.

Muscle mass and plasma myostatin after exercise training: a substudy of Renal Exercise (RENEXC)—a randomized controlled trial
Author, year	Zhou et al., 2019 50	Duration of intervention	12 months
Participants CKD stage Age (years)	CKD—non‐dialysis Stages 3–5 67 ± 13 E1: 53 E2: 59	Sarcopenia outcomes
		Muscle mass	Muscle strength	Physical performance
		Between groups: ∆ SMM by DXA (NS) ∆ ASMM by DXA (NS) Within Group (E1): ↔SMM by DXA* ↔ASMM by DXA* Within group (E2): ↑SMM by DXA** ↑ASMM by DXA*	NA	NA
Intervention description
Refer to intervention details described in Hellberg et al. 51 above.

Data shown as either Mean ± SD or Median (Range); CKD: chronic kidney disease; RE: resistance exercise; AE: aerobic exercise; ET: endurance training; E: exercise; C: control; RPE: rated perceived exertion; 1‐RM: one repetition maximum; SMM: skeletal muscle mass; ASMM; appendicular skeletal muscle mass; BIA: bioelectrical impedance analysis; MRI: magnetic resonance imaging; DXA: dual‐energy absorptiometry; STS: sit‐to‐stand test; TUG: timed‐up‐and‐go test; 6MWT: 6 min walking test; SPPB: short performance physical battery; NA: not available.

∆, change; ↑, increase, ↓, decrease; ↔, no change. NS, not significant.

^* P < 0.05.

^** P < 0.01.

^*** P < 0.001.