Effects of Low-Impact Strengthening Exercises on Limb Pain and Strength in Diabetic Patients with End-Stage Renal Disease

Strengthening Exercises in End-Stage Renal Disease


  • Khizra Asif The university of faislabad
  • Warda Khan The university of faidlabad
  • Hafiza Mubashra Zahid The university of faislabad
  • Mehwish Tariq Government college university faislabad
  • Mariam Mehmood The university of faislabad
  • Ume-Habiba The university of faislabad




diabetic nephropathy, end-stage renal disease, hemodialysis, numeric pain rating scale, quality of life


Background: Diabetic nephropathy becomes a disease with a high mortality rate in this modern era of technology. Dialysis in diabetic patients affects kidney functioning is the most common treatment for end-stage renal failure but had different musculoskeletal complications due to bone mineral metabolisms like muscular cramping, atrophy and muscular weakness, restless leg syndrome and limb pain that lowers the quality of life and physical function. Objective: To evaluate the effects of low-impact strengthening exercises on limb pain, strength, glycemic control, hypertension and quality of life of patients with end-stage renal disease. Methods: The randomized controlled study was designed to check the effectiveness of low-impact strengthening exercises on patients involved in the treatment and control group. Using non-probability purposive sampling, data was collected from different hospitals in Faisalabad by providing treatment for six consecutive weeks. Outcomes of measures were pain, strength, glucose level, blood pressure and quality of life which were estimated through the numeric pain rating scale, manual muscle testing, glucometer, sphygmomanometer and kidney disease quality of life questionnaire respectively. Results: Low-impact strengthening exercises in the treatment group showed improvement in muscle strength, blood pressure, glycemic level, pain and quality of life in diabetic patients with end-stage renal disease as compared to the control group. Mean values showed that there was a statistically significant difference in different variables between both groups. Conclusion: It was concluded that there is a statistically significant difference between both groups in the improvement of limb pain and limb muscle strength by low-impact strengthening exercises. These exercises have positive effects on diabetic patients with end-stage renal disease in the treatment group as compared to the control group.


Thomas MC, Brownlee M, Susztak K, et al. Diabetic kidney disease. Nature reviews Disease primers 2015; 1(1): 1-20.

Reidy K, Kang HM, Hostetter T, Susztak K. Molecular mechanisms of diabetic kidney disease. The Journal of clinical investigation 2014; 124(6): 2333-40.

Johansen KL, Shubert T, Doyle J, Soher B, Sakkas GK, Kent-Braun JA. Muscle atrophy in patients receiving hemodialysis: effects on muscle strength, muscle quality, and physical function. Kidney international 2003; 63(1): 291-7.

Piccoli GB, Grassi G, Cabiddu G, et al. Diabetic kidney disease: a syndrome rather than a single disease. The review of diabetic studies: RDS 2015; 12(1-2): 87.

Ghaderian SB, Hayati F, Shayanpour S, Mousavi SSB. Diabetes and end-stage renal disease; a review article on new concepts. Journal of renal injury prevention 2015; 4(2): 28.

Maric-Bilkan C. Sex differences in diabetic kidney disease. Mayo Clinic Proceedings; 2020: Elsevier; 2020. p. 587-99.

Gheith O, Farouk N, Nampoory N, Halim MA, Al-Otaibi T. Diabetic kidney disease: world wide difference of prevalence and risk factors. Journal of nephropharmacology 2016; 5(1): 49.

Carrero JJ, Chmielewski M, Axelsson J, et al. Muscle atrophy, inflammation and clinical outcome in incident and prevalent dialysis patients. Clinical nutrition 2008; 27(4): 557-64.

Young DO, Lund RJ, Haynatzki G, Dunlay RW. Prevalence of the metabolic syndrome in an incident dialysis population. Hemodialysis International 2007; 11(1): 86-95.

Chen C-T, Lin S-H, Chen J-S, Hsu Y-J. Muscle wasting in hemodialysis patients: new therapeutic strategies for resolving an old problem. The Scientific World Journal 2013; 2013.

Capitanini A, Lange S, D'Alessandro C, et al. Dialysis exercise team: the way to sustain exercise programs in hemodialysis patients. Kidney and Blood Pressure Research 2014; 39(2-3): 129-33.

Johansen KL, Painter PL, Sakkas GK, Gordon P, Doyle J, Shubert T. Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis: a randomized, controlled trial. Journal of the American Society of Nephrology 2006; 17(8): 2307-14.

Tao X, Chow SKY, Wong FKY. A nurse-led case management program on home exercise training for hemodialysis patients: A randomized controlled trial. International journal of nursing studies 2015; 52(6): 1029-41.

