**1. Introduction**

Hemodialysis (HD) is a common kind of renal replacement therapy for patients with end-stage renal disease (ESRD), which affects up to 90% of patients globally. Muscle wasting, decreased visceral protein storage, and physical function related to uremic myopathy and neuropathy all contribute to patients with ESRD having impaired physical function and activity [1].

Dialysis has a profound impact on how patients interact with their surroundings and how they may play social roles in their families and in society. The necessity of quitting their employment due to financial difficulties, acceptance of treatment schedules with set days and times, frequent hospital stays, and knowledge of their growing reliance on others [2].

The prevalence of depression among HD patients ranges from 20% to 60%, while the levels of worry and stress range from 21% to 48%. Physical activity among patients receiving HD is regarded as a safe and practical non-pharmacological method to lessen depression [3].

The physical and cognitive symptoms of depression include feelings of melancholy, worthlessness, difficulty sleeping, loss of appetite and sexual drive, as well as a lack of interest in routine tasks. When depressive symptoms last longer than 2 weeks, a clinical diagnosis of depression is made (**Figure 1**) [5].

 **Figure 1.**  *Depression symptoms [ 4 ].* 

 Chronic medical conditions advance significantly as a result of depression. Because depressed people are so hopeless, they are less likely to comply, which aggravates their medical condition. Additionally, nutritional shortages result from loss of appetite, which makes matters worse. A vicious loop would be created by physical health deterioration and depression. Patients on dialysis attempt suicide far more frequently than the overall population [ 6 ].

 Patients on HD encounter a variety of changes and limits in their everyday life, such as hydration and nutrition restrictions, physical and cognitive impairment, and the inability to perform prior roles, responsibilities, or activities. Patients usually deal with severe psychological load, mostly anxiety and sadness, which has a detrimental impact on how the disease will progress. Death, illness, poor quality of life, limited lifespan, and, worst of all, suicidal thoughts are all associated with depression ( **Figure 2** ) [ 8 ].

 Intradialytic exercise (IDE) is frequently advised to patients to promote their physical activity. IDE may be helpful in lowering the degree of exhaustion, improved sleep quality, increasing exercise tolerance, enhancing quality of life, and even improving psychological status, according to earlier studies. IDE can boost the effectiveness of dialysis, reducing inflammation and boosting nutrition and bone mineral density in the process [ 9 ].

*Effect of Intra-Dialytic Physical Exercise on Depression in Hemodialysis Patients DOI: http://dx.doi.org/10.5772/intechopen.113360*

#### **Figure 2.**

 *Prevalence of anxiety and depression in chronic kidney disease patients undergoing HD [ 7 ].* 

 The term "intradialytic exercise" refers to exercise training carried out during the HD session to improve the patient's strength and endurance, hence focusing on a variety of physiological and psychological characteristics. Different equipment is employed according to the type of exercise, ranging from stretching to weight training to aerobic activity. HD patients' general health and hospitalization rate have been shown to benefit via IDE [ 10 ].

 Usually, the first 2 hours of HD therapy are spent engaging in intraadialytic activity. For HD patients, it is a practical non-pharmacological treatment. Placement of a cycle ergometer in front of the treatment chair or at the foot of a bed is the most typical example of IDE training ( **Figure 3** ) [ 12 ].

 **Figure 3.**  *Intradialytic cycling exercise training program [ 11 ].* 

These are some categories into which exercise may be divided: Aerobic exercise (AE), which works vast muscle groups, is rhythmic, continuous, and typically suggested to increase endurance. Strength training, also known as resistance exercise (RE), is known to enhance muscle growth and strength. Combination exercise (CE), which combines AE and RE, does the same. Every training plan has distinct fitness and health objectives [13].
