Endurance training during maintenance hemodialysis in pediatric and adolescent patients-theory and best practice suggestions.

Patients on maintenance hemodialysis (HD) spend significant sedentary time traveling to and receiving dialysis, which leaves little time for social or sport events. Also, chronic HD patients are not physically fit, too exhausted after HD, and are not necessarily motivated to perform sports. There is increasing evidence that endurance training during HD can both increase dialysis efficacy and improve the ability of patients to participate in social life. With limited spare time, how can we motivate patients to train? Would that training improve endurance and modify leisure activity choice? Since HD patients would be a captive audience, we would suggest that endurance training during HD would be a preferred solution, if pediatric and adolescent patients could be persuaded to participate. There are few data on how training should be organized, as well as which parameters are best markers of safety and efficacy. And, most importantly, motivational aspects for performing endurance training on a regular basis clearly have to be considered. It is therefore in any case important to assess whether training improves endurance and, thus, quality of life or also quality of care parameters.