Effectiveness of Exercise in Reducing Symptom Burden Among Hemodialysis Patients: A Non-Pharmacological Intervention Approach

Bushra Alshammari^1*J. Silvia Edison¹Sameer Abdulmalik¹Awatif M Alrasheeday²Bander Albagawi³Laila Lafi Alharbi⁴Hajer I Motakef⁵Laila Alshammari¹Bahia Galal Siam¹Nawal Abdullah Alharbi⁶Wejdan Assiri⁷Amirah Abdulaziz Almoqad⁸Abdulrahman Ebrahim Aldibas⁹Farhan Alshammari¹⁰

• ¹Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail, Saudi Arabia, Hail, Saudi Arabia
• ²Nursing Administration Department, College of Nursing, University of Hail,, Hail, Saudi Arabia
• ³Medical Surgical Department, College of Nursing, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
• ⁴King Salman Specialist Hospital, Emergency department Director, Hail Health cluster, Hail, Saudi Arabia
• ⁵Maternal and Child health department, College of Nursing, University of Hail, Hail, Saudi Arabia
• ⁶Academic affairs & Medical education, Maternity and Children’s Hospital, Hail Health Cluster, Ministry of Health, Hail, Saudi Arabia
• ⁷Program manager for critical care nursing, Ministry of Health, Riyadh, Saudi Arabia
• ⁸Quality department, Riyadh Health Cluster, Riyadh, Saudi Arabia
• ⁹King Saud Medical City, Riyadh, Saudi Arabia
• ¹⁰Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail, Hail, Saudi Arabia

Background:End-stage renal disease (ESRD) patients undergoing hemodialysis (HD) often experience a substantial symptom burden, which negatively impacts their quality of life. While pharmacological treatments are commonly used to manage these symptoms, non-pharmacological interventions, such as exercise, have gained attention for their potential to alleviate both physical and psychological symptoms without additional medication-related side effects. Compared to other strategies that often target a limited range of symptoms-such as meditation for depression or music therapy for anxiety-exercise offers broader benefits, making it particularly promising for patients receiving HD. Objective:This study aimed to evaluate the effectiveness of an exercise intervention in reducing the symptom burden among patients receiving HD in, Saudi Arabia. A quasi-experimental pre-post design was conducted with 72 HD patients recruited by convenience sampling from two hospitals. Participants engaged in a structured exercise program for 12 weeks, with sessions conducted three times per week for 30 minutes. Symptom severity was assessed using the Dialysis Symptom Index (DSI) before and after the intervention. Data were analyzed using paired t-tests, with a significance level set at p < .05.Results: A total of 72 HD patients participated in the study. The exercise intervention led to a statistically significant reduction in overall symptom severity scores, decreasing from 105.94 ± 9.77 pre-intervention to 102.50 ± 9.61 post-intervention (p < .001). Significant improvements were noted in multiple symptoms, including constipation (p = .002), decreased appetite (p < .001), restless legs (p = .001), fatigue (p < .001), joint pain (p = .045), difficulty concentrating (p = .045), and several emotional symptoms such as worrying (p = .024), nervousness (p = .002), trouble sleeping (p < .05), and feelings of sadness (p < .001). Sociodemographic factors, including younger age, female gender, shorter dialysis duration, and higher comorbidity burden, were significantly associated with greater baseline symptom severity.The findings demonstrate that a structured exercise program is an effective nonpharmacological intervention for reducing symptom burden among HD patients. These results support incorporating exercise into routine HD care to enhance patient well-being. Future initiatives should focus on integrating supervised, accessible exercise programs into dialysis centers to maximize adherence and therapeutic benefit.