***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Functional limitations , altered cardiac autonomic activity , and psychological distress are known disorders in chronic hemodialysis ( HD ) patients , relating to increased morbidity and mortality . The aim of this study was to examine the influence of an exercise training program on emotional parameters and heart rate variability ( HRV ) indices , as well as to determine whether emotional stress contributes to autonomic dysfunction in these patients . Methods Forty-four HD patients were r and omly assigned into group A ( 24 patients , aged 46.3 ± 11.2 years ) , who participated in a 1-year intradialytic exercise training program and group B ( 20 patients , aged 45.8 ± 10.8 years ) , who were used as controls . At baseline and a year after , measures of HRV were obtained for the estimation of st and ard deviation of RR intervals , the mean square successive differences , percentage of RR intervals differing by more than 50 ms from the preceding RR interval ( pNN50 ) , and low to high frequency components . Emotional parameters ( Beck Depression Inventory – BDI and Hospital Anxiety and Depression Scale – HADS ) were also assessed by vali date d question naires . Moreover , all patients performed a spiroergometric study for the estimation of VO2peak . Results At baseline , all measurements were similar in the two groups and remained almost unchanged after a year in group B. After a year of training , VO2peak increased from 16.79 ± 5.24 to 22.33 ± 4.90 ml/kg per min ( P > 0.001 ) in group A. Trained patients also showed an increase in st and ard deviation of RR intervals by 58.8 % ( P > 0.001 ) , the mean square successive differences by 68.1 % ( P > 0.001 ) , pNN50 by 23.5 % ( P > 0.001 ) , and a low to high frequency ratio by 17.3 % ( P > 0.001 ) . Finally , at the end of the study , group A showed a decrease in BDI score by 34.5 % ( P > 0.001 ) and HADS by 23.9 % ( P > 0.001 ) . Canonical correlation revealed significant inverse correlation among depression ( in BDI and HADS ) and HRV indices before and after exercise training . Conclusion Cardiac autonomic modulation seemed to be sensitive to the experience of persistent depression in HD patients .  Significantly , exercise training  reduced emotional distress and concomitantly improved HRV OBJECTIVES Regular exercise is known to reduce arterial stiffness ( AS ) in hemodialysis patients . However , the impact of a more realistic intradialytic form of exercise , such as pedaling , is unclear . We aim ed to examine ( i ) the effect of intradialytic pedaling exercise on AS over 4 months and ( ii ) the longer term effect of pedaling on AS 4 months after exercise cessation . METHODS Patients on stable in-center hemodialysis ( 3 x/week ) were r and omly assigned 1:1 to either intradialytic pedaling exercise ( EX ) or to a control group receiving usual hemodialysis ( nonEX ) for 4 months . At baseline and 4 months , peripheral and central blood pressure ( BP ) indices , heart rate ( HR ) , augmentation index HR corrected ( AIx75 ) , and carotid-femoral pulse wave velocity ( cfPWV ) were assessed ( applanation tonometry ) . Measurements were repeated in the EX group 4 months postexercise cessation . RESULTS As per protocol analysis was completed in 10 EX group participants ( 58 ± 17 years , body mass index 26 ± 4 kg/m2 ) and 10 nonEX group participants ( 53 ± 15 years , body mass index 27 ± 6 kg/m2 ) . Peripheral and central BP was unchanged in both groups . AIx75 was unchanged in the EX group , however , a significant median increase of 3.5 % [ interquartile range , IQR 1.0 , 8.5 ] was noted in the nonEX group ( P = 0.009 ) . We noted a significantly greater absolute decrease in cfPWV in the EX group compared to controls : -1.00 [ IQR -1.95 , 0.05 ] vs. 0.20 [ IQR -0.10 , 0.90 ] ( P = 0.033 ) . Interestingly , the decrease in cfPWV observed in the EX group was partially reversed 4 months after exercise cessation . CONCLUSION Intradialytic pedaling exercise has a beneficial impact on AS . This relationship warrants further investigation . CLINICAL TRIALS REGISTRATION Trial Number # NCT03027778 ( clinical trials.gov ) Purpose Physical inactivity and sleep disturbance are frequently observed and relate to poor clinical outcomes in maintenance hemodialysis patients . We