The Intradialytic Exercise, Cognitive Behavioral Therapy, and Deep Breath Relaxation for QOL In Hemodialysis Patients: Systematic Review

  • Akhmad Huda Stikes Rajekwesi, Bojonegoro
  • Faridah Mohd Said Faculty of Nursing, Lincoln University College, Malaysia
  • Jayasree S Kanathasan Faculty of Nursing, Lincoln University College, Malaysia
  • Sofyan Hadi Hasibuan Stikes Rajekwesi Bojonegoro
  • Firnanda Erindia Faculty of Nursing, Universitas Airlangga
  • Kushariyadi Kushariyadi


Chronic kidney disease (CKD) patients undergoing continuous hemodialysis (HD) experience decreased daily physical activity, lower tolerance to exercise and poorer health-related quality of life. Thus, HD patients need interventions that focus on their physical and psychological characteristics to improve their quality of life. This study aims to discuss the effectiveness of intradialytic exercise, cognitive behavior therapy and deep breath relaxation in improving the quality of life of hemodialysis patients. The study used a systematic literature review design to identify articles on intradialytic exercise, cognitive behavior therapy and deep breath relaxation from 2019-2023 was obtained from PubMed, ScienceDirect and Google Scholar. Seven studies found that intradialytic exercise enhances CKD patients' quality of life during hemodialysis. Four studies noted cognitive behavioral therapy's positive impact on physiological aspects, enhancing patients’ well-being. Additionally, six studies observed deep breath relaxation's beneficial effects on physiological parameters, ultimately enhancing patients' quality of life during hemodialysis. Intradialytic exercise, cognitive behavior therapy and deep breath relaxation are effective in improving the quality of life of hemodialysis patients. Furthermore, these three interventions helped accelerate the medical approach to chronic kidney disease.


Al Naamani, Z., Gormley, K., Noble, H., Santin, O., & Al Maqbali, M. 2021. Fatigue, anxiety, depression and sleep quality in patients undergoing haemodialysis. BMC Nephrology, 22(1), 157.
Albadr, A., Azer, S., Abd Elhamed, N., & Mostafa, N. 2020. Effect of Intradialytic Hemodialysis Exercises on Fatigue and Leg cramps. Assiut Scientific Nursing Journal, 8(20), 131–140.
Aliakbari, F., Safei, F., Deriss, F., & Salehitali, S. 2021. Breathing exercise and respiratory parameters in chronic kidney disease patients with hemodialysis. International Journal of Epidemiology and Health Sciences, 2(10), 1.
Amalia, V., Wulan, S. M. M., Sulastri, N., Santoso, D., & Melaniani, S. 2022. Effect of Intradialytic cycling exercise on 2 minutes walking test and VO2max in chronic kidney disease patients. International Journal of Health Sciences, 858–868.
Astuti, Y. S., & Utami, T. W. 2021. The Cognitive Behavioral Therapy Reduces Depression in Chronic Kidney Disease Patients Undergoing Hemodialysis. Indonesian Journal of Global Health Research, 3(1), 109–118.
Canaud, B., Collins, A., & Maddux, F. 2020. The renal replacement therapy landscape in 2030: reducing the global cardiovascular burden in dialysis patients. Nephrology Dialysis Transplantation, 35(Supplement_2), ii51–ii57.
Chang, H.-C., Chen, C.-H., & Cheng, Y.-Y. 2022. Therapeutic Effects of Intradialytic Exercise on Life Quality of Patients with End-Stage Renal Disease: Study Protocol for a Randomized Control Trial. Healthcare, 10(6), 1103.
do Valle, F. M., Valle Pinheiro, B., Almeida Barros, A. A., Ferreira Mendonça, W., de Oliveira, A. C., de Oliveira Werneck, G., de Paula, R. B., & Moura Reboredo, M. 2020. Effects of intradialytic resistance training on physical activity in daily life, muscle strength, physical capacity and quality of life in hemodialysis patients: a randomized clinical trial. Disability and Rehabilitation, 42(25), 3638–3644.
Eroglu, H., & Metin, Z. G. 2022. Benson Relaxation Technique Combined With Music Therapy for Fatigue, Anxiety, and Depression in Hemodialysis Patients. Holistic Nursing Practice, 36(3), 139–148.
Evans, M., Lewis, R. D., Morgan, A. R., Whyte, M. B., Hanif, W., Bain, S. C., Davies, S., Dashora, U., Yousef, Z., Patel, D. C., & Strain, W. D. 2022. A Narrative Review of Chronic Kidney Disease in Clinical Practice: Current Challenges and Future Perspectives. Advances in Therapy, 39(1), 33–43.
