**6.3 Cardiovascular function**

Systematic PE protects heart tissue in ESRD patients and slows the progression of coronary artery disease by reducing myocardial oxygen demand and facilitating better perfusion. Inflammatory indicators are reduced, and endothelial function is improved as a result. The NO levels can be raised and coronary arteries and other vessels dilated in as little as a few weeks of PE practice. Chronic AE lowers heart rate, systolic and mean blood pressure, and both at rest and during submaximal activity, decreasing myocardial oxygen demand in those with CHD. Submaximal PE improves arterial compliance, lowers peripheral vascular resistance, and boosts cardiac output in HD patients. As a result of reduced sympathetic tone, these beneficial adaptations may be due to increased parasympathetic activity, decreased catecholamine levels, and decreased endogenous cardiac output stimulation. PE, particularly the AE, raises resting vagal tone while lowering sympathetic tone in both healthy people and those with kidney disease [63].

There are only a few studies showing that PE can help patients with left ventricular dysfunction by increasing myocardial contractility, ejection fraction, stroke volume, and left ventricular mass. Improvements in skeletal muscle performance are another evidence of PE's beneficial effect on heart function [64]. The ejection fraction increased significantly after 30 minutes of intradialytic AE at 60–70% of maximum heart rate, according to the results of study. It was discovered that pre- and posttraining left ventricular ejection fractions were associated with VO2peak [64]. HD patients who participated in an outpatient exercise training programme saw similar improvements in heart function [65]. Finally, long-term exercise helps hypertensive HD patients regulate their blood pressure and lowers their mortality rate [43, 66].

### **6.4 Glycaemic control and insulin resistance**

With AE, you will have better IS and less IR. RE also lowered blood glucose levels, indicating that it could be a viable option for diabetic patients looking to improve their glycaemic control [13]. Muscle tissue insensitivity is the major source of IR, which is a common symptom of uraemia regardless of the kind of renal illness present. Regular physical activity enhances IS in healthy persons as well as those suffering from disorders linked to a sedentary lifestyle [67]. When establishing training programmes to enhance IR, total exercise length should be considered, with 3 hours of exercise per week being proven to be more effective than 2 hours [68]. Patients on HD may be more resistant to the effects of exercise on IR if they are in a uraemic setting. The results of a 12-month trial comprising 3 to 5 courses per week demonstrated that exercise has an impact on IR in this group.

A combination of CE and AE or RE is better at controlling blood sugar than either one alone. As a result of the CE increasing IS, adipose tissue loss, increased muscle mass, and decreased visceral and subcutaneous fat are all observed. When AE or RE is used alone, the glycated haemoglobin level improves. Patients who had CE, on the other hand, had better glycaemic control [13].

#### **6.5 Renal function**

Many studies have looked at how exercise affects CKD prognostic variables. Patients with CV illness and CKD demonstrated improved eGFR with exercise therapy, according to one study [69]. Another study [70] confirmed that patients *Effect of Exercise on Health-Related Quality of Life in Patients with End-Stage Renal Disease DOI: http://dx.doi.org/10.5772/intechopen.101133*

with stage 3–4 CKD benefited from moderate-intensity exercise in terms of kidney function and BMI.

Meta-analysis of the impact of PE found that eGFR increased considerably in individuals with non-dialysis CKD, as did SBP, DBP, and BMI. PE had a rapid and considerable impact on TG levels (3 months). When it came to non-dialysis CKD patients, PE had no impact on SCr, TC, HDL-C, or LDL-C [41].

Kidney health benefits from exercise that includes both aerobic and resistance components. A meta-analysis of adult patients with CKD looked at renal function and discovered that combining exercise with medication significantly increased estimated glomerular filtration rate. The amount of creatinine in the blood was also reduced. These individuals' blood pressure has also reduced dramatically. There were no significant differences in proteinuria, cholesterol levels, physical composition, or quality of life between the groups.

#### **6.6 HD efficiency**

The inclusion of intradialytic AE significantly increased dialysis efficacy after the first month in a randomised controlled trial (RCT) and remained elevated throughout the programme [17]. Another RCT found that interdialytic mixed resistance and aerobic exercise enhanced physical performance in the sitting to standing, handgrip force task, time up and go, and 6-minute walk tests. Similarly, mini-nutritional assessment long-form scores increased considerably following the intervention period. The somatic and mental components of the QoL scale expanded significantly, but hospital anxiety and sadness decreased little. According to the results of the biological parameters, combined exercise reduced blood pressure while increasing HDL-C, LDL-C, and TGs levels throughout the body; however, there was no significant effect of intervention time on C-reactive protein, haemoglobin, albumin, or total cholesterol levels in the study participants' blood. In both the urea reduction ratio and the 6-minute walk test, aerobic and resistive training produced significant improvements. They dramatically increased dialysis efficiency and productivity [16].

#### **6.7 Physical function and QoL**

Regular exercise has been shown in a number of trials to help prevent CKDrelated pulmonary function losses by strengthening respiratory muscles and increasing pulmonary function [71, 72]. After a year of training at home, participants with pre-dialysis CKD showed only minor gains in hand grip and knee extension strength [71]. Study after study found that older adults who were given more supervision gained more strength than older adults who were left alone, but these increases were often minimal [73]. Studies show that working out increases peak VO2 by 41% at the ventilatory threshold and 36% at the peak of activity. Ventilatory efficiency, on the other hand, was same between the two groups. The training groups did not differ in terms of strength or body composition; however, the 6MWT and 1STS showed improvement.

People with CKD had poorer HRQL even when they participate in exercise programmes despite evidence to the contrary [14]. Recent meta-analyses [43] reveal that physical activity improves aerobic capacity, walking ability, and HRQoL. The SF-36 domains of physical functioning, role physical, and role emotional all increased over time as a result of exercise training, resulting in remarkable improvements in overall health. After the exercise intervention, all five dimensions of Kidney Disease Quality of Life improved [74]. The EXITE (Exercise Introduction to Enhance Dialysis Performance) experiment found that MHD patients' functional status improved after a simple, personalised six-month home-walking programme. When compared to the normal treatment group, the exercise group exhibited a significant improvement in social interaction and cognitive performance, but the other 17 categories showed no significant differences [40]. There were five studies out of the 21 included in a meta-analysis that showed an increase in the SF-36 physical component score after exercise training, with a mean increase of 10%. In spite of the fact that the overall SF-36 physical component score changed little, the exercise group's physical component score increased by 43% [74].