aim ed to investigate the effect of intradialytic exercise on daily physical activity and sleep quality , measured by an accelerometer , in maintenance hemodialysis patients . Methods This study r and omly assigned ambulatory maintenance hemodialysis patients aged ≥ 20 years on dialysis ≥ 6 months , without a hospitalization history for the previous 3 months to 4 groups : aerobic exercise ( AE ) , resistance exercise ( RE ) , combination exercise ( CE ) , and control . A stationary bike was used for AE and a TheraB and ® /theraball for RE . A 12-week intradialytic exercise program ( 3 times/week ) was completed in the AE ( n = 11 ) , RE ( n = 10 ) , and CE ( n = 12 ) groups . The control group ( n = 13 ) received only warm-up stretching . At baseline and 12-week follow-up , daily physical activity and sleep quality were measured with a triaxial accelerometer ( wActiSleep-BT ; ActiGraph , Pensacola , FL ) during a continuous 7-day wear period . Results We observed a significant increase in metabolic equivalent ( MET ; kcal/h/kg ) in the AE ( 1.02 ± 0.03 vs 1.04 ± 0.04 , P = 0.04 ) and CE ( 1.06 ± 0.05 vs 1.09 ± 0.08 , P = 0.01 ) groups at 12 weeks compared with baseline . When comparing between-group changes in MET , there was a significant increase in METs in the CE group ( 0.03 ± 0.03 vs − 0.01 ± 0.04 , P = 0.02 ) compared with the control group . The total number of sedentary bouts ( per week ) decreased significantly in the AE ( 200 ± 37 vs 174 ± 36 , P = 0.01 ) , RE ( 180 ± 31 vs 130 ± 49 , P = 0.03 ) , and CE groups ( 180 ± 45 vs 152 ± 46 , P = 0.04 ) at 12 weeks compared with baseline . The average sleep fragmentation index , indicating poor sleep quality , decreased significantly at 12 weeks compared with baseline in the AE ( 51.4 ± 8.0 vs 44.5 ± 9.6 , P = 0.03 ) and RE groups ( 52.3 ± 7.3 vs 40.0 ± 15.4 , P = 0.01 ) . Conclusions Intradialytic exercise appears to be clinical ly beneficial in improving daily physical activity and sleep quality in maintenance hemodialysis patients Previous studies have suggested the benefits of physical exercise for patients on dialysis . We conducted the Exercise Introduction to Enhance Performance in Dialysis trial , a 6-month r and omized , multicenter trial to test whether a simple , personalized walking exercise program at home , managed by dialysis staff , improves functional status in adult patients on dialysis . The main study outcomes included change in physical performance at 6 months , assessed by the 6-minute walking test and the five times sit-to-st and test , and in quality of life , assessed by the Kidney Disease Quality of Life Short Form ( KDQOL-SF ) question naire . We r and omized 296 patients to normal physical activity ( control ; n=145 ) or walking exercise ( n=151 ) ; 227 patients ( exercise n=104 ; control n=123 ) repeated the 6-month evaluations . The distance covered during the 6-minute walking test improved in the exercise group ( mean distance±SD : baseline , 328±96 m ; 6 months , 367±113 m ) but not in the control group ( baseline , 321±107 m ; 6 months , 324±116 m ; P<0.001 between groups ) . Similarly , the five times sit-to-st and test time improved in the exercise group ( mean time±SD : baseline , 20.5±6.0 seconds ; 6 months , 18.2±5.7 seconds ) but not in the control group ( baseline , 20.9±5.8 seconds ; 6 months , 20.2±6.4 seconds ; P=0.001 between groups ) . The cognitive function score ( P=0.04 ) and quality of social interaction score ( P=0.01 ) in the kidney disease component of the KDQOL-SF improved significantly in the exercise arm compared with the control arm . Hence , a simple , personalized , home-based , low-intensity exercise program managed by dialysis staff may improve physical performance and quality of life in patients on dialysis BACKGROUND Sedentary behavior is associated with an increased risk for death in the general population . However , the association between inactivity and mortality has not been studied in a large cohort of dialysis patients despite the high prevalence of sedentary behavior in this group . METHODS We used the Dialysis Morbidity and Mortality Study Wave 2 , a prospect i ve study of a national sample of 4,024 incident peritoneal dialysis and hemodialysis patients from 1996 to 1997 , to determine whether sedentary behavior is associated with increased