***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 
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    ***EXAMPLES*** 
    Input: INTRODUCTION Cardiovascular disease is the major cause of death in hemodialysis patients . Regular aerobic or intradialytic exercise may play a role in reducing cardiovascular mortality in these patients . The aim of this study was to evaluate the relationship between intradialytic exercise and echocardiographic findings . METHODS AND MATERIAL S Forty patients were enrolled in the study from Shahrekord Hemodialysis Center . They were r and omly assigned into the exercise and control groups . In the exercise group , the patients had a 30-minute exercise program per dialysis session , 3 times a week , for 3 months .  Electrocardiography and echocardiography  were done at the beginning of the study and 3 months later . RESULTS The mean age and body mass index of the patients were 43.2 + /- 10.5 years and 21.7 + /- 5.4 kg/m2 , respectively .  Left ventricular ejection fraction increased and systolic pulmonary artery pressure and right ventricular size decreased significantly after the study in the exercise group patients . CONCLUSIONS Our results showed the improvement of cardiac systolic and diastolic function in patients who had physical exercise during dialysis sessions . Regular intradialysis exercise can be suggested for hemodialysis patients without cardiac disease Background The anabolic response to progressive resistance exercise training ( PRET ) in haemodialysis patients is unclear . This pilot efficacy study aim ed to determine whether high-intensity intradialytic PRET could reverse atrophy and consequently improve strength and physical function in haemodialysis patients . A second aim was to compare any anabolic response to that of healthy participants completing the same program . Methods In a single blind controlled study , 23 haemodialysis patients and 9 healthy individuals were r and omly allocated to PRET or an attention control ( SHAM ) group . PRET completed high-intensity exercise leg extensions using novel equipment . SHAM completed low-intensity lower body stretching activities using ultra light resistance b and s. Exercises were completed thrice weekly for 12 weeks , during dialysis in the haemodialysis patients . Outcomes included knee extensor muscle volume by magnetic resonance imaging , knee extensor strength by isometric dynamometer and lower body tests of physical function . Data were analysed by a per protocol method using between-group comparisons . Results PRET elicited a statistically and clinical ly significant anabolic response in haemodialysis patients  ( PRET — SHAM , mean difference [ 95 % CI ] : 193[63 to 324 ] cm3 ) that was very similar to the response in healthy participants  ( PRET — SHAM , 169[−41 to 379 ] cm3 ) . PRET increased strength in both haemodialysis patients and healthy participants . In contrast , PRET only enhanced lower body functional capacity in the healthy participants . Conclusions Intradialytic PRET elicited a normal anabolic and strength response in haemodialysis patients . The lack of a change in functional capacity was surprising and warrants further investigation 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 ) Objective : This study aim ed to investigate the effect of continuous progressive resistance training on body composition , functional capacity and self-reported quality of life in end-stage renal disease patients . Design : A r and omized controlled trial . Subjects : The study included 52 hemodialysis patients ( aged 55.7 ± 14.03 years ) r and omized into exercise ( progressive resistance training ( PRT ) , n = 28 ) or control ( CON , n = 24 ) groups . Intervention : Patients r and omized into the PRT group received prescribed strength exercises in two sets of 15–20 repetitions , in a repetition maximum training zone regime , thrice a week for 12 weeks , during hemodialysis . Patients r and omized into the CON group received a sham-exercise with active mobilization of the arms and legs without load and progression . Main outcome measure : Body composition using dual-energy X-ray absorptiometry ( DXA ) , strength using h and grip dynamometry ( HGS ) , repeated sit-to-st and test ( STT ) , 6-minute walk test , flexibility and the SF-36 question naire ( quality of life ( QoL ) ) were assessed at baseline and at 12 weeks . Results : Leg lean mass ( P = 0.04 , effect size ( ES ) of 0.56 ) , bone mineral content ( P = 0.02 , ES of 0.65 ) , leg strength in STT repetitions ( P = 0.01 , ES of 0.66 ) and flexibility ( P < 0.01 , ES of 1.03 ) were significantly improved in the PRT group compared to the CON group . Walking capacity , HGS and QoL were not different between the groups . Conclusion : 12 weeks of PRT with a repetition maximum training zone regime provided significant load to increase leg lean mass and STT performance as well as bone mineral content , compared to the CON , which continued to deteriorate . There was lack of efficacy on walking test , HGS and OBJECTIVE Abnormalities in mineral and bone metabolism are frequent in chronic kidney disease patients .  