key: cord-0325449-at2wqpxi authors: Ribeiro, H. S.; Andrade, F. P.; Leal, D. V.; Oliveira, J. S. d.; Wilund, K.; Viana, J. L. title: How is Exercise Prescribed for Hemodialysis Patients? A Scoping Review Protocol date: 2021-12-30 journal: nan DOI: 10.1101/2021.12.21.21268178 sha: 3c932aa9d0108b7b0c5c66a1c63bea62e4d296ec doc_id: 325449 cord_uid: at2wqpxi Objective: The objective of this scoping review is to describe how exercise has been prescribed for hemodialysis patients. Introduction: Exercise interventions have received more attention from the nephrology community in the last few years. Despite some limitations in the findings, there is currently robust evidence suggesting that exercise is clinically important and provides benefits to hemodialysis patients. Even so, there is little evidence precisely detailing and describing how exercise can be prescribed and delivered for this population. Inclusion criteria: Based on the PCC framework, we will review and include evidence from hemodialysis patients (Participants); describing exercise interventions (Concept); in all settings and designs (Context). The evidence that included any other kidney replacement therapy other than hemodialysis will be excluded. Methods: This review will follow the JBI methodology for scoping reviews and the PRISMA-ScR. We will perform a comprehensive literature search using MEDLINE, EMBASE, SPORTDiscuss, CINAHL, and LILACS databases without date or language restrictions from inception until December 2021. Websites, books, and guidelines from prominent societies and associations will also be searched. Experimental, quasi-experimental, observational, and protocol evidence from adults with chronic kidney disease ([≥]18 years) undergoing hemodialysis that prescribed exercise as an intervention will be considered. Two independent reviewers will screen title and abstract and perform the full-text review. Data extraction will be done by the main reviewer and checked by a second reviewer. Data characterizing the exercise interventions (e.g., type, setting, frequency, duration, intensity, volume, progression, periodization, professionals involved, etc.) will be extracted from selected evidence. The qualitative and quantitative results will be synthesized and presented in tables and figures along with a narrative summary. Adults with chronic kidney disease (CKD) undergoing maintenance hemodialysis (HD) treatment usually have highly sedentary behaviour 1,2 , leading to musculoskeletal impairments and an increased prevalence of sarcopenia and frailty 3, 4 . Exercise programs (e.g., resistance/strength, aerobic, and combined) have been proposed as therapeutic interventions to mitigate these outcomes 5, 6 . Previous evidence have also shown that exercise programs produce positive effects on cardiorespiratory fitness, physical function, quality of life, neuropsychological disorders, and sleep quality in hemodialysis patients [7] [8] [9] . While exercise interventions have received much greater attention from the nephrology community in the last few years 10 , there is still little evidence showing the implementation of exercise as part of the standard care for hemodialysis patients 11 . This indicates that apart from better understanding the benefits of prescribing exercise, the nephrology community requires more pragmatic and detailed intervention protocols that describe how to deliver and implement sustainable exercise programs for this population. A preliminary search of MEDLINE, the Cochrane Database of Systematic Reviews and Joanna Briggs Institute (JBI) Evidence Synthesis was conducted. While systematic reviews on the effects of exercise on hemodialysis patients are ongoing, no scoping reviews (published or in progress) mapping the characteristics of exercise prescription for these patients were identified. Thus, the objective of this scoping review is to describe how exercise has been prescribed for hemodialysis patients. What types of exercise interventions are most frequently delivered to adults with CKD undergoing maintenance hemodialysis? What are the main characteristics and variables adopted to prescribe exercise interventions to adults with CKD undergoing hemodialysis? . CC-BY-NC-ND 4.0 International license It is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint This scoping review will consider evidence from reports/studies that prescribed exercise interventions for adults with CKD (≥18 years) from all genders (i.e., female, male, non-binary, etc.) undergoing hemodialysis. Evidence that included other kidney replacement therapies (e.g., peritoneal dialysis and kidney transplant), non-dialysis, pediatric patients (<18 years), or acute kidney injury will not be considered. We will consider any evidence from reports/studies that prescribed or recommended exercise interventions for adults with CKD undergoing maintenance hemodialysis. Exercise is classically defined as a "physical activity that is planned, structured, repetitive, and purposive in the sense that improvement or maintenance of one or more components of physical fitness and health is an objective" 12 . Non-experimental evidence, such as websites, books, and guidelines from prominent societies and associations that recommended or described exercise interventions will also be considered. We will consider all exercise possibilities and types that have been prescribed and recommended worldwide. No restriction will be applied to the setting or design. Evidence from all available sources regarding exercise prescription during dialysis, out of dialysis, in a fitness center, home-based, inhospital, or others will be considered. This scoping review will consider all study designs and evidence (e.g., experimental, quasiexperimental, observational, protocol, etc.). In addition, grey literature sources, websites, books, and guidelines from prominent societies and associations will also be searched. On the other hand, systematic reviews, conference abstracts, commentaries, and letters to the editor will not be considered. The proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews 13 and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) 14 . is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted December 30, 2021. ; https://doi.org/10.1101/2021.12.21.21268178 doi: medRxiv preprint The search strategy will aim to locate both peer-review published studies and non-scientific evidence. An initial limited search of MEDLINE was undertaken to identify articles on the topic. