The Effectiveness of Intradialytic Exercise in Reducing Fatigue among Hemodialysis Patients Based on Roy Adaptation Model

Syarief Hidayatullah Bahri; Priyanto Priyanto

doi:10.33860/mnj.v7i1.4301

Authors

Syarief Hidayatullah Bahri
nursesyarief@gmail.com
Master of Nursing Study Program, Ngudi Waluyo University, Semarang, Indonesia
Priyanto Priyanto Master of Nursing Study Program, Ngudi Waluyo University, Semarang, Indonesia

Keywords:

Fatigue; Hemodialysis; Intradialytic Exercise; Roy Adaptation Model

Abstract

Background: Fatigue is one of the most common and distressing problems among hemodialysis patients, significantly affecting their quality of life and adherence to treatment. This condition arises from physiological and psychological imbalances experienced during the hemodialysis process. Within the framework of the Roy Adaptation Model, fatigue is understood as a maladaptive response to prolonged stressors, while intradialytic exercise can function as an adaptive mechanism to enhance positive adjustment.

Methods: This conceptual study employed a literature-based review approach by synthesizing evidence from recent national and international publications from 2022 to 2025. Thematic analysis was conducted based on the four adaptive modes of the Roy Adaptation Model: physiological, self-concept, role function, and interdependence.

Results: The synthesis revealed that intradialytic exercise, which refers to physical activity performed during hemodialysis, effectively reduces fatigue levels by improving muscle perfusion, enhancing cardiovascular function, and stabilizing hormonal balance. This adaptive intervention supports physiological stability and promotes better psychosocial adjustment in hemodialysis patients.

Conclusion: Intradialytic exercise serves as an effective adaptive nursing intervention to minimize fatigue and improve the overall quality of life in hemodialysis patients. These findings provide both theoretical and practical implications for developing comprehensive and sustainable nursing strategies grounded in the Roy Adaptation Model.

KEYWORDS: Fatigue; Hemodialysis; Intradialytic Exercise; Roy Adaptation Model

References

Afrasiabifar, A., Karimi, Z., & Hassani, P. (2022). Roy’s adaptation model-based patient education for promoting the adaptation of hemodialysis patients. Iranian Red Crescent Medical Journal, 15(7), 566–572. https://doi.org/10.5812/ircmj.12024

Astri Zeini Wahida, Hotma Rumahorbo, M. (2023). The effectiveness of intradialytic exercise in ameliorating fatigue symptoms in patients with chronic kidney failure undergoing hemodialysis : A systematic literature review and meta-analysis. Journal of Taibah University Medical Sciences, 18(3), 512–525. https://doi.org/10.1016/j.jtumed.2022.11.004

Balconi, M., Angioletti, L., Filippis, D. De, & Bossola, M. (2022). Association between fatigue , motivational measures ( BIS / BAS ) and semi-structured psychosocial interview in hemodialytic treatment. BMC Psychology, 1–11.

Cebrian, A., Escobar, C., Aranda, U., Palacios, B., Capel, M., Sicras, A., … Alcázar, R. (2022). The 2021 European Society of Cardiology Cardiovascular Disease Prevention Guidelines : adding albuminuria to the SCORE scale increases the prevalence of very high / high cardiovascular risk among patients with chronic kidney disease. Clinical Kidney Journal, 15(6), 1204–1208.

Chakraborty, S., Kundu, M., & Mukherjee, C. (2024). Assesment of Quality of Life of Chronic Kidney Disease Patient Attending in Selected Hospitals, West Bengal. Jurnal Internasional Granthaalayah, 12, 106–119. https://doi.org/10.29121/granthaalayah.v12.i2.2024

Esquivel-garzon, N., Marquez-herrera, M., & Parra, D. I. (2025). Development of a caring model applying the conceptual , theoretical and empirical structure from caring science theory. Journal of Research in Nursing, (3). https://doi.org/10.1177/17449871241303396

Eugenio, R., Burdelis, M., José, F., Melo, S., & Ii, C. (2023). Prevalence and predisposing factors for fatigue in patients with chronic renal disease undergoing hemodialysis : a cross-sectional study. Sao Paulo Med, 141(5), 1–9.