Gulve EA. Exercise and glycemic control in diabetes: benefits, challenges, and adjustments to pharmacotherapy. Physical Therapy 2008; 88(11): 1297-321.

Dwyer JP, Parving H-H, Hunsicker LG, et al. Renal dysfunction in the presence of normoalbuminuria in type 2 diabetes: results from the DEMAND study. Cardiorenal medicine 2012; 2(1): 1-10.

Neelofar K, Ahmad J. A comparative analysis of fructosamine with other risk factors for kidney dysfunction in diabetic patients with or without chronic kidney disease. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2019; 13(1): 240-4.

Painter P, Carlson L, Carey S, Paul SM, Myll J. Physical functioning and health-related quality-of-life changes with exercise training in hemodialysis patients. American Journal of Kidney Diseases 2000; 35(3): 482-92.

Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Annals of internal medicine 2009; 150(9): 604-12.

Toth-Manikowski S, Atta MG. Diabetic kidney disease: pathophysiology and therapeutic targets. Journal of diabetes research 2015; 2015.

Caravaca F, Gonzales B, Bayo MÁ, Luna E. Musculoskeletal pain in patients with chronic kidney disease. Nefrología (English Edition) 2016; 36(4): 433-40.

Lok P, Crawford J. The effect of organisational culture and leadership style on job satisfaction and organisational commitment: A cross‐national comparison. Journal of management development 2004.

Soderland P, Lovekar S, Weiner DE, Brooks DR, Kaufman JS. Chronic kidney disease associated with environmental toxins and exposures. Advances in chronic kidney disease 2010; 17(3): 254-64.

Imtiaz S, Salman B, Qureshi R, Drohlia MF, Ahmad A. A review of the epidemiology of chronic kidney disease in Pakistan: A global and regional perspective. Saudi Journal of Kidney Diseases and Transplantation 2018; 29(6): 1441.

Carter R, Lubinsky J. Rehabilitation research: principles and applications: Elsevier Health Sciences; 2015.

Ghonemy TA, Farag SE, Soliman SA, El-Okely A, El-Hendy Y. Epidemiology and risk factors of chronic kidney disease in the El-Sharkia Governorate, Egypt. Saudi Journal of Kidney Diseases and Transplantation 2016; 27(1): 111.

Leehey DJ, Moinuddin I, Bast JP, et al. Aerobic exercise in obese diabetic patients with chronic kidney disease: a randomized and controlled pilot study. Cardiovascular diabetology 2009; 8(1): 1-8.

Malaki M, Willis Aa, Jones R. Congenital anomalies of the inferior vena cava. Clinical radiology 2012; 67(2): 165-71.

Youssef MK, Philips MV. Effect of exercise in patients with diabetic kidney disease. International Journal of Therapy And Rehabilitation 2016; 23(10): 472-9.

Parsons TL, Toffelmire EB, King-VanVlack CE. The effect of an exercise program during hemodialysis on dialysis efficacy, blood pressure and quality of life in end-stage renal disease (ESRD) patients. Clinical nephrology 2004; 61(4): 261-74.

Nomura T, Kawae T, Kataoka H, Ikeda Y. Loss of lower extremity muscle strength based on diabetic polyneuropathy in older patients with type 2 diabetes: Multicenter Survey of the Isometric Lower Extremity Strength in Type 2 Diabetes: Phase 2 study. Journal of diabetes investigation 2021; 12(3): 390-7.

Wagenmakers AJ, Pedersen BK. The anti-inflammatory effect of exercise: its role in diabetes and cardiovascular disease control. Essays in biochemistry 2006; 42: 105-17.

Larsen MK, Matchkov VV. Hypertension and physical exercise: the role of oxidative stress. Medicina 2016; 52(1): 19-27.

El‐Katab S, Omichi Y, Srivareerat M, Davenport A. Pinch grip strength as an alternative assessment to hand grip strength for assessing muscle strength in patients with chronic kidney disease treated by haemodialysis: a prospective audit. Journal of human nutrition and dietetics 2016; 29(1): 48-51.




How to Cite

Asif, K. ., Khan, W., Zahid, H. M., Tariq, M. ., Mehmood, M. ., & Ume-Habiba. (2022). Effects of Low-Impact Strengthening Exercises on Limb Pain and Strength in Diabetic Patients with End-Stage Renal Disease: Strengthening Exercises in End-Stage Renal Disease. The Healer Journal of Physiotherapy and Rehabilitation Sciences, 2(2), 129–138. https://doi.org/10.55735/hjprs.v2i2.83