Structured exercise improves vascular access and functional outcomes in hemodialysis patients: a randomized controlled trial

BACKGROUND: Vascular access complications are a major source of morbidity in patients receiving maintenance hemodialysis (HD). Exercise has been shown to enhance cardiovascular and functional outcomes in this population, but its impact on vascular access parameters remains inadequately explored. OBJECTIVE: To investigate the effects of a 12-week structured exercise program-including intradialytic cycling, walking, and isolated wrist exercises-on vascular access diameter, physical function, depression, and quality of life in HD patients. METHODS: In this single-center, parallel-group randomized controlled trial, 100 HD patients were allocated to an exercise (n = 50) or control (n = 50) group. Eligible participants were adults aged 18-65 years undergoing HD for at least 6 months, with an established arteriovenous fistula, graft, or catheter. Exclusion criteria included active vascular complications, cardiovascular or orthopedic conditions that contraindicated exercise, or unwillingness to participate. Baseline vascular diameters were assessed via ultrasound by a nephrologist. The intervention group engaged in a combined aerobic and localized resistance exercise program for 12 weeks. Primary outcome was vascular access diameter (measured by ultrasound). Secondary outcomes included functional capacity (6-minute walk test), depression (Beck Depression Inventory [BDI]), and patient-reported quality of life (KDQOL-36). Repeated-measures ANOVA and multivariate regression were used to evaluate within- and between-group differences. RESULTS: The exercise group demonstrated a significantly greater increase in vessel diameter compared with the control group (mean change: 0.9 ± 0.3 mm vs 0.1 ± 0.2 mm; P <.01; Cohen's d = 0.8). Improvements were also observed in 6MWT distance, BDI scores, and all KDQOL-36 domains (P <.05). Multivariate regression identified age as a negative predictor and HD duration as a positive predictor of vascular adaptation. No adverse events were reported. CONCLUSION: A 12-week structured exercise program significantly improved vascular access diameter and functional and psychological outcomes in HD patients. These findings support the clinical utility of tailored exercise interventions as a noninvasive adjunct to routine dialysis care. Clinical Trial Registration: Registered at ClinicalTrials.gov: NCT06428773.