Physical Exercise Intervention In Reducing The Severity Level Of Restless Leg Syndrome In Hemodialysis Patients: Literature Review

Wasis Dwi Hartanto(1*)
(1) Universitas Jenderal Soedirman Purwokerto
(*) Corresponding Author
DOI : 10.30604/jika.v8i3.2179


Restless Leg Syndrome (RLS) is a serious problem that is often experienced by Hemodialysis (HD) patients. Some nonpharmacological therapies can be done to reduce RLS symptoms such as stretching exercises, aerobics, cool dialysate therapy, Physical Activity Therapy (PAT) , reflexology, and aromatherapy massage. This literature review aims to determine the effect of Physical Exercise Intervention (PEI) in reducing RLS symptoms in patients undergoing HD including the type of movement, exercise duration, and frequency. Data were collected from PUBMED, Science Direct, Proquest, Ebscohost, CNBI, and e-resources with a total of 522 articles. These articles were limited to the criteria of English language and experimental design within the last 10 years.  Physical Exercise Intervention could be applied with RLS including stretching exercises and aerobic exercises based on seven selected articles. Meanwhile, the most appropriate PEI duration was 30-40 minutes and the most appropriate PEI  frequency was three times per week. The most widely used instrument to assess the degree of RLS was the international Restless Legs Syndrome Severity Scale (IRLS). PEI is effective in reducing RLS of hemodialysis patients. The most factors contribute to the effectiveness of PEI are the type of movement, the duration of exercises, and the frequency of exercises performed.


physical exercises; restless leg syndrome; hemodialysis


Akba?, P., & Yaman Sözbir, ?. (2021). Non-pharmacological methods used in coping with restless leg syndrome (RLS): A systematic review. Sleep & Biological Rhythms, 19(3), 215–225.

Alcalde-Bezhold, G., Alcázar-Arroyo, R., Angoso-de-Guzmán, M., Arenas, M. D., Arias-Guillén, M., Arribas-Cobo, P., Díaz-Gómez, J. M., García-Maset, R., González-Parra, E., Hernández-Marrero, D., Herrero-Calvo, J. A., Maduell, F., Molina, P., Molina-Núñez, M., Otero-González, A., Pascual, J., Pereira-García, M., Pérez-García, R., Dolores del Pino y Pino, M., … de Sequera-Ortiz, P. (2021). Hemodialysis Centers Guide 2020. Nefrología (English Edition), 41, 1–77.

Aliasgharpour, M., Abbasi, Z., Razi, S. P., & Kazemnezhad, A. (2016). The Effect of Stretching Exercises on Severity of Restless Legs Syndrome in Patients on Hemodialysis. Asian Journal of Sports Medicine, 7(2), 1–5.

Aukerman, M. M., Aukerman, D., Bayard, M., Tudiver, F., Thorp, L., & Bailey, B. (2006). Exercise and restless legs syndrome: a randomized controlled trial. Journal of the American Board of Family Medicine : JABFM, 19(5), 487–493.

Barcellos, F., Santos, I., Umpierre, D., Bohlke, M., & Hallal, P. (2015). Effects of exercise in the whole spectrum of chronic kidney disease: A systematic review. CKJ: Clinical Kidney Journal, 8.

Batool-Anwar, S., Li, Y., De Vito, K., Malhotra, A., Winkelman, J., & Gao, X. (2016). Lifestyle Factors and Risk of Restless Legs Syndrome: Prospective Cohort Study. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 12(2), 187–194.

Bennett, P., Fraser, S., Barnard, R., Haines, T., Ockerby, C., Street, M., Wang, W., & Daly, R. (2015). Effects of an intradialytic resistance training programme on physical function: a prospective stepped-wedge randomized controlled trial. Nephrology Dialysis Transplantation, 31, gfv416.

Buchfuhrer, M. J. (2016). Clinician’s Manual on Restless Legs Syndrome (2nd ed.). Adis Cham.

Cederberg, K. L. J., & Motl, R. W. (2021). Feasibility and efficacy of a physical activity intervention for managing restless legs syndrome in multiple sclerosis: Results of a pilot randomized controlled trial. Multiple Sclerosis and Related Disorders, 50, 102836.

