Changes in renal function resulting from chronic kidney disease (CKD) or hemodialysis (HD) have repercussions on sleep and quality of life. Patients with CKD often experience complications in the musculoskeletal system, such as frailty and fatigue, with impact their lifestyle and physical capacity. Exercise programs performed during HD have potential to reverse such complications and influence both sleep and quality of life. However, the evidence on this topic remains limited.

To investigate the effectiveness of an intradialytic resistance exercise protocol compared to intradialytic aerobic exercise protocol on the sleep and quality of life in CKD patients.

This is a randomized controlled trial. Thirty-two patients with CKD in HD were randomly allocated into two groups of intradialytic exercise, during the first 90 minutes of hemodialysis for 3 months: Group A (resistance exercise protocol, performing 8 exercises using elastic bands, dumbbells, and a Swiss ball, 2 sets of 8-12 repetitions, with an interval of 2-3 minutes between sets, and an exercise of 6 on the modified OMNI scale) and GROUP B (aerobic exercise protocol performing 20 minutes of exercise on a cycle ergometer with an intensity between 5 and 7 on the modified Borg scale). Sleep quality (measured by the Pittsburgh Sleep Quality Index) and health-related quality of life (measured by the EQ-5D-3L) were measured at baseline and 3 months after randomization. Visual inspection of histograms was used to assess data normality. Linear mixed model was used to assess the differences in intra and intergroup. The level of statistical significance was set at 5%.

Participants in Group A received an average of 31.4 (±3.4) sessions of effective exercise and Group B received an average of 32.5 (± 3.5) sessions. In the intragroup analysis, a significant improvement in sleep quality was observed for Group A (pre: 7.1±4.0; post: 5.1± 3.7; 95% confidence interval [95%CI]: -3.2 to -0.6), but it did not occur in Group B (pre: 6.6 ±3.0; post: 5.3 ± 2.4; 95%CI: -3.0 to 0.5). For the intergroup analysis, no significant changes were observed (mean difference [MD]: 0.7; 95%CI: -1.6 to 2.9). For health-related quality of life, no significant changes were observed in intragroup analysis (Group A, pre: 0.86 ± 0.16, post: 0.87 ± 0.13, 95%CI: -0.06 to 0.07; and Group B, pre: 0.86 ± 0.1, post: 0.91 ± 0.2, 95%CI: -0.01 to 0.11) and in intergroup analysis (MD: 0.04; 95%CI: -0.04 to 0.1).

Only resistance exercise seems to be effective for sleep quality after 3 months of treatment. However, there are no differences between the exercise protocols for sleep quality and health-related quality of life. These results suggest that future studies should be conducted with the inclusion of other clinical variables, such as pain, which may influence the effect of treatment.

Intradialytic exercise based on resistance exercise can benefit patients with CKD in the improvement of sleep quality. This type of exercise might be incorporated in hemodialysis centers under the guidance of physiotherapists.