***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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    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 Objective To examine how poor reporting and inadequate methods for key method ological features in r and omised controlled trials ( RCTs ) have changed over the past three decades . Design Mapping of trials included in Cochrane review s. Data sources Data from RCTs included in all Cochrane review s published between March 2011 and September 2014 reporting an evaluation of the Cochrane risk of bias items : sequence generation , allocation concealment , blinding , and incomplete outcome data . Data extraction For each RCT , we extracted consensus on risk of bias made by the review authors and identified the primary reference to extract publication year and journal . We matched journal names with Journal Citation Reports to get 2014 impact factors . Main outcomes measures We considered the proportions of trials rated by review authors at unclear and high risk of bias as surrogates for poor reporting and inadequate methods , respectively . Results We analysed 20 920 RCTs ( from 2001 review s ) published in 3136 journals . The proportion of trials with unclear risk of bias was 48.7 % for sequence generation and 57.5 % for allocation concealment ; the proportion of those with high risk of bias was 4.0 % and 7.2 % , respectively . For blinding and incomplete outcome data , 30.6 % and 24.7 % of trials were at unclear risk and 33.1 % and 17.1 % were at high risk , respectively . Higher journal impact factor was associated with a lower proportion of trials at unclear or high risk of bias . The proportion of trials at unclear risk of bias decreased over time , especially for sequence generation , which fell from 69.1 % in 1986 - 1990 to 31.2 % in 2011 - 14 and for allocation concealment ( 70.1 % to 44.6 % ) . After excluding trials at unclear risk of bias , use of inadequate methods also decreased over time : from 14.8 % to 4.6 % for sequence generation and from 32.7 % to 11.6 % for allocation concealment . Conclusions Poor reporting and inadequate methods have decreased over time , especially for sequence generation and allocation concealment . But more could be done , especially in lower impact factor journals Background There is emerging evidence that exercise training could positively impact several of the cardiovascular risk factors associated with sudden cardiac death amongst patients on haemodialysis . The primary aim of this study is to evaluate the effect of an intradialytic exercise programme on left ventricular mass . Method and design Prospect i ve , r and omised cluster open-label blinded endpoint clinical trial in 130 patients with end stage renal disease on haemodialysis . Patients will be r and omised 1:1 to either 1 ) minimum of 30 min continuous cycling thrice weekly during dialysis or 2 ) st and ard care .  The primary outcome is change in left ventricular mass at 6 months , assessed by cardiac MRI ( CMR ) . In order to detect a difference in LV mass of 15 g between groups at 80 % power , a sample size of 65 patients per group is required . Secondary outcome measures include abnormalities of cardiac rhythm , left ventricular volumes and ejection fraction , physical function measures , anthropometric measures , quality of life and markers of inflammation , with interim assessment for some measures at 3 months . Discussion This study will test the hypothesis that an intradialytic programme of exercise leads to a regression in left ventricular mass , an important non-traditional cardiovascular risk factor in end stage renal disease . For the first time this will be assessed using CMR . We will also evaluate the efficacy , feasibility and safety of an intradialytic exercise programme using a number of secondary end-points . We anticipate that a positive outcome will lead to both an increased patient uptake into established intradialytic programmes and the development of new programmes nationally and internationally . Trial registration numberIS RCT N11299707 ( registration date 5th March 2015 ) 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 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 Blinding embodies a rich history spanning over two centuries . Most research ers worldwide underst and blinding terminology , but confusion lurks beyond a general comprehension . Terms such as single blind , double blind , and triple blind mean different things to different people . Moreover , many medical research ers confuse blinding with allocation concealment . Such confusion indicates misunderst and ings of both . The term blinding refers to keeping trial participants , investigators ( usually health-care providers ) , or assessors ( those collecting outcome data ) unaware of the assigned intervention , so that they will not be influenced by that knowledge . Blinding usually reduces differential assessment of outcomes ( information bias ) , but can also improve compliance and retention of trial participants while reducing biased supplemental care or treatment ( sometimes called co-intervention ) . Many investigators and readers naïvely consider a r and omised trial as high quality simply because it is double blind , as if double-blinding is the sine qua non of a r and omised controlled trial . Although double blinding ( blinding investigators , participants , and outcome assessors ) indicates a strong design , trials that are not double blinded should not automatically be deemed inferior . Rather than solely relying on terminology like double blinding , research ers should explicitly state who was blinded , and how . We recommend placing greater credence in results when investigators at least blind outcome assessment s , except with objective outcomes , such as death , which leave little room for bias . If investigators properly report their blinding efforts , readers can judge them . Unfortunately , many articles do not contain proper reporting . If an article cl aims blinding without any accompanying clarification , readers should remain sceptical about its effect on bias reduction Background / Aims : Patients requiring haemodialysis have cardiovascular and immune dysfunction . Little is known about the acute effects of exercise during haemodialysis . Exercise has numerous health benefits but in other population s has a profound impact upon blood pressure , inflammation and immune function ; therefore having the potential to exacerbate cardiovascular and immune dysfunction in this vulnerable population . Methods : Fifteen patients took part in a r and omised-crossover study investigating the effect of a 30-min bout of exercise during haemodialysis compared to resting haemodialysis . We assessed blood pressure , plasma markers of cardiac injury and systemic inflammation and neutrophil degranulation . Results : Exercise  increased blood pressure immediately post-exercise ; however , 1 hour after exercise blood pressure was lower than resting levels ( 106±22 vs. 117±25 mm Hg ) . No differences in h-FABP , cTnI , myoglobin or CKMB were observed between trial arms . Exercise did not alter circulating concentrations of IL-6 , TNF-α or IL-1ra nor clearly suppress neutrophil function . Conclusions : This study demonstrates fluctuations in blood pressure during haemodialysis in response to exercise . However , since the fall in blood pressure occurred without evidence of cardiac injury , we regard it as a normal response to exercise superimposed onto the haemodynamic response to haemodialysis . Importantly , exercise  did not exacerbate systemic inflammation or immune dysfunction ; intradialytic exercise was well tolerated Abstract Inflammation , endothelial dysfunction , and mineral bone disease are critical factors contributing to morbidity and mortality in hemodialysis ( HD ) patients .  Physical exercise alleviates inflammation and increases bone density . Here , we investigated the effects of intradialytic aerobic cycling exercise on HD patients . Forty end-stage renal disease patients undergoing HD were r and omly assigned to either an exercise or control group . The patients in the exercise group performed a cycling program consisting of a 5-minute warm-up , 20 minutes of cycling at the desired workload , and a 5-minute cool down during 3 HD sessions per week for 3 months . Biochemical markers , inflammatory cytokines , nutritional status , the serum endothelial progenitor cell ( EPC ) count , bone mineral density , and functional capacity were analyzed . After 3 months of exercise , the patients in the exercise group showed significant improvements in serum albumin levels , the body mass index , inflammatory cytokine levels , and the number of cells positive for CD133 , CD34 , and kinase insert domain-conjugating receptor . Compared with the exercise group , the patients in the control group showed a loss of bone density at the femoral neck and no increases in EPCs . The patients in the exercise group also had a significantly greater 6-minute walk distance after completing the exercise program . Furthermore , the number of EPCs significantly correlated with the 6-minute walk distance both before and after the 3-month program . Intradialytic aerobic cycling exercise programs can effectively alleviate inflammation and improve nutrition , bone mineral density , and exercise tolerance in HD patients Cardiovascular ( CV ) disease is the most common cause of mortality in end‐stage kidney disease ( ESKD ) , and arterial stiffness , measured by pulse wave velocity ( PWV ) , is an independent predictor of all‐cause and CV mortality . B‐type natriuretic peptide ( BNP ) levels are high in patients with CV disease and ESKD , and increases in BNP may also be a marker of CV risk 
    Output:
    
Conclusions There is insufficient evidence demonstrating whether cycling exercise during HD improves patient outcomes .