Background: End stage renal disease (ESKD) patients’ aerobic capacity tends to be only half of that of normal; their strength is low, and they are likely to have problems with mobility and basic activities of daily living. Exercise capacity as measured by peak VO2, has been shown to be a very strong predictor of survival in ESKD. Dialysis patients usually display psychosocial problems such as depression, anxiety, and social withdrawal. Several authors observed that depressive symptoms increase mortality risk in chronic kidney disease patients. Different types of exercise training may be an effectiveness therapy to improve peak VO2 and depression in hemodialysis patients, but the evidence is limited.

Objectives: We conducted a meta-analysis of relevant randomized controlled trials (RCTs) to examine this issue.

Methods: A systematic literature search was completed in May 2014 to identify randomized controlled trials of combined aerobic and resistance exercise training studies in hemodialysis patients. RCTs were identified by computerized searching in PubMed and CINAHL. A meta-analysis was performed to evaluate the effectiveness of combined aerobic and resistance exercise training in hemodialysis patients. The primary outcome was the change of peak VO2. The secondary outcome was the change in depression.

Results: Six RCTs were identified that met the criteria for this study, with a total of 262 participants. The estimate of the overall effect size of peak VO2 addition was 0.492 (95% confidence interval 0.241 to 0.743) and was statistically significant (P =0.000) compared with usual care. The estimate of the overall effect size of depression reduction was -1439 (95% confidence interval -1.938 to -0.941) and was statistically significant (P = 0.000) compared with usual care.

Conclusions: Combined aerobic and resistance exercise training is a effective therapy for improving peak VO2 and depression in hemodialysis patients.