The Influence of Aerobic and Strength Training on Oxidative Stress and Antioxidant Status in Hemodialysis Patients: A Randomized Controlled Trial

ABSTRACT Background and Aims To investigate the effects of a 6‐month supervised, personalized combined aerobic and resistance training program on oxidative stress, antioxidant capacity, infection‐related biomarkers, and body composition in maintenance hemodialysis (MHD) patients. Methods In this single‐center, randomized controlled trial (nonblinded, parallel design), 61 MHD patients (standard thrice‐weekly 4‐h sessions) were randomly assigned to either an exercise group (n = 36) or a control group (n = 35). The exercise intervention comprised: The exercise group received 6 months of supervised training (three times a week, 2 h before dialysis), including: ①Aerobic exercise: A 20‐min stationary cycling session at RPE 13 (with heart rate maintained at 60%–70% of maximum heart rate). ②Resistance training: Four lower‐body exercises (leg extension, straight leg raise, hip abduction, hip flexion) using ethylene‐vinyl acetate resistance bands (10 reps/set, RPE 13). The control group received standard care. Primary outcomes were oxidative stress markers (MDA, AOPP), antioxidant indicators (CAT, THIOL, TBIL), infection markers (IL‑6, PCT, CRP, Hcy), and body composition measures (muscle mass, BMI). Results After 6 months of intervention, the exercise group exhibited significantly reduced levels of MDA (p < 0.05) and AOPP (p < 0.05). CAT activity (p < 0.05), THIOL levels (p < 0.05), and TBIL levels (p < 0.001) were significantly increased. IL‐6, PCT, CRP, and Hcy were lower than those in the control group (p < 0.05). The exercise group also demonstrated improved Kt/V (p < 0.05) and attenuated declines in muscle mass and BMI compared to controls (p < 0.05). Conclusion This structured exercise program effectively mitigates oxidative damage, boosts antioxidant defenses, reduces infection markers, and enhances dialysis efficiency and body composition in MHD patients. These findings provide evidence for incorporating supervised exercise as a novel therapeutic strategy in nephrology care.