Effect of Intradialytic Resistance Exercise on Restless Legs Syndrome Among Hemodialysis Patients: A Pilot Randomized Controlled Trial
DOI:
https://doi.org/10.33755/jkk.v12i1.955Keywords:
restless legs syndrome; hemodialysis; intradialytic exercise; resistance training; symptom management; quasi-experimental studyAbstract
Background: Restless legs syndrome (RLS) is common and burdensome among patients undergoing hemodialysis (HD). Intradialytic exercise provides a pragmatic opportunity for symptom management; however, evidence on resistance exercise during HD remains limited.
Objective: This pilot study evaluated the effect of intradialytic resistance exercise on RLS severity in adults receiving maintenance HD.
Methods: A two-arm, parallel-group pilot randomized controlled trial was conducted in two HD units (January–April 2025). Adults on thrice-weekly HD for ≥3 months with at least moderate RLS (IRLS ≥11) were randomized 1:1 to intradialytic resistance exercise (IRE) or usual care. The IRE group performed supervised elastic-band exercises during the first 2 hours of HD, three times weekly for 8 weeks. Outcomes were assessed at baseline, week 4, and week 8. The primary outcome was the International Restless Legs Syndrome Scale (IRLS) score, analyzed using mixed-effects models.
Results: Forty-two participants were enrolled (IRE n=21; control n=21), with 90.5% completing the study. A significant group×time interaction was observed (p<0.001). At week 8, the IRE group demonstrated a clinically meaningful reduction in IRLS compared with controls (mean difference −8.4; 95% CI −11.7 to −5.0; Cohen’s d=1.11). Adherence was high and no serious adverse events occurred.
Conclusions: An 8-week intradialytic resistance exercise program was feasible, safe, and effective in significantly reducing RLS severity among HD patients. Larger trials are warranted to confirm long-term benefits and implementation potential.
References
1. Zhou X, Liu Y, Zhang X, Wang C, Liu S, Jiang Y. Global prevalence of restless legs syndrome among hemodialysis patients: A systematic review and meta‐analysis. Brain Behav. 2024;14(1):e3378.
2. Fauzi A, Triaswati R. The effect of intradialytic stretching training on restless legs syndrome and sleep quality in hemodialysis patients. Korean Journal of Adult Nursing. 2021;33(1):37–43.
3. Lee CL, Wang PC, Chen YL, Chen ZY, Uen CC, Lai HY, et al. Comparisons of intradialytic exercise versus home-based exercise in hemodialysis patients: a narrative review. Biomedicines. 2024;12(10):2364.
4. Altayb Ismail MA, Daffalla I, Singh T, Siddique QR, Almadhoun MKIKH, Irfan R, et al. Efficacy of Aerobic and Stretching Exercises in Managing Willis-Ekbom Disease (Restless Leg Syndrome) Among Hemodialysis Patients. Cureus. 2024;16(10):e71470.
5. Josse M, Turc-Baron C, Patrier L, Connes P, Grandperrin A, Nottin S, et al. Acute exercise before dialysis is as cardioprotective as during dialysis: a randomized controlled trial. Clinical Journal of the American Society of Nephrology. 2025;10–2215.
6. Huang M, Lv A, Wang J, Xu N, Ma G, Zhai Z, et al. Exercise training and outcomes in hemodialysis patients: systematic review and meta-analysis. Am J Nephrol. 2019;50(4):240–54.
7. Hargrove N, El Tobgy N, Zhou O, Pinder M, Plant B, Askin N, et al. Effect of aerobic exercise on dialysis-related symptoms in individuals undergoing maintenance hemodialysis: a systematic review and meta-analysis of clinical trials. Clinical Journal of the American Society of Nephrology. 2021;16(4):560–74.
8. Feng X, Sun J, Wang Z, Zhang N, Liu Y, Wang Z, et al. The impact of intradialytic elastic band exercise on physical and cognitive abilities in patients on maintenance hemodialysis: a randomized controlled trial. Ren Fail. 2025;47(1):2482124.
9. de Oliveira AMS, Schuster RC, Heinzmann-Filho JP. Tendências de pesquisas sobre fisioterapia no Google Trends pela população brasileira nos últimos 5 anos. Revista Brasileira de Tecnologias Sociais. 2025;12(2):56–65.
10. Zhu Z, Yang D, Zhang J, Jiang W, Wu FY. Bidirectional Joint Iterative l 1-RLS Estimation for Single-Carrier Underwater Acoustic Communication: Algorithm and Undersea Experimental Results. IEEE Sens J. 2025;
11. Brown VA. An introduction to linear mixed-effects modeling in R. Adv Methods Pract Psychol Sci. 2021;4(1):2515245920960351.
12. Muhammad LN. Guidelines for repeated measures statistical analysis approaches with basic science research considerations. J Clin Invest. 2023;133(11).
13. Brysbaert M. Applying Mixed-Effects Models in Research on Second Language Acquisition: A Tutorial for Beginners. Languages. 2025;10(2):20.
14. Pender D, McGowan E, McVeigh JG, McCullagh R. The effects of Intradialytic Exercise on Key indices of Sarcopenia in patients with end-stage renal disease: A systematic review of Randomized controlled trials. Arch Rehabil Res Clin Transl. 2023;5(1):100252.
15. Garrido-Ardila EM, Lemus MÁC, del Valle Ramírez-Durán M, Jiménez-Palomares M, Hidalgo-Barquero MVM, González-Sánchez B, et al. Effects of Exercise on Sarcopenia and Frailty in Haemodialysis Patients: A Systematic Review. Medicina (B Aires). 2025;61(12):2204.
16. Allen RP, Picchietti DL, Auerbach M, Cho YW, Connor JR, Earley CJ, et al. Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report. Sleep Med. 2018;41:27–44.
17. Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, et al. Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria–history, rationale, description, and significance. Sleep Med. 2014;15(8):860–73.
18. Syifanaurah S, Anna A, Eryani T. Translation and Content Validation of the Self-Administered Version of the International Restless Leg Syndrome Severity Scale (sIRLS). Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal). 2024;10(3).
19. Mouelhi Y, Jouve E, Castelli C, Gentile S. How is the minimal clinically important difference established in health-related quality of life instruments? Review of anchors and methods. Health Qual Life Outcomes. 2020;18(1):136.
20. Guo Y, Sang Y, Pu T, Li X, Wang Y, Yu L, et al. Relation of serum hepcidin levels and restless legs syndrome in patients undergoing peritoneal dialysis. Front Med (Lausanne). 2021;8:685601.
21. Kang H. Sample size determination and power analysis using the G* Power software. J Educ Eval Health Prof. 2021;18.
22. Serdar CC, Cihan M, Yücel D, Serdar MA. Sample size, power and effect size revisited: simplified and practical approaches in pre-clinical, clinical and laboratory studies. Biochem Med (Zagreb). 2021;31(1):27–53.
