Effects of a Pre-Dialysis Breathing and Exercise Program on Quality of Life, Hemodynamic Parameters, and Dialysis Adequacy in Hemodialysis Patients

Gizem Zorlu Görgülügil,1 Aysun Ünal,2 Gamze Nazik,2 Esra Kocabıyık,2 Alperen Burak Kocabıyık,1 Gökhan Köker,1 Üstün Yılmaz31Department of Internal Medicine, Antalya Training and Research Hospital, Antalya, Turkiye; 2Department of Hemodialysis, Antalya Training and Research Hospital, Antalya, Turkiye; 3Department of Nephrology, Antalya Training and Research Hospital, Antalya, TurkiyeCorrespondence: Gizem Zorlu Görgülügil, Department of Internal Medicine, Antalya Training and Research Hospital, Varlık Mah. Kazım Karabekir Cad. Muratpaşa, Antalya, Turkiye, Tel +905334319703, Email gizemzorlug@gmail.comObjective: Physical inactivity and reduced quality of life are common in patients undergoing maintenance hemodialysis. Although intradialytic exercise has been extensively investigated, the effects of structured pre-dialysis exercise combined with breathing techniques on mental well-being, hemodynamic parameters, and dialysis adequacy remain unclear. This study aimed to evaluate the impact of a pre-dialysis structured exercise program on quality of life, hemodynamic status, and dialysis adequacy in maintenance hemodialysis patients.Methodology: This prospective, controlled, non-randomized interventional study was conducted in a tertiary-care hemodialysis unit over 8 weeks. A total of 53 maintenance hemodialysis patients were included. The intervention group received a 20 minute structured exercise and breathing program before each dialysis session, three times weekly, while the control group received standard care. Outcomes included Physical and Mental Component Summary scores derived from SF-36, PSQI, FAS, hemodynamic parameters, Kt/V, and URR. Time × group interactions were analyzed using linear mixed-effects models.Results: A greater increase in MCS was observed in the intervention group; however, the time × group interaction did not reach statistical significance (p=0.081), indicating a trend toward improved mental well-being. Significant reductions were found in systolic blood pressure (p=0.049) and pulse rate (p=0.033). No significant interaction was observed for PCS, PSQI, FAS, diastolic blood pressure, respiratory rate, or oxygen saturation. Significant time - group interactions were detected for Kt/V (p=0.018) and URR (p=0.013); however, the observed changes were small and values remained within clinically acceptable ranges.Conclusion: Pre-dialysis structured exercise was associated with favorable hemodynamic effects and a trend toward improved mental well-being without compromising dialysis adequacy. These preliminary findings suggest that supervised pre-dialysis exercise may be a feasible supportive strategy in hemodialysis care.Keywords: dialysis adequacy, exercise therapy, hemodialysis, quality of life