Fauzi, A., & Triaswati, R. (2021). The Effect of Intradialytic Stretching Training on Restless Legs Syndrome and Sleep Quality in Hemodialysis Patients. Korean Journal of Adult Nursing, 33(1), 37–43.

Gallot, M., Nathalie, R., & Alexandre, G. (2019). Effect of intradialytic physical activity on the quality of life, biological parameters and sleep in hemodialysis patients. Journal of Clinical Nephrology, 3, 168–174.

Giannaki, C. D., Hadjigeorgiou, G. M., Karatzaferi, C., Pantzaris, M. C., Stefanidis, I., & Sakkas, G. K. (2014). Epidemiology, impact, and treatment options of restless legs syndrome in end-stage renal disease patients: an evidence-based review. Kidney International, 85(6), 1275–1282.

Giannaki, C. D., Sakkas, G. K., Karatzaferi, C., Maridaki, M. D., Koutedakis, Y., Hadjigeorgiou, G. M., & Stefanidis, I. (2015). Combination of Exercise Training and Dopamine Agonists in Patients with RLS on Dialysis: A Randomized, Double-Blind Placebo-Controlled Study. ASAIO Journal (American Society for Artificial Internal Organs : 1992), 61(6), 738–741.

Giannaki, C., Sakkas, G. K., Hadjigeorgiou, G., Karatzaferi, C., Patramani, G., Eleftherios, L., Liakopoulos, V., Koutedakis, Y., & Stefanidis, I. (2010). Non-Pharmacological Management of Periodic Limb Movements During Hemodialysis Session in Patients With Uremic Restless Legs Syndrome. ASAIO Journal (American Society for Artificial Internal Organs : 1992), 56, 538–542.

Gopaluni, S., Sherif, M., & Ahmadouk, N. A. (2016). Interventions for chronic kidney disease-associated restless legs syndrome. The Cochrane Database of Systematic Reviews, 11(11), CD010690.

Hargrove, N., El Tobgy, N., Zhou, O., Pinder, M., Plant, B., Askin, N., Bieber, L., Collister, D., Whitlock, R., Tangri, N., & Bohm, C. (2021). Effect of aerobic exercise on dialysis-related symptoms in individuals undergoing maintenance hemodialysis a systematic review and meta-analysis of clinical trials. Clinical Journal of the American Society of Nephrology, 16(4), 560–574.

Harrison, E. G., Keating, J. L., & Morgan, P. (2018). Novel Exercises for Restless Legs Syndrome: A Randomized, Controlled Trial. Journal of the American Board of Family Medicine : JABFM, 31(5), 783–794.

Harrison, E. G., Keating, J. L., & Morgan, P. E. (2019). Non-pharmacological interventions for restless legs syndrome: a systematic review of randomised controlled trials. Disability and Rehabilitation, 41(17), 2006–2014.

Huang, C.-W., Lee, M.-J., Wang, L.-J., Lee, P.-T., Tu, Y.-K., Hsu, C.-W., & Lin, P.-Y. (2020). Comparative efficacy and acceptability of treatments for restless legs syndrome in end-stage renal disease: a systematic review and network meta-analysis. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 35(9), 1609–1618.

Huang, M., Lv, A., Wang, J., Xu, N., Ma, G., Zhonghui, Z., Zhang, B., Gao, J., & Ni, C. (2019). Exercise Training and Outcomes in Hemodialysis Patients: Systematic Review and Meta-Analysis. American Journal of Nephrology, 50, 1–15.

Kambampati, S., Wasim, S., Kukkar, V., Awad, V., & Malik, B. (2020). Restless Leg Syndrome in the Setting of Patients With End-Stage Renal Disease on Hemodialysis: A Literature Review. Cureus, 12.

Krase, A. A., Flouris, A. D., Karatzaferi, C., Giannaki, C. D., Stefanidis, I., & Sakkas, G. K. (2020). Separate and combined effects of cold dialysis and intradialytic exercise on the thermoregulatory responses of hemodialysis patients: a randomized-cross-over study. BMC Nephrology, 21, 1–8.

Manal, K. Y. (2019). Efficacy of neuromuscular electric stimulation versus aerobic exercise on uraemic restless legs syndrome. International Journal of Therapy & Rehabilitation, 26(10), 1–12.

Mao, S., Shen, H., Huang, S., & Zhang, A. (2014). Restless legs syndrome in dialysis patients: a meta-analysis. Sleep Medicine, 15(12), 1532–1538.

