Self-management education and exercise training reduce fatigue in haemodialysis patients
A meta-analysis of 30 studies found that self-management education and exercise training were both associated with significant reductions in fatigue among adults receiving haemodialysis, while cognitive behavioural therapy showed no clear benefit.
Fatigue is a common and debilitating symptom in adults undergoing haemodialysis, substantially reducing quality of life. Researchers conducted a systematic review and meta-analysis of 30 randomised controlled trials and quasi-experimental studies (search through January 2026) to assess whether non-pharmacological interventions could reduce this burden.
Self-management education demonstrated a significant effect on fatigue with a standardised mean difference of 0.98 (95% CI [0.69, 1.28], p < 0.001), rated as moderate certainty evidence. Exercise training also showed a significant benefit with an effect size of 0.82 (95% CI [0.44, 1.20], p < 0.001), though the certainty of evidence was lower. In contrast, cognitive behavioural therapy did not reach statistical significance (SMD = 1.45, 95% CI [−0.46, 3.37], p = 0.137), and the evidence was rated very low certainty. The authors emphasise that self-management education may be integrated into routine clinical care, while exercise training could serve as an adjunctive strategy. However, the variability in study quality and the inconsistent findings for cognitive behavioural therapy underscore the need for larger, higher-quality trials to clarify which interventions work best and for whom.
The effect sizes observed—0.98 for self-management education and 0.82 for exercise—represent moderate to large practical improvements in fatigue scores, suggesting these interventions could meaningfully enhance daily functioning in dialysis patients. Self-management education likely works by helping patients better understand their condition, anticipate symptoms, and adopt habits that conserve energy. Exercise training may reduce fatigue through improvements in cardiovascular fitness, muscle strength, and mood, though dialysis patients often face time and physical constraints. The cognitive behavioural therapy finding (p = 0.137, very low certainty) suggests either that the intervention as delivered did not adequately target dialysis-specific fatigue, or that the existing trials were too small or heterogeneous to detect a real effect. One key limitation is that the certainty grades ranged from moderate to very low, reflecting variation in trial design, sample size, and how fatigue was measured across studies—so these results should inform clinical decisions but not substitute for individualised assessment.
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Open in Cadence →References
- The Impact of Educational or Behavioural Interventions on Fatigue in Adults Receiving Haemodialysis: A Systematic Review and Meta-Analysis. — Journal of renal care (Read the original)