***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: Background Exercise training in hemodialysis patients improves fitness , physical function , quality of life and markers of cardiovascular disease such as arterial stiffness . The majority of trials investigating this area have used supervised exercise training during dialysis ( intradialytic ) , which may not be feasible for some renal units . The aim of this trial is to compare the effects of supervised intradialytic with unsupervised home-based exercise training on physical function and arterial stiffness . Methods and design This is a r and omised , controlled clinical trial . A total of 72 hemodialysis patients will be r and omised to receive either six months of  intradialytic exercise training , home-based exercise training or usual care . Intradialytic patients will undergo three training sessions per week on a cycle ergometer and home-based patients will be provided with a walking program to achieve the same weekly physical activity . Primary outcome measures are six-minute walk distance ( 6 MWD ) and aortic pulse wave velocity ( PWV ) . Secondary outcome measures include augmentation index , peripheral and central blood pressures , physical activity and self-reported health . Measures will be made at baseline , three and six months . Discussion The results of this study will help determine the efficacy of home-based exercise training in hemodialysis patients . This may assist in developing exercise guidelines specific for these patients .Trial Registration BACKGROUND Patients with chronic heart failure ( CHF ) have a continuing high mortality . Autonomic dysfunction may play an important role in the pathophysiology of cardiac death in CHF . UK-HEART examined the value of heart rate variability ( HRV ) measures as independent predictors of death in CHF . METHODS AND RESULTS In a prospect i ve study powered for mortality , we recruited 433 out patients 62+/-9.6 years old with CHF ( NYHA functional class I to III ; mean ejection fraction , 0.41+/-0.17 ) .  Time-domain HRV indices and conventional prognostic indicators were related to death by multivariate analysis . During 482+/-161 days of follow-up , cardiothoracic ratio , SDNN , left ventricular end-systolic diameter , and serum sodium were significant predictors of all-cause mortality . The risk ratio for a 41.2-ms decrease in SDNN was 1.62 ( 95 % CI , 1.16 to 2.44 ) . The annual mortality rate for the study population in SDNN subgroups was 5.5 % for > 100 ms , 12.7 % for 50 to 100 ms , and 51.4 % for < 50 ms . SDNN , creatinine , and serum sodium were related to progressive heart failure death . Cardiothoracic ratio , left ventricular end-diastolic diameter , the presence of nonsustained ventricular tachycardia , and serum potassium were related to sudden cardiac death . A reduction in SDNN was the most powerful predictor of the risk of death due to progressive heart failure . CONCLUSIONS CHF is associated with autonomic dysfunction , which can be quantified by measuring HRV . A reduction in SDNN identifies patients at high risk of death and is a better predictor of death due to progressive heart failure than other conventional clinical measurements . High-risk subgroups identified by this measurement are c and i date s for additional therapy after prescription of an ACE inhibitor 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 AIM To evaluate the effects of a yoga-based exercise program on pain , fatigue , sleep disturbance , and biochemical markers in hemodialysis patients . MATERIAL S AND METHODS In 2004 a r and omized controlled trial was carried out in the outpatient hemodialysis unit of the Nephrology Department , Uludag University Faculty of Medicine . Clinical ly stable hemodialysis patients ( n=37 ) were included and followed in two groups : the modified yoga-based exercise group ( n=19 ) and the control group ( n=18 ) . Yoga-based exercises were done in groups for 30 min/day twice a week for 3 months . All of the patients in the yoga and control groups were given an active range of motion exercises to do for 10 min at home . The main outcome measures were pain intensity ( measured by the visual analogue scale , VAS ) , fatigue ( VAS ) , sleep disturbance ( VAS ) , and grip strength ( mmHg ) ; biochemical variables-- urea , creatinine , calcium , alkaline phosphatase , phosphorus , cholesterol , HDL-cholesterol , triglyceride , erythrocyte , hematocrit -- were evaluated . RESULTS After a 12-week intervention , significant improvements were seen in the variables : pain -37 % , fatigue -55 % , sleep disturbance -25 % , grip strength + 15 % , urea -29 % , creatinine -14 % , alkaline phosphatase -15 % , cholesterol -15 % , erythrocyte + 11 % , and hematocrit count + 13 % ; no side-effects were seen . Improvement of the variables in the yoga-based exercise program was found to be superior to that in the control group for all the variables except calcium , phosphorus , HDL-cholesterol and triglyceride levels . CONCLUSION A simplified yoga-based rehabilitation program is a complementary , safe and effective clinical treatment modality in patients with end-stage renal disease BACKGROUND Kidney failure is associated with muscle wasting and physical impairment . Moderate- to high-intensity strength training improves physical performance , nutritional status and quality of life in people with chronic kidney disease and in dialysis patients . However , the effect of low-intensity strength training has not been well documented , thus