**9. Intradialytic exercise (IDE)**

In order to urge patients to be more physically active, doctors often prescribe IDE (intermittent daily encouragement). It reduces fatigue, improves sleep quality, increases exercise tolerance, raises QoL, and even improves psychological status when used correctly. Furthermore, it has been proposed that IDE can boost dialysis's efficiency, which in turn reduces inflammation and boosts bone mineral density.

Because they may combine both aerobic and anaerobic elements into a single training session, the sit-to-stand test and the 6-minute walk test have been found to increase fitness. The depressive state index dropped significantly. The results of the QoL survey, with the exception of physiological discomfort, did not demonstrate a substantial rise. There were no significant changes in dry weight, blood pressure, Kt/V, or metabolic variables except for intradialytic hypotension. According to a meta-analysis, IDE raises Kt/V and maximum oxygen consumption during physical activity, reduces depression, and enhances the physical component of quality of life (QoL). SBP and DBP could both be dramatically reduced with IDE. In the end, IDE had no effect on the mental component of QoL. The enhanced muscle blood flow and expanded capillary surface area caused by IDE, on the other hand, may help HD remove toxins more effectively. There was also less dropout and increased compliance with the IDE [94] in addition to better acceptance and adherence.

## **10. Analyses of intradialytic vs. non-clinical exercise programmes**

Home-based exercise (HBE) was found to be as effective as centre-based training in CKD patients who were not on dialysis. After 12 and 24 weeks, all of the cardiopulmonary metrics, including VO2peak, improved significantly. This was also seen during follow-up with respect to functional ability assessments. QoL and sleep both improved significantly [95].

In other research, researchers have compared the effects of IDE and HBE on the symptoms of HD. Neither their 6-minute walk test distance nor their pulse wave velocity changed significantly during the course of the study's 6-month follow-up period (which included blood pressure readings from both the peripheral and central nervous systems as well as physical activity). The second trial found that both groups' levels of physical activity grew significantly over time. While the onelegged standing test had a significant group-time interaction, the Short Physical Performance Battery, the timed up-and-go test, the STS-10 right and left hand grab, and the one-heel left leg rise all had a significant time influence. There was no change in the HRQoL score. Physical activity levels and physical function changed similarly in response to both treatments [96]. As a result, the effectiveness of IDE and HBE is comparable, and both produce positive effects.
