Electronic versions



  • Sharlene A. Greenwood
    Kings College London
  • Pelagia Koufaki
    Queen Margaret University
  • Jamie Macdonald
  • Sunil Bhandari
    Hull University Teaching Hospitals NHS
  • James O. Burton
    University of Leicester
  • Indranil Dasgupta
    Heart of England NHS Foundation Trust
  • Kenneth Farrington
    Lister Hospital
  • Ian Ford
    University of Glasgow
  • Philip A Kalra
    Salford Royal Foundation NHS Trust
  • Sharon Kean
    University of Glasgow
  • Mick Kumwenda
    Glan Clwyd Hospital
  • Iain C Macdougall
    Manchester Royal Infirmary
  • Claudia-Martina Messow
    University of Glasgow
  • Sandip Mitra
    Manchester Royal Infirmary
  • Chante Reid
    King’s College Hospital NHS Foundation Trust
  • Alice C Smith
    University of Nottingham
  • Maarten W Taal
    University of Nottingham
  • Peter C. Thompson
    Queen Elizabeth University Hospital
  • David C Wheeler
    University College London
  • Claire White
    King’s College Hospital NHS Foundation Trust
  • Magdi Yaqoob
    The Royal London Hospital
  • Thomas Mercer
    Queen Margaret University
Whether clinically implementable exercise interventions in people receiving hemodialysis (HD) therapy improve health-related quality of life (HRQoL) remains unknown. The PrEscription of intraDialytic exercise to improve quAlity of Life (PEDAL) study evaluated the clinical benefit and cost-effectiveness of a 6-month intradialytic exercise program.

In a multicenter, single-blinded, randomized, controlled trial, people receiving HD were randomly assigned to (i) intradialytic exercise training (exercise intervention group [EX]) and (ii) usual care (control group [CON]). Primary outcome was change in Kidney Disease Quality of Life Short-Form Physical Component Summary (KDQOL-SF 1.3 PCS) from baseline to 6 months. Cost-effectiveness was determined using health economic analysis; physiological impairment was evaluated by peak oxygen uptake; and harms were recorded.

We randomized 379 participants; 335 and 243 patients (EX n = 127; CON n = 116) completed baseline and 6-month assessments, respectively. Mean difference in change PCS from baseline to 6 months between EX and CON was 2.4 (95% confidence interval [CI]: −0.1 to 4.8) arbitrary units (P = 0.055); no improvements were observed in peak oxygen uptake or secondary outcome measures. Participants in the intervention group had poor compliance (47%) and poor adherence (18%) to the exercise prescription. Cost of delivering intervention ranged from US$598 to US$1092 per participant per year. The number of participants with harms was similar between EX (n = 69) and CON (n = 56). A primary limitation was the lack of an attention CON. Many patients also withdrew from the study or were too unwell to complete all physiological outcome assessments.

A 6-month intradialytic aerobic exercise program was not clinically beneficial in improving HRQoL as delivered to this cohort of deconditioned patients on HD.


  • rehabilitation, Physical activity, Chronic Kidney Disease, Physical Function
Original languageEnglish
Pages (from-to)2159-2170
Number of pages12
JournalKidney International Reports
Issue number8
Early online date29 May 2021
Publication statusPublished - 1 Aug 2021

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