representing the objective of this pilot study . METHODS Fifty participants ( mean + /- SD , age 69 + /- 13 years ) receiving long-term haemodialysis ( 3.7 + /- 4.2 years ) were r and omized to intra-dialytic low-intensity strength training or stretching ( attention-control ) exercises twice weekly for a total of 48 exercise sessions . The primary study outcome was physical performance assessed by the Short Physical Performance Battery score ( SPPB ) after 36 sessions , if available , or carried forward from 24 sessions . Secondary outcomes included lower body strength , body composition and quality of life . Measurements were obtained at baseline and at completion of 24 ( mid ) , 36 ( post ) and 48 ( final ) exercise sessions . RESULTS Baseline median ( IQR ) SPPB score was 6.0 ( 5.0 ) , with 57 % of the participants having SPPB scores below 7 . Exercise adherence was 89 + /- 15 % . The primary outcome could be computed in 44 participants . SPPB improved in the strength training group compared to the attention-control group [ 21.1 % ( 43.1 % ) vs. 0.2 % ( 38.4 % ) , respectively , P = 0.03 ] . Similarly , strength training participants exhibited significant improvements from baseline compared to the control group in knee extensor strength , leisure-time physical activity and self-reported physical function and activities of daily living ( ADL ) disability ; all P < 0.02 . Adverse events were common but not related to study participation . CONCLUSIONS Intra-dialytic , low-intensity progressive strength training was safe and effective among maintenance dialysis patients . Further studies are needed to establish the generalizability of this strength training program in dialysis patients Background Patients with obesity , diabetes , and chronic kidney disease ( CKD ) are generally physically inactive , have a high mortality rate , and may benefit from an exercise program . Methods We performed a 24-week r and omized controlled feasibility study comparing aerobic exercise plus optimal medical management to medical management alone in patients with type 2 diabetes , obesity ( body mass index [ BMI ] > 30 kg/m2 ) , and stage 2 - 4 CKD ( estimated glomerular filtration rate [ eGFR ] 15 - 90 mL/min/1.73 m2 with persistent proteinuria ) . Subjects r and omized to exercise underwent thrice weekly aerobic training for 6 followed by 18 weeks of supervised home exercise . The primary outcome variable was change in proteinuria . Results Seven subjects r and omized to exercise and 4 control subjects completed the study .  Exercise training result ed in an increase in exercise duration during treadmill testing , which was accompanied by slight but insignificant decreases in resting systolic blood pressure and 24-hour proteinuria . Exercise did not alter GFR , hemoglobin , glycated hemoglobin , serum lipids , or C-reactive protein ( CRP ) . Caloric intake and body weight and composition also did not change with exercise training . Conclusion Exercise training in obese diabetic patients with CKD is feasible and may have clinical benefits . A large-scale r and omized controlled trial to determine the effects of exercise on renal functions , cardiovascular fitness , inflammation , and oxidative stress in diabetic patients with CKD is planned Twenty-five hemodialysis patients were r and omized into comparable exercising ( E , N = 14 ) and sedentary control ( N = 11 ) groups . After baseline testing , training was 3 to 5 times weekly for a mean of 12 + /- 4 ( SD ) months . Maximal aerobic capacity increased 21 % ( P less than 0.01 ) , and the duration s for the grade d exercise stress  test improved 19 % ( P less than 0.01 ) in E , but did not change in controls ( 8 + /- 4 months ) . Declining blood pressures in 8 hypertensive E led to reductions in antihypertensive medications ; no changes occurred in 9 hypertensive controls . Exercise lowered plasma total triglyceride levels 33 % ( 280 + /- 258 to 175 + /- 95 mg/dl ; P less than 0.01 ) , but no change occurred in total and low-density lipoprotein cholesterol concentrations . High-density lipoprotein cholesterol levels rose 16 % in E ( 31 + /- 9 to 36 + /- 12 mg/dl ; P less than 0.02 ) , but did not change in controls . An increase in the affinity of insulin for receptors on mononuclear cells was associated with a 20 % decrease in fasting plasma insulin levels ( 24 + /- 7 to 19 + /- 2 microU/ml , N = 8 ; P less than 0.05 ) and a 42 % improvement in glucose disappearance rates ( 1.9 + /- 1.0 to 2.6 + /- 1.2 % per min , N = 6 ) in E. There were no changes in the body weights or diets of the patients . A 27 % increase in red blood cell mass ( P less than 0.02 ) with no change in plasma volume result ed in a 27 % increase in hematocrit ( 24 + /- 3 % to 31 + /- 5 % , P less than 0.01 ) and a 20 % increase in hemoglobin ( 8 + /- 1 to 10 + /- 2 g/dl ; P less than 0.01 ) in E. 
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RESULTS 41 trials ( 928 participants ) comparing exercise training with sham exercise or no exercise were included ; overall , improved aerobic capacity , muscular functioning , cardiovascular function , walking capacity , and health-related quality of life were associated with various exercise interventions , although the preponderance of data were for dialysis patients and used aerobic exercise programs .
Regular exercise training generally is associated with improved health outcomes in individuals with CKD .
Correctly design ed exercise rehabilitation may be an effective part of care for adults with CKD .