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# Pedaling during dialysis: about 90 minutes a week or more was linked to fewer deaths
- URL: https://nephspace.com/intradialytic-exercise-dose-mortality/
- Published: 2026-10-20T15:14:31.000Z
- Updated: 2026-10-20T15:14:31.000Z
- Description: In a Portuguese cohort of 741 hemodialysis patients followed for about three years, those who cycled at least about 90 minutes a week during dialysis had about a third of the adjusted risk of death of those who declined. Lighter exercisers did no better than decliners.
- Author: Dr Wael Hussein
- Tags: Dialysis, #story, #has-audio, #research, #full-story, #in-center-dialysis, Stories

**🎧 Listen:** [Weekly · Oct 20](https://nephspace.com/weekly-oct-20/), from 14:59.

### The background

Efforts to lower mortality on hemodialysis have recently centered on machines and filters: hemodiafiltration, which lowered deaths compared with high-flux hemodialysis in the European CONVINCE trial, and expanded hemodialysis with medium cutoff dialyzers, which so far has evidence on symptoms rather than survival. (We covered both in our Deep Dive, Two Roads.) Exercise during dialysis is a much lower-tech option, but evidence on hard outcomes has been limited.

### What the study did

This prospective cohort followed patients in 20 hemodialysis units in Portugal (2016 to 2021), where an intradialytic exercise program was offered as routine care, delivered by the dialysis staff, with support from NephroCare, the clinic network of Fresenius Medical Care. Eligible patients were offered a cycle ergometer each session. Aerobic minutes per week were recorded over the first year, then patients were followed for up to three more years. The 741 patients were grouped as those who declined (394), those who pedaled less than 87 minutes a week (174) and those who pedaled 87 minutes or more (173). About 94% were on hemodiafiltration.

### What they found

- Over a median of 2.8 years, deaths occurred in 21.6% of decliners, 19% of lighter exercisers and 6.4% of those pedaling 87 minutes or more.
- After adjustment for age, comorbidity, access, body composition, laboratory values and other factors, the higher-exercise group had about a third of the risk of death of decliners (hazard ratio 0.35; 95% CI, 0.18 to 0.69). The lighter exercisers' risk was similar to decliners'.
- Among exercisers, each extra 50 minutes a week was associated with lower mortality (hazard ratio 0.46).
- The higher-exercise group had fewer hospitalizations and hospital days per year than decliners, but the adjusted risk of being hospitalized was not significantly lower (hazard ratio 0.75; 95% CI, 0.55 to 1.02).

### Why it matters

The authors argue that a meaningful dose is needed, and that many patients won't reach it with exercise during dialysis alone. Even in this program, uptake and adherence were hard: of 1,270 eligible patients, 459 (more than a third) declined; fewer than half of those who started completed the year; and only about a quarter of the patients analyzed reached about 90 minutes a week. The investigators deserve credit for running the program in 20 units for a full year with trained regular dialysis staff and every session logged on a tracking platform.

Our take: in the US, programs like this are practically nonexistent. Exercise during dialysis has real potential, but changing anything about the workflow in a dialysis unit is a huge undertaking. Proper trials are needed, both to find the best way to bring exercise into dialysis units and to see whether it changes outcomes.

### Caveats

This is an observational study, so it shows an association, not cause and effect. Those who exercise may also be healthier or more adherent in other ways. About 44% of screened patients weren't eligible for the program, so the cohort is a healthier subset, and activity outside dialysis wasn't measured. Exercise was counted as one average over the first year, so someone who started strong and then stopped is judged by that average, and exercise wasn't measured after the first year. Decliners were older and sicker than exercisers. The lighter and heavier exercisers were similar at baseline apart from BMI and body fat, and the lighter group did no better than decliners, which the authors argue points to the dose.

Funding and ties: supported by Portugal's Foundation for Science and Technology (FCT); the authors declare no relevant financial interests. Two authors are affiliated with Fresenius Medical Care's NephroCare in Lisbon, ethics approval came from the Fresenius Medical Care Portugal ethics committee, and outcome data came from Fresenius's clinical database. Dr. Hussein serves on the Fresenius Medical Care US Home Medical Advisory Board (see our disclosures).

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**The source:** Martins PM, Leal DV, Ferreira AA, Wilund KR, Viana JL. Association of Intradialytic Exercise With Mortality and Hospitalization: A Cohort Study. Kidney Med. Published online October 9, 2026 (article in press). doi:10.1016/j.xkme.2026.101570 [Read the original](https://doi.org/10.1016/j.xkme.2026.101570?ref=nephspace.com)

**🎧 Listen:** [Weekly · Oct 20](https://nephspace.com/weekly-oct-20/), from 14:59.

*Physician-led, AI-assisted. Dr. Wael Hussein chooses every item NephSpace covers and reviews and edits every story before it is published. The first draft was written in our own words with AI (Claude, by Anthropic) from the full text of the paper and checked against our reading notes; Dr. Hussein then reviewed and edited it. For education and information only, not medical advice. Please talk to your own physician or care team about your health. Clinicians: read the original before changing practice. See our* [*disclaimer*](https://nephspace.com/disclaimer/) *and* [*disclosures*](https://nephspace.com/disclosures/)*. Spotted an error?* [*Tell us*](mailto:hello@nephspace.com?subject=Correction)*.*