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles were used to develop a full search strategy for MEDLINE, EMBASE, SPORTDiscuss, CINAHL, and LILACS databases (see Appendix 1). The search strategy, including all identified keywords and index terms, will be adapted for each included database and/or information source. Databases will be searched from the date of inception to December 2021. The reference list of all included sources of evidence will be screened for additional studies. We will not apply language or date restrictions. Sources of unpublished studies and grey literature to be searched include Google Scholar and Google.com. Following the search, all identified citations will be collated and uploaded into Covidence software (Veritas Health Innovation, Melbourne, AU) and duplicates removed for the screening process. Following a pilot test, titles and abstracts will then be screened by two independent reviewers (H.S.R and F.P.A) for assessment against the inclusion criteria for the review. Potentially relevant sources will be retrieved in full. The full text of selected evidence will be assessed in detail against the inclusion criteria by the same two independent reviewers. Reasons for exclusion of sources of evidence at full text that do not meet the inclusion criteria will be recorded and reported in the scoping review. Any disagreements that arise between the reviewers at each stage of the selection process will be resolved through discussion, or with an additional reviewer (D.V.L). The results of the search and the study inclusion process will be reported in full in the final scoping review and presented in PRISMA-ScR flow diagram 14 . Data will be extracted from evidence included in the scoping review by the main reviewer (H.S.R) and checked for a second reviewer (F.P.A) using a data extraction spreadsheet developed by the reviewers adapted from JBI Manual for Evidence Synthesis 15 . The data extracted will include specific details about how exercise has been prescribed for adults with CKD undergoing maintenance hemodialysis (e.g., type, setting, frequency, duration, intensity, volume, progression, periodization, professionals involved, etc.). Also, additional general information will be extracted, such as author(s), year of publication, source of evidence, and country. A draft extraction form is provided (see Appendix 2) . The draft data extraction tool will be modified and revised as necessary during the process . CC-BY-NC-ND 4.0 International license It is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted December 30, 2021. ; of extracting data from each included evidence source. Any disagreements that arise between the reviewers will be resolved through discussion, or with an additional reviewer (D.V.L). If necessary, authors of papers will be contacted to request missing or additional data. The qualitative and quantitative results will be synthesized and presented in tables and figures along with a narrative summary. The frequencies of the extracted data will be displayed in network diagrams and/or heat maps. A narrative summary will accompany the illustrations and will describe how the results relate to the reviews objective and questions. The findings from the scoping review will be reported in accordance with PRISMA-ScR guideline 14 . Noor is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted December 30, 2021. ; https://doi.org/10.1101/2021.12.21.21268178 doi: medRxiv preprint Prevalence and correlates of physical activity across kidney disease stages: an observational multicentre study Accelerometer-measured physical activity and functional behaviours among people on dialysis Physical inactivity: a risk factor and target for intervention in renal care Phenotypes Influencing Low Physical Activity in Maintenance Dialysis Management of Physical Frailty in Patients Requiring Hemodialysis Therapy Effects of intradialytic exercise on cardiopulmonary capacity in chronic kidney disease: systematic review and meta-analysis of randomized clinical trials Exercise interventions improve depression and anxiety in chronic kidney disease patients: a systematic review and meta-analysis Effects of intradialytic exercise on the physical function, depression and quality of life for haemodialysis patients: a systematic review and metaanalysis of randomised controlled trials A Global Approach to Increasing Physical Activity and Exercise in Kidney Care: The International Society of Renal Nutrition and Metabolism Global Renal Exercise Group Global Policy Barriers and Enablers to Exercise and Physical Activity in Kidney Care Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research Updated methodological guidance for the conduct of scoping reviews PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation Chapter 11: Scoping Reviews There is no conflict of interest in this scoping review.