Background: Exercise is important for patients on hemodialysis, but details and descriptions on how it is prescribed are lacking. We reviewed the existing literature and described how exercise is being prescribed for patients on hemodialysis. Methods: A scoping review according to the JBI and PRISMA-ScR guidelines was conducted. MEDLINE, EMBASE and other databases were searched from inception until December 2021. Websites, books, and guidelines were also searched. We included evidence from patients on hemodialysis, describing exercise protocols, in all settings and designs. Results: Two hundred and eighty-five studies were included, yielding 327 exercise protocols. Aerobic (38.8%) and strength (21.4%) were the most prescribed exercise types. Exercise was mainly prescribed during dialysis (71.0%) and delivered within the first half of the session (94.6%). Although 33.3% of the exercise protocols did not report whether there was supervision or not, those that did were mostly delivered by physiotherapists (20.5%) and exercise physiologists (17.4%). The most followed exercise training principles were type (99.0%) and frequency (93.2%), whereas progression was adopted in 40.7% protocols. The most prescribed frequency and duration were three times/week (79.9%) and 30–60-min (69.2%) sessions, respectively. Exercise intensity was predominantly prescribed in moderate cut-offs (72.3%), mostly assessed by subjective methods (47.5%). Conclusions: Aerobic and strength were the most prescribed exercise types, mainly during dialysis. Interventions were mostly supervised by physiotherapists and exercise physiologists. Future exercise protocols for patients on hemodialysis should adopt recommended exercise principles, especially with systematic progression.

Athletes physically overload to improve performance. Unbalanced stress/recovery may induce overtraining, which is difficult to diagnosis as no diagnostic marker exists. Hormonal responses to a 55/80 cycle (30-min of alternating blocks of 1-min at 55% and 4-min at 80% maximum work rate) may highlight early-stage overtraining (overreaching), as blunted cortisol and testosterone responses to 55/80 follows intensified training. However, the reliability of hormonal responses to 55/80 when not overreached is unknown. Therefore, reported blunted hormonal responses could be due to inconsistent cortisol and testosterone responses to 55/80. Participants (n = 23) completed three 55/80 bouts, >7 days apart, with no exercise 24 h pre-trials. Pre-exercise urine osmolality and stress questionnaire responses were measured. Pre, post, and 30-min post-exercise saliva samples were collected for cortisol and testosterone assessment. Salivary cortisol and testosterone responses, osmolality and well-being were not different between trials. Salivary cortisol and testosterone elevated from pre- to post-exercise [by 4.2 nmol^.L⁻¹ (cortisol) and 307 pmol^.L⁻¹ (testosterone)], and 30 min post-exercise [by 160 pmol^.L⁻¹ (testosterone) only]. Intraclass correlation coefficients for pre to peak post-exercise cortisol (0.89; good) and testosterone (0.53; moderate) were calculated. This demonstrates that 55/80 induces reliable elevations of salivary cortisol and testosterone when in a healthy state.

Purpose: Physical overexertion can lead to detrimental overreaching states without sufficient recovery, which may be identifiable by blunted exercise-induced cortisol and testosterone responses. A running test (RPE_TP) elicits reproducible plasma cortisol and testosterone elevations (in a healthy state) and may detect blunted hormonal responses in overreached athletes. This current study determined the salivary cortisol and testosterone responses reproducibility to the RPE_TP, to provide greater practical validity using saliva compared with the previously utilized blood sampling. Second, the relationship between the salivary and plasma responses was assessed. Methods: A total of 23 active, healthy males completed the RPE_TP on 3 occasions. Saliva (N = 23) and plasma (N = 13) were collected preexercise, postexercise, and 30 minutes postexercise. Results: Salivary cortisol did not elevate in any RPE_TP trial, and reduced concentrations occurred 30 minutes postexercise (P = .029, η² = .287); trial differences were observed (P < .001, η² = .463). The RPE_TP elevated (P < .001, η² = .593) salivary testosterone with no effect of trial (P = .789, η² = .022). Intraindividual variability was 25% in cortisol and 17% in testosterone. “Fair” intraclass coefficients of .46 (cortisol) and .40 (testosterone) were found. Salivary and plasma cortisol positively correlated (R = .581, P = .037) yet did not for testosterone (R = .345, P = .248). Conclusions: The reproducibility of salivary testosterone response to the RPE_TP is evident and supports its use as a potential tool, subject to further confirmatory work, to detect hormonal dysfunction during overreaching. Salivary cortisol responds inconsistently in a somewhat individualized manner to the RPE_TP.

