Internet-based remote exercise interventions for maintenance hemodialysis patients: a systematic review of the evidence.

OBJECTIVE: This study aimed to synthesize the relevant evidence regarding remote exercise management for patients undergoing Maintenance hemodialysis(MHD) using an evidence-based approach. The goal was to provide clinicians with evidence-based recommendations to facilitate the more effective application of internet technologies in managing remote exercise for this patient population. METHODS: A comprehensive search was conducted across multiple databases, professional association websites, guideline repositories, and evidence-based resource platforms to identify all relevant evidence on exercise in MHD patients. The search covered publications from database inception to January 31, 2025. Two independent reviewers evaluated the quality of eligible studies, extracted data according to the inclusion criteria, and assigned evidence levels. RESULTS: A total of 18 publications were included: 2 guidelines, 2 expert consensuses, 4 systematic reviews, 9 randomized controlled trials, and 1 quasi-experimental study. Thirty-two best evidence statements were synthesized across seven domains: remote exercise preparation, remote exercise requirements, pre-exercise assessment, exercise prescription, remote exercise monitoring, exercise support, and precautions. CONCLUSION: The evidence synthesized in this study provides preliminary guidance for the development of remote exercise management strategies in MHD patients. It may assist healthcare professionals in raising awareness of exercise management and in exploring the integration of internet technologies to improve support for this population. At the same time, further high-quality, multicentre studies are needed to confirm these findings and establish standardized approaches for broader clinical application. PROSPERO REGISTRATION NUMBER: CRD420251037918.