Prevalence and Correlates of Physical Activity Among Hemodialysis Patients: A Systematic Review and Meta-Analysis

Physical activity has been recommended as an effective strategy to prevent complications in patients receiving hemodialysis. Multiple guidelines for chronic kidney disease recommend at least 150 min per week of moderate-intensity physical activity. However, the prevalence of meeting recommended physical activity levels among hemodialysis patients remains unclear, and the factors influencing physical activity participation require further investigation. We systematically searched PubMed, Web of Science, MEDLINE, EMBASE, CINAHL, Scopus, PsycINFO, China National Knowledge Infrastructure, WanFang, Chinese Biomedical Literature Service System, and SPORTDiscus from inception to March 5, 2025. The Agency for Healthcare Research and Quality was used to evaluate the methodological quality of included studies. The pooled prevalence was calculated using a random-effects model. Subgroup analysis was conducted to explore sources of heterogeneity. We screened 24,566 records, reviewed 252 full texts, and included 12 studies (N = 8938). The pooled prevalence of meeting recommended physical activity was 32% (95% CI, 20%-46%). Higher prevalence was observed in studies with shorter dialysis vintage, self-administered PA instruments, smaller sample sizes, and those published before 2020. Factors underlying inactivity were multifactorial, spanning pathophysiological, psychological, and treatment-related domains. This review indicates a low prevalence of meeting recommended physical activity levels among hemodialysis patients, which is influenced by multiple factors. It is recommended that future studies further explore intervention strategies targeting physical activity on dialysis and non-dialysis days, based on factors that influence physical activity, to improve adherence.