Huang, M., Li, S., & Wang, J. (2024). The effects of exercise training interventions on depression in hemodialysis patients. Frontiers in Psychology, (January), 1–12. https://doi.org/10.3389/fpsyt.2023.1321413

Io, H., Muto, M., Sasaki, Y., Ishizaka, M., Kano, T., & Fukuzaki, H. (2023). Impact of anemia treatment for left ventricular hypertrophy using long ‑ acting erythropoietin ‑ stimulating agents from the pre ‑ dialysis to maintenance dialysis period in patients with chronic kidney disease , retrospective longitudinal cohort study. BMC Nephrology, 1–9. https://doi.org/10.1186/s12882-023-03133-1

Khairallah, H. R., & Al-Ashour, I. A. (2025). Impact of evidence-based nursing interventions on the health status of hemodialysis patients: a quasi-experimental study. Anaesthesia, Pain and Intensive Care, 29(6), 616–622. https://doi.org/10.35975/apic.v29i6.2837

Khemchandani, M., Nasir, K., Qureshi, R., Dhrolia, M., & Ahmad, A. (2023). From Exhaustion to Empowerment : Investigating Fatigue and Its Associations in Patients With End-Stage Renal Disease on Maintenance Hemodialysis. Cureus, 15(11). https://doi.org/10.7759/cureus.49070

Kim, J., Lee, S., Kim, J. H., Im, D. W., & Lee, D. (2023). Comparing predictions among competing risks models with rare events : application to KNOW ‑ CKD study — a multicentre cohort study of chronic kidney disease. Scientific Reports, 1–13. https://doi.org/10.1038/s41598-023-40570-2

Krismiadi, D. (2024). Adaptasi pada Pasien Gagal Ginjal Kronik yang Melakukan Terapi Hemodialisis Berdasarkan Teori Sister Calista Roy: Literatur Review. Indonesian Health Science Journal, 4(1), 27–34.

Lai, Y., Wang, C., Lin, H., & Lin, Y. (2025). Intradialytic Exercise : Effects on Arterial Stiffness and Gait Speed in Patients Undergoing Hemodialysis. Clinical Research, 1–12. https://doi.org/10.12659/MSM.947604

Lin, C. H., Hsu, Y. J., Hsu, P. H., Lee, Y. L., Lin, C. H., Lee, M. S., & Chiang, S. L. (2022). Effects of intradialytic exercise on dialytic parameters, health‐related quality of life, and depression status in hemodialysis patients: A randomized controlled trial. International Journal of Environmental Research and Public Health, 18(17), 1–16. https://doi.org/10.3390/ijerph18179205

Minanton, Tina Muzaenah, S. (2022). Latihan Intradialitik Meningkatkan Kinerja Dialisis dan Hasil Kesehatan Pasien: Mini Review. Penelitian Keperawatan Kontemporer, (27), 24–33.

Nassar, M. K., Tharwat, S., Gawad, S. M. A., Elrefaey, R., & Elsawi, A. A. (2023). Symptom burden , fatigue , sleep quality and perceived social support in hemodialysis patients with musculoskeletal discomfort : a single center experience from Egypt. BMC Musculoskeletal Disorders, 1–12. https://doi.org/10.1186/s12891-023-06910-z

Picariello, F., Moss-morris, R., Macdougall, I. C., & Chilcot, J. (2022). The role of psychological factors in fatigue among end-stage kidney disease patients : a critical review. Clinical Kidney Journal, 10(1), 79–88. https://doi.org/10.1093/ckj/sfw113

Ren, N., Yang, H., Cai, Z., Wang, R., Wang, Z., Zhao, Y., … Chen, Y. (2023). Comparative efficacy of nine exercise methods on the prognosis in chronic kidney disease patients with hemodialysis : a systematic review and network meta ‑ analysis. European Journal of Medical Research, 1–11. https://doi.org/10.1186/s40001-023-01270-9

Rhee, S. Y., Song, J. K., Hong, S. C., Choi, J. W., Jeon, H. J., Shin, D. H., … Oh, J. (2022). Intradialytic exercise improves physical function and reduces intradialytic hypotension and depression in hemodialysis patients. Korean Journal of Internal Medicine, 34(3), 588–598. https://doi.org/10.3904/kjim.2017.020

