Protein2026-06

Combination effect of nutrition and exercise intervention in patients with maintenance dialysis: A systematic review and meta-analysis.

Uno Chiharu, Nishioka Shinta, Tsuchida Yohei, Kabasawa Hideyuki et al. — Clinical nutrition ESPEN

Summary

A review of existing studies found that combining nutritional support (often supplements) with exercise improved physical abilities like walking and movement in adult hemodialysis patients. However, this combined approach did not show clear benefits for their overall dietary intake, body composition, or quality of life. The certainty of these findings was noted as very low, suggesting more research is needed.

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Key points

Combining nutrition and exercise improved physical performance in hemodialysis patients.
Nutrition interventions often involved oral supplements, alongside resistance or aerobic exercise.
No clear benefits were observed for dietary intake, body composition, or quality of life.
The evidence supporting these findings was considered to be of very low certainty.

What the study looked at

This study aimed to understand if combining nutritional support with exercise could improve physical performance, nutritional status, dietary intake, and quality of life for adults undergoing dialysis. Researchers conducted a systematic review and meta-analysis, which means they gathered and analyzed data from multiple existing studies. They included eight trials involving 231 adult hemodialysis patients. The nutritional interventions typically involved oral supplements, while exercise programs included resistance training, aerobic exercise, or electrical muscle stimulation, performed two to three times a week for several months. The findings indicated that the combined nutrition and exercise program significantly improved physical abilities such as walking distance and speed. However, the study did not find clear benefits for other important aspects like overall dietary intake, body composition (e.g., muscle mass), or the patients' reported quality of life. The authors also noted that the certainty of the evidence for all outcomes was very low.

Dietary takeaway

For individuals on dialysis, maintaining muscle health and physical function is crucial, and adequate protein intake is a key component. While this study primarily looked at supplements, a balanced diet rich in protein from whole foods, combined with regular exercise, is generally recommended. Remember that this is just one review of studies, and the findings had low certainty, so it's always best to discuss your specific dietary and exercise needs with your healthcare provider.

Abstract

OBJECTIVE: Although nutritional and exercise interventions in mixed populations of non-dialysis and dialysis chronic kidney disease patients can improve muscle health, no study has specifically targeted dialysis patients or assessed their dietary intake. This systematic review and meta-analysis examined whether combined interventions improve physical performance, nutritional status, dietary intake, and quality of life (QOL) in adults receiving dialysis. METHODS: Following the PRISMA 2020 statement (PROSPERO CRD42024543470, registered on May 16, 2024), PubMed, Ichushi Web, and Web of Science were searched to September 30, 2024 for randomized, cluster-randomized, or crossover trials comparing combined nutrition plus exercise with sole either alone or with no intervention in adults (≥18 years) on hemodialysis or peritoneal dialysis. Favorable outcomes included physical performance, skeletal muscle mass, body mass index, energy and protein intake, QOL, and mortality, whereas the unfavorable outcome was gastrointestinal symptoms. Random-effects meta-analyses calculated mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: Eight trials with 231 hemodialysis patients were eligible; seven contributed to quantitative synthesis. Nutritional interventions involved mainly oral supplements, and exercise (resistance, aerobic, or neuromuscular electrical stimulation) was performed two to three times/week for 3-12 months. Combined therapy significantly improved the 6MWT distance (MD 45.17 m, 95% CI 12.60-77.75), gait speed (MD 0.09 m/s, 95% CI 0.02 to 0.17), and TUG time (MD -1.44 s, 95% CI -2.63 to -0.25). No significant differences were observed in the Sit-to-Stand test, lean body mass, BMI, intake, or QOL. CONCLUSIONS: Compared with nutritional intervention alone, combined nutrition and exercise intervention was associated with improved physical performance outcomes in hemodialysis patients but showed no clear benefit for dietary intake, body composition, or QOL. The certainty of evidence was very low for all outcomes.

View on PubMed →DOI: 10.1016/j.clnesp.2026.103389