Greenberg, J. L., Phillips, K. A., Steketee, G., Hoeppner, S. S., & Wilhelm, S. 2019. Predictors of Response to Cognitive-Behavioral Therapy for Body Dysmorphic Disorder. Behavior Therapy, 50(4), 839–849.
Grover, S., Goyal, V., Chorsiya, V., Ganguly, N. K., & Saha, G. K. 2022. Effect of intradialytic exercises (IDE) on maximal oxygen consumption and quality of life undergoing hemodialysis in Indian population—a pilot study. Bulletin of Faculty of Physical Therapy, 27(1), 27.
Gültekin, A. C., Türkmen, E., Taran, F., Dilek, M., Sayarlıoğlu, H., & Arık, N. 2022. The effects and differences of kidney transplantation and hemodialysis treatments on quality of life. Journal of Medicine and Palliative Care, 3(3), 247–253.
Hagemann, P. de M. S., Martin, L. C., & Neme, C. M. B. 2019. The effect of music therapy on hemodialysis patients’ quality of life and depression symptoms. Brazilian Journal of Nephrology, 41(1), 74–82.
Hamed, L. A., & Aziz, T. M. A. 2020. Effect of Deep Breathing Exercise Training on Fatigue’ Level among Maintenance Hemodialysis Patients: Randomized Quasi-experimental Study. Egyptian Journal of Health Care, 11(4), 634–644.
Hu, H., Liu, X., Chau, P. H., & Choi, E. P. H. 2022. Effects of intradialytic exercise on health-related quality of life in patients undergoing maintenance haemodialysis: a systematic review and meta-analysis. Quality of Life Research, 31(7), 1915–1932.
Jensen, M. K., Andersen, S. S., Andersen, S. S., Liboriussen, C. H., Kristensen, S., & Jochumsen, M. 2022. Modulating Heart Rate Variability through Deep Breathing Exercises and Transcutaneous Auricular Vagus Nerve Stimulation: A Study in Healthy Participants and in Patients with Rheumatoid Arthritis or Systemic Lupus Erythematosus. Sensors, 22(20), 7884.
Kharbteng, L., Monaliza, Kumar, V., Kaur, S., & Ghai, S. 2020. Effectiveness of a breathing training program on quality of life in patients with predialysis chronic kidney disease: A randomized controlled trial. Indian Journal of Palliative Care, 26(3), 271.
Khatib, S. T., Hemadneh, M. K., Hasan, S. A., Khazneh, E., & Zyoud, S. H. 2018. Quality of life in hemodialysis diabetic patients: a multicenter cross-sectional study from Palestine. BMC Nephrology, 19(1), 49.
Kim, S., Park, H.-J., & Yang, D.-H. 2022. An intradialytic aerobic exercise program ameliorates frailty and improves dialysis adequacy and quality of life among hemodialysis patients: a randomized controlled trial. Kidney Research and Clinical Practice, 41(4), 462–472.
Krismiadi, D., Wihastuti, T. A., & Ismail, D. D. S. L. 2023. Differences Between the Effects of The Benson Relaxation Technique and Deep Breath on Anxiety, Sleep Quality, and Fatigue in Hemodialysis Patients. Jurnal Aisyah : Jurnal Ilmu Kesehatan, 8(2).
Liao, B., Zhao, L., Peng, Y., Chen, J., Chen, W., & Wang, X. 2020. Effect of comprehensive nursing intervention on negative emotion, quality of life and renal function of hemodialysis patients. International Journal of Clinical and Experimental Medicine, 13(2), 949‐957.
Ling, C., Evans, D., Zhang, Y., Luo, J., Hu, Y., Ouyang, Y., Tang, J., & Kuang, Z. 2020. The effects of cognitive behavioural therapy on depression and quality of life in patients with maintenance haemodialysis: a systematic review. BMC Psychiatry, 20(1), 369.
Malini, H., Forwaty, E., Cleary, M., Visentin, D., Oktarina, E., & Lenggogeni, D. P. 2022. The Effect of Intradialytic Range of Motion Exercise on Dialysis Adequacy and Fatigue in Hemodialysis Patients. Journal of Nursing Research, 30(4), e221.
Moeinzadeh, F., Shahidi, S., & Shahzeidi, S. 2022. Evaluating the effect of intradialytic cycling exercise on quality of life and recovery time in hemodialysis patients: A randomized clinical trial. Journal of Research in Medical Sciences, 27(1), 84.