Sakiqi, J., Vasilopoulos, G., Koutelekos, I., Polikandrioti, M., & Dousis, E. (2022). Depression Among Hemodialysis Patients : Related Factors and the Impact of Insomnia and Fatigue. Cureus, 14(5). https://doi.org/10.7759/cureus.25254

Shi, R., Zhu, J., Zhu, L., Zhao, W., Li, H., Chen, Q., & Pan, H. (2024). Exploring the nexus between fatigue , body composition , and muscle strength in hemodialysis patients. European Journal of Medical Research, 1–8. https://doi.org/10.1186/s40001-024-01852-1

Sri, A., Purba, G., Sepadha, D., Sagala, P., Hasibuan, A. S., & Lubis, S. (2024). Efektivitas Intradialytic Exercise Terhadap Kekuatan Otot dan Skor Fatigue Pada Pasien Gagal Ginjal Kronik ( GGK ) di Ruang Hemodialisa Grandmed Effectiveness of Intradialytic Exercise on Muscle Strength and Fatigue Score in Chronic Kidney Failure ( CKF ). Jurnal Keperawatan Dan Fisioterapi (JKF), (c), 15–20.

Tabibi, M. A., Cheema, B., Salimian, N., Corrêa, H. de L., & Ahmadi, S. (2023). The effect of intradialytic exercise on dialysis patient survival: a randomized controlled trial. BMC Nephrology, 24(1), 1–9. https://doi.org/10.1186/s12882-023-03158-6

Vergara, A., Wang, K., Colombo, D., Gheblawi, M., Rasmuson, J., Mandal, R., … Oudit, G. Y. (2023). Urinary angiotensin-converting enzyme 2 and metabolomics in COVID-19-mediated kidney injury. Clinical Kidney Journal, 16(2), 272–284.

Verrelli, D., Sharma, A., Alexiuk, J., Tays, Q., Rossum, K., Sharma, M., … Bohm, C. (2024). Original Investigation Effect of Intradialytic Exercise on Cardiovascular Outcomes in Maintenance Hemodialysis : A Systematic Review and Meta-Analysis. Kidney 360, 5.

Yabe, H., Yamaguchi, T., Kono, K., Sakakibara, A., Sugimoto, H., & Ishikawa, Y. (2023). Effect of intradialytic exercise on fall occurrences in older patients undergoing hemodialysis : a single ‑ center non ‑ randomized study. Renal Replacement Therapy, 1–8. https://doi.org/10.1186/s41100-023-00503-1

Yogalakshmi, S., Sasikala, D., Varughese, S., & Sundararajan, V. (2024). Integrated Dialysis Nursing Intervention for Ameliorating Fatigue in Hemodialysis Patients. Ethiopian Journal of Health Sciences, 34(5), 389–396. https://doi.org/10.4314/ejhs.v34i5.7

You, Q., Bai, D., Wu, C., Chen, H., Hou, C., & Gao, J. (2022). Prevalence and Risk Factors of Postdialysis Fatigue in Patients Under Maintenance Hemodialysis : A Systematic Review and Meta-Analysis. Asian Nursing Research, 16(5), 292–298. https://doi.org/10.1016/j.anr.2022.11.002

Zheng, X., Zhang, Z., Cheng, Y., Yang, Q., & Xu, B. (2023). Factors associated with subgroups of fatigue in maintenance hemodialysis patients : a cross- sectional study. Renal Failure, 45(1). https://doi.org/10.1080/0886022X.2023.2221129

Zou, Z. H., Zhang, J. Q., Yi, Z. H., Chen, X., & Qing, W. (2025). Effects of intradialytic exercise on frailty in maintenance hemodialysis patients : a systematic review and. Frontiers in Psychology, (November). https://doi.org/10.3389/fphys.2025.1600219

Zuo, M., Zhu, W., Lin, J., Zhuo, J., He, X., Jing, X., & Tang, J. (2022). The impact of nurse ‑ led nonpharmacological multidisciplinary holistic nursing care on fatigue patients receiving hemodialysis : a randomized , parallel ‑ group , controlled trial. BMC Nursing, 1–9. https://doi.org/10.1186/s12912-022-01126-3