Physical exercise can improve many indicators of physical functioning , and recent studies showed beneficial effects on bone mineral density in the general population . The aim of this study was to evaluate the effects of resistance exercise training on bone markers and body composition in hemodialysis ( HD ) patients . DESIGN This was a r and omized controlled trial . SUBJECTS The study included 13 HD patients ( 46.2 % men ) . INTERVENTION Patients were divided into a control group and an exercise group , which performed 8 weeks of intradialytic resistance exercise . Serum sclerostin , bone alkaline phosphatase ( BAP ) , insulin , leptin , 25-hydroxyvitamin D , 1,25-dihydroxyvitamin D , and body composition were measured before and after the exercise period . RESULTS In the exercise group , BAP levels increased from 11.4 ± 6.5 to 14.6 ± 6.4 U/L ( P < .05 ) and serum 1,25-dihydroxyvitamin D levels from 46.0 ± 23.5 to 87.2 ± 31.8 ng/mL ( P < .05 ) . After  exercise , serum BAP levels were inversely correlated with serum sclerostin ( r = -0.96 , P < .05 ) . There was no change in body composition in either group . CONCLUSION Resistance exercise training appears to be an interesting approach for stimulating BAP production in HD patients and may prevent bone loss and stimulate bone formation BACKGROUND Cardiovascular disease ( CVD ) mortality rates are greatly elevated in chronic kidney disease patients receiving maintenance haemodialysis therapy . The purpose of this study was to evaluate the efficacy of intradialytic endurance exercise training on novel risk factors that may contribute to this excessive CVD risk . METHODS Seventeen haemodialysis patients were r and omized to either an intradialytic exercise training ( cycling ) group ( EX ; n = 8) or a non-exercising control group ( CON ; n = 9 ) for 4 months . At baseline and following the intervention , we measured serum parameters related to CVD risk and renal function , used echocardiography to measure variables related to cardiac structure and function and assessed physical performance by a vali date d shuttle walk test . RESULTS Performance on the shuttle walk test increased by 17 % in EX ( P < 0.05 ) , but did not change in CON . There was no change in serum lipids or inflammatory markers ( C-reactive protein , interleukin-6 ) in either group . Serum thiobarbituric acid reactive substances , a marker of oxidative stress , were reduced by 38 % in EX ( P < 0.05 ) , but did not change in CON . In addition , serum alkaline phosphatase ( ALP ) , a putative risk factor for vascular calcification , was reduced by 27 % in EX ( P < 0.05 ) , but did not change in CON . There was no change in left atrial volume , left ventricular mass or myocardial performance index in either group . However , the thickness of the epicardial fat layer was reduced by 11 % in EX ( P < 0.05 ) , but did not change in CON . Furthermore , the change in physical performance was inversely correlated to the change in epicardial fat ( r = -0.63 ; P = 0.03 ) . CONCLUSIONS These results suggest that endurance exercise training may improve CVD risk in haemodialysis patients by decreasing novel risk factors including serum oxidative stress , ALP and epicardial fat QUESTION Does inspiratory muscle training improve respiratory muscle strength , functional capacity , lung function and quality of life of patients with chronic kidney disease ? Does inspiratory muscle training improve these outcomes more than breathing exercises ? DESIGN Systematic review and meta- analysis of r and omised trials . PARTICIPANTS People with chronic kidney disease undergoing dialysis treatment . OUTCOME MEASURES The 
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There was no impact on total cholesterol , interleukin-6 , or hemoglobin levels .
There was no difference in incidence of adverse events between the IDT and control groups .
Aerobic , resistance , and combined training during hemodialysis , as well as FES and IMT , demonstrated to be effective for the treatment of the patient with ESRD .