Neto, A. W. G., Boslooper-Meulenbelt, K., Geelink, M., van Vliet, I. M. Y., Post, A., Joustra, M. L., Knoop, H., Berger, S. P., Navis, G. J., & Bakker, S. J. L. 2020. Protein Intake, Fatigue and Quality of Life in Stable Outpatient Kidney Transplant Recipients. Nutrients, 12(8), 2451.
P, R., & Lobo, D. 2021. Supportive Therapy for Fatigue in Hemodialysis Patients. International Journal of Health Sciences and Research, 11(7), 367–373.
Rashid, S., Qureshi, A. G., Noor, T. A., Yaseen, K., Sheikh, M. A. A., Malik, M., & Malik, J. 2023. Anxiety and Depression in Heart Failure: An Updated Review. Current Problems in Cardiology, 48(11), 101987.
Ravera, A., Santema, B. T., Sama, I. E., Meyer, S., Lombardi, C. M., Carubelli, V., Ferreira, J. P., Lang, C. C., Dickstein, K., Anker, S. D., Samani, N. J., Zannad, F., van Veldhuisen, D. J., Teerlink, J. R., Metra, M., & Voors, A. A. 2021. Quality of life in men and women with heart failure: association with outcome, and comparison between the Kansas City Cardiomyopathy Questionnaire and the EuroQol 5 dimensions questionnaire. European Journal of Heart Failure, 23(4), 567–577.
Rochmawati, E., Utomo, E. K., & Makiyah, S. N. N. 2022. Improving dialysis adequacy and quality of life in patients undergoing hemodialysis with twice a week range of motion exercise. Therapeutic Apheresis and Dialysis, 26(1), 140–146.
Sari, R. Y., Kartini, Y., Faizah, I., Rohmawati, R., & Hasina, S. N. 2023. Combination of AROM with deep breathing exercise against fatigue and quality of life of hemodialysis patients; an experimental study. Journal of Nephropharmacology.
Shirazian, S., Smaldone, A. M., Jacobson, A. M., Fazzari, M. J., & Weinger, K. 2023. Improving quality of life and self-care for patients on hemodialysis using cognitive behavioral strategies: A randomized controlled pilot trial. PLOS ONE, 18(5), e0285156.
Sovatzidis, A., Chatzinikolaou, A., Fatouros, I. G., Panagoutsos, S., Draganidis, D., Nikolaidou, E., Avloniti, A., Michailidis, Y., Mantzouridis, I., Batrakoulis, A., Pasadakis, P., & Vargemezis, V. 2020. Intradialytic Cardiovascular Exercise Training Alters Redox Status, Reduces Inflammation and Improves Physical Performance in Patients with Chronic Kidney Disease. Antioxidants, 9(9), 868.
Suhardjono, Umami, V., Tedjasukmana, D., & Setiati, S. 2019. The effect of intradialytic exercise twice a week on the physical capacity, inflammation, and nutritional status of dialysis patients: A randomized controlled trial. Hemodialysis International, 23(4), 486–493.
Sutinah, & Azhari, R. 2020. The effects of relaxation breathing on fatigue in patients with chronic kidney disease undergoing hemodialysis. Malahayati International Journal of Nursing and Health Science, 03(1), 15–21.
Valsaraj, B. P., Bhat, S. M., Prabhu, R., & Kamath, A. 2021. Follow-Up Study on the Effect of Cognitive Behaviour Therapy on Haemodialysis Adherence. Sultan Qaboos University Medical Journal [SQUMJ], 21(1), e58-65.
Vogiatzaki, E., Michou, V., Liakopoulos, V., Roumeliotis, A., Roumeliotis, S., Kouidi, E., & Deligiannis, A. 2022. The effect of a 6-month intradialytic exercise program on hemodialysis adequacy and body composition: a randomized controlled trial. International Urology and Nephrology, 54(11), 2983–2993.
Zhianfar, L., Nadrian, H., Jafarabadi, M. A., Espahbodi, F., & Shaghaghi, A. 2020. Effectiveness of a multifaceted educational intervention to enhance therapeutic regimen adherence and quality of life amongst iranian hemodialysis patients: A randomized controlled trial (MEITRA study). Journal of Multidisciplinary Healthcare, 13, 361–372.
How to Cite
HUDA, Akhmad et al. The Intradialytic Exercise, Cognitive Behavioral Therapy, and Deep Breath Relaxation for QOL In Hemodialysis Patients: Systematic Review. NurseLine Journal, [S.l.], v. 9, n. 1, p. 68-76, may 2024. ISSN 2541-464X. Available at: <>. Date accessed: 21 july 2024. doi:

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