Excessive exercise with limited recovery may lead to detrimental states of overreaching or the overtraining syndrome. Chronic maladaptation in endocrine and immune mechanisms occur with the incidence of these states. Exercise-induced cortisol and testosterone responses have been proposed as biomarkers of overreaching, with blunted responses following intensified-training periods. Yet, limited information on the effects of overreaching in immunity is available. Healthy individuals completed a 30-min running protocol (the RPE_TP) before and after a 12-day intensified-training period. Blood and saliva were collected before, after and 30min after RPE_TP at pre-training and post-training. Plasma and salivary cortisol and testosterone, leucocyte proliferation and polymorphonuclear leucocyte phagocytic activity were examined. Plasma and salivary cortisol were acutely unaffected pre-training (−14% and 0%, p ​> ​0.05) and post-training (−14% and +46%, p ​> ​0.05). Comparing pre-training with post-training, blunted responses were observed in plasma testosterone (43%–19%, p ​< ​0.05) and salivary testosterone (55%–24%, p ​> ​0.05). No acute or resting changes in total leucocyte counts or most leucocyte subsets occurred pre-training or post-training. Yet, a 194% acute elevation in γδ T-lymphocyte number occurred pre-training (p ​< ​0.05), and average resting concentrations were 174% higher post-training. Baseline phagocytic activity was 47% lower post-training (p ​< ​0.05). Intensified training was detrimental, significantly reducing phagocytic activity. Testosterone blunted post-training, indicating an excessive training-related hypothalamic-pituitary gonadal dysfunction. The γδ T-lymphocytes sensitivity to exercise was noted, rendering it as a potential stress-responsive cellular marker. The usefulness of the RPE_TP to track the onset of overreaching is proposed.

Purpose:Progressively overloading the body to improve physical performance may lead to detrimental states of overreaching/overtraining syndrome. Blunted cycling-induced cortisol and testosterone concentrations have been suggested to indicate overreaching after intensified training periods. However, a running-based protocol is yet to be developed or demonstrated as reproducible. This study developed two 30-min running protocols, (1) 50/70 (based on individualized physical capacity) and (2) RPE_TP(self-paced), and measured the reproducibility of plasma cortisol and testosterone responses.Methods:Thirteen recreationally active, healthy men completed each protocol (50/70 and RPE_TP) on 3 occasions. Venous blood was drawn preexercise, postexercise, and 30 min postexercise.Results:Cortisol was unaffected (bothP > .05; 50/70, = .090; RPE_TP, = .252), while testosterone was elevated (bothP < .05; 50/70, 35%, = .714; RPE_TP, 42%, = .892) with low intraindividual coefficients of variation (CV_i) as mean (SD) (50/70, 7% [5%]; RPE_TP, 12% [9%]). Heart rate (50/70, effect size [ES] = 0.39; RPE_TP, ES = −0.03), speed (RPE_TP, ES = −0.09), and rating of perceived exertion (50/70 ES = −0.06) were unchanged across trials (all CV_i < 5%,P < .05). RPE_TPshowed greater physiological strain (P < .01).Conclusions:Both tests elicited reproducible physiological and testosterone responses, but RPE_TPinduced greater testosterone changes (likely due to increased physiological strain) and could therefore be considered a more sensitive tool to potentially detect overtraining syndrome. Advantageously for the practitioner, RPE_TPdoes not require a priori exercise-intensity determination, unlike the 50/70, enhancing its integration into practice.