Acute Effect of Intradialytic Aerobic Exercise on Cardiac Stunning in Patients With Chronic Kidney Disease: A Systematic Review and Meta‐Analysis

BACKGROUND AND PURPOSE: Intradialytic aerobic exercise (IAE) has emerged as a possible cardioprotective strategy for patients with chronic kidney disease (CKD). However, there is still no summary of the IAE prescription variables and their acute effect on reducing cardiac stunning in patients undergoing hemodialysis (HD). The aim of this review was to analyze the effect of a single IAE session compared to the HD without exercise on cardiac stunning in patients with CKD. METHODS: Non-randomized intervention studies, crossover trials, and randomized controlled trials involving patients with CKD undergoing HD were included. The primary outcomes were regional wall motion abnormalities (RWMA) and global longitudinal strain (GLS). The search was conducted on April 5, 2024 in eight databases. Studies in English, Portuguese, or Spanish were included with no date restriction. The Physiotherapy Evidence Database scale and the Cochrane collaboration risk of bias tool were used. Meta-analyses were performed using RevMan version 5.4 with random-effects models, reporting mean difference (MD) and 95% confidence interval (95% CI). RESULTS: Three studies were included, totaling 97 patients (67 males). In echocardiography performed near the end of the HD session, IAE favored a reduction in the RWMA compared to the HD without exercise (MD -1.86 segments, 95% CI -3.09 to -0.62, p = 0.003). However, the decline in GLS at the end of the exercise (MD -0.50%, 95% CI -1.56 to 0.56, p = 0.35), and near the end of the HD session (MD -0.86%, 95% CI -1.85 to 0.14, p = 0.09) was not affected. DISCUSSION: A single session of IAE can reduce RWMA at the end of the HD session, compared to the HD session without exercise. No significant effect on GLS was observed. The data supporting these findings are of low methodological quality and have a high risk of bias. TRIAL REGISTRATION: This systematic review was registered in PROSPERO (CRD42024496368).