Exercise prescriptions for patients on hemodialysis in Brazil: a scoping review

Exercise is being incorporated into the treatment of patients on hemodialysis; however, little is known about the major characteristics of these interventions. To describe the exercise protocols prescribed for hemodialysis patients in Brazil. A scoping review was conducted following JBI and Prisma-ScR guidelines. Searches were carried out in Medline, Embase and three other databases until May 2024. Other sources (websites, books and guidelines) were also investigated. Evidence from patients on hemodialysis describing exercise protocols in all settings and designs in Brazil was included. Forty-five pieces of evidence were found, resulting in 54 exercise protocols from 16 Brazilian states. Strength exercises (33.3%), followed by aerobic exercises (22.2%), were the most prescribed, mainly to be performed during dialysis (85.2%). The most prevalent professionals supervising the programs were physiotherapists and exercise physiologists (37.0% and 18.5%, respectively). All protocols implemented the principles of type and frequency training, while progression was adopted in only 53.7%. The main prescription was three times per week (88.9%). Exercise intensity was predominantly determined by subjective methods (33.3%). Aerobic and strength exercises during dialysis were the most commonly prescribed modalities in Brazil, with the majority of programs being properly supervised by qualified professionals. However, existing protocols have not employed systematic progression throughout the intervention, which would be appropriate for providing better physiological responses and adaptations.