Matar, S. G., El-Nahas, Z. S., Aladwan, H., Hasanin, M., Elsayed, S. M., Nourelden, A. Z., Benmelouka, A. Y., & Ragab, K. M. (2022). Restless Leg Syndrome in Hemodialysis Patients: A Narrative Review. The Neurologist, 27(4), 194–202.

Menezes, A., Motta, D., Carvalho, F., Santana-Santos, E., Júnior, M., Figueirôa, M., Farias, M., & Bastos, K. (2018). Restless Legs Syndrome in Dialysis Patients: Does the Dialysis Modality Influence Its Occurrence and Severity? International Journal of Nephrology, 2018, 1–6.

Mortazavi, M., Vahdatpour, B., Ghasempour, A., Taheri, D., Shahidi, S., Moeinzadeh, F., Dolatkhah, B., & Dolatkhah, S. (2013). Aerobic exercise improves signs of restless leg syndrome in end stage renal disease patients suffering chronic hemodialysis. TheScientificWorldJournal, 2013, 628142.

Pernefri. (2018). Pedoman Pelayanan Hemodialisis di Pelayanan Kesehatan.

Riskesdas Kemenkes RI, 2018. (2018). Laporan_Nasional_RKD2018_FINAL.pdf. In Badan Penelitian dan Pengembangan Kesehatan (p. 674).

Rosa, C. S. C., Giannaki, C. D., Krase, A., Mplekou, M., Grigoriou, S. S., Stefanidis, I., Lavdas, E., Pappas, A., Bloxham, S., Karatzaferi, C., & Sakkas, G. K. (2020). Effects of 12 months of detraining on health-related quality of life in patients receiving hemodialysis therapy. International Urology & Nephrology, 52(9), 1771–1778.

Sakkas, G. K., Giannaki, C. D., Karatzaferi, C., Maridaki, M., Koutedakis, Y., Hadjigeorgiou, G. M., & Stefanidis, I. (2015). Current trends in the management of uremic restless legs syndrome: A systematic review on aspects related to quality of life, cardiovascular mortality and survival. Sleep Medicine Reviews, 21, 39–49.

Salma, B.-A., Yanping, L., Katerina, D. V., Atul, M., John, W., & Xiang, G. (2023). Lifestyle Factors and Risk of Restless Legs Syndrome: Prospective Cohort Study. Journal of Clinical Sleep Medicine, 12(02), 187–194.

Shahgholian, N., Jazi, S. K., Karimian, J., & Valiani, M. (2016). The effects of two methods of reflexology and stretching exercises on the severity of restless leg syndrome among hemodialysis patients. Iranian Journal of Nursing & Midwifery Research, 21(3), 219–224.

Shohani, M., Kazemi, F., Rahmati, S., & Azami, M. (2020). The effect of yoga on the quality of life and fatigue in patients with multiple sclerosis: A systematic review and meta-analysis of randomized clinical trials. Complementary Therapies in Clinical Practice, 39, 101087.

Soleimani, M. (2016). The effect of progressive muscle relaxation on the severity of restless leg syndrome in patients under treatment with hemodialysis. HAYAT, 22, 279–290.

Song, Y., Hu, R., Diao, Y., Chen, L., & Jiang, X. (2017). Effects of Exercise Training on Restless Legs Syndrome, Depression, Sleep Quality, and Fatigue Among Hemodialysis Patients: A Systematic Review and Meta-analysis. Journal of Pain and Symptom Management, 55.

Xia, M., He, Q., Ying, G., Fei, X., Zhou, W., & He, X. (2022). Clinical Efficacy and Safety of Massage for the Treatment of Restless Leg Syndrome in Hemodialysis Patients: A Meta-Analysis of 5 Randomized Controlled Trials. Frontiers in Psychiatry, 13, 843263.

Zhang, L.-Y., Ma, X.-Y., Lin, J., Liu, W.-H., Guo, W., Yin, L., Wang, S.-X., Li, X., Li, J., Jin, L.-L., Tian, Z.-L., Du, Y.-T., & Tuo, H.-Z. (2020). Prevalence and Risk Factors of Restless Legs Syndrome in Hemodialysis Patients. Nature and Science of Sleep, 12, 19–27.

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