mortality during a 1-year period in this group after adjusting for confounding variables . RESULTS The study population consisted of the 2,837 patients with accurate survival data who were able to ambulate and transfer . Eleven percent of the sedentary patients died during the study period compared with 5 % of nonsedentary patients . In a survival analysis , sedentary behavior ( hazard ratio , 1.62 ; 95 % confidence interval , 1.16 to 2.27 ) was associated with an increased risk for death at 1 year after adjusting for all variables that we postulated might be associated with survival and for differences between sedentary and nonsedentary patients . CONCLUSION Sedentary behavior is associated with an increased risk for mortality among dialysis patients similar in magnitude to that of other well-established risk factors , such as a one-point reduction in serum albumin concentration . More attention should be given to exercise behavior in dialysis patients , and controlled clinical trials are needed to further define the association of sedentary behavior with mortality PURPOSE To investigate the effect of progressive resistance training ( PRT ) on body composition , physical fitness , quality of life , lipid and nutritional profile of patients on hemodialysis ( HD ) . METHODS A non equivalent comparison group pretest and posttest design study was used with 40 participants who were r and omly assigned to the exercise group ( 20 participants ) and the comparison group ( 20 participants ) . The exercise group received PRT for 30 minutes per session , 3 sessions a week , for 12 weeks , while the comparison group received usual care . The PRT consisted of upper and lower body exercises using elastic b and s and s and bags . Outcome measures evaluated were : body composition , physical fitness , quality of life , and lipid profile . RESULTS Skeletal muscle mass , grip , leg muscle strength , and quality of life all improved significantly in the exercise group . Body fat rate , total cholesterol and triglyceride rate decreased significantly in the exercise group . CONCLUSION These results suggest that PRT improves body composition , physical fitness , quality of life , and lipid profile of patients on HD .  PRT using elastic b and s and s and bags can be utilized as part of a regular care plan for these patients Objective : To assess the effects of intradialytic exercise training on health-related quality of life indices in haemodialysis patients . Subjects/ patients : Thirty-five patients on haemodialysis , with a mean ( SD ) age of 48.8 ( 13.9 ) years , volunteered to participate in the study . They were r and omized either to rehabilitation group ( group A : 19 patients ) , following a 10-month intradialytic exercise training programme or to  control group ( group B : 14 patients ) . After the r and omization , two of the patients , one of each group , withdrew from the study for reasons unrelated to exercise training . Method : All patients at the beginning and the end of the study underwent clinical examination , laboratory tests and a treadmill exercise testing with spiroergometric study for the evaluation of their aerobic capacity ( Vo2peak ) . A formal psychosocial assessment , which included affective ( Beck Depression Inventory ) , health-related quality of life ( Quality of Life Index , Living Question naire of Minnesota , Life Satisfaction Index and Short Form-36 question naire ) and personality ( Eysenck Personality Question naire ) parameters , was evaluated at beginning and end of the study . The dose of erythropoietin was changed as needed , according to the level of the haemoglobin , aim ing to keep it at 11 ( 2 ) g/dL during the study . Results : Baseline values were similar between the two groups . After training in group A , Vo2peak was increased by  
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Results : Included 20 trials ( 677 participants ) indicated that various exercise types improved aerobic capacity , walking capacity , and health-related QoL totally .
Of note , aerobic exercise and combined exercise were the predominant exercise types .
Conclusion : Based on our evidence , aerobic exercise or combined exercise at least for 8 weeks to 12 months , 3 times weekly , will be beneficial to physical conditions of the patients with ESRD undergoing HD .