Effect of Exercise on Parathyroid Hormone Levels in Dialysis Patients: A Systematic Review and Meta-Analysis

Exercise has been increasingly recognized as a safe and effective adjunct therapy for improving physiological and biochemical outcomes in dialysis patients. However, its specific impact on parathyroid hormone (PTH) regulation remains uncertain. This systematic review and meta-analysis aimed to determine the effect of exercise interventions on PTH levels in adults undergoing dialysis.

A systematic search of PubMed, Scopus, Embase, Web of Science, and Google Scholar databases was conducted up to October 31, 2025, without language or date restrictions. Eligible interventional studies compared exercise-based programs with standard dialysis care and reported quantitative PTH outcomes. Methodological quality was assessed using RoB 2.0 for randomized controlled trials and ROBINS-I for non-randomized trials. Pooled standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated using a random-effects model, with subgroup, sensitivity, and publication bias analyses performed to assess the robustness of results.

Nine eligible studies involving 438 dialysis patients were analyzed. Pooled results showed a significant reduction in PTH levels in the exercise groups compared with controls (SMD = -0.70; 95% CI: -1.00 to -0.40; p < 0.001). This effect remained consistent across study designs, randomized controlled trials (SMD = -0.68) and non-randomized trials (SMD = -0.72), and across both short-term (≤ 12 weeks; SMD = -0.71; 95% CI: -0.99 to -0.42) and long-term (> 12 weeks; SMD = -0.81; 95% CI: -1.37 to -0.25) interventions, with no significant subgroup difference. Sensitivity analysis confirmed that no single study significantly altered the pooled effect size, and funnel plot assessment with Egger's test indicated no publication bias (p = 0.181). Several individual trials also reported concurrent improvements in serum calcium and phosphate balance following exercise.

Exercise interventions significantly lower PTH levels in dialysis patients and may be integrated as a non-pharmacological adjunct to conventional secondary hyperparathyroidism management. Implementing structured physical activity during dialysis sessions can help improve mineral balance and endocrine stability. Further large-scale, multicenter randomized controlled trials with standardized protocols and longer follow-up periods are warranted to establish optimal exercise regimens for this population.