'There is nothing more deceptive than an obvious fact: more evidence for the prescription of exercise during haemodialysis (intradialytic exercise) is still required

With regard to the recent editorial,1 we applaud the author’s call to arms for nephrologists to ‘prescribe’ exercise during haemodialysis (HD). It is true that exercise has tremendous health benefits, with many likely benefits for HD patients. Staying physically active is essential to maintaining health, and unquestionably clinicians caring for HD patients should be counselling patients to increase physical activity levels. There are, however, unresolved questions that must be answered before structured programmes of intradialytic exercise (IDE) can simply be ‘prescribed’ by clinicians, as Deschamps suggests. The UK Renal Association clinical practice guidelines for cardiovascular disease state that exercise should be encouraged for all HD patients,2 but practical recommendations on prescribing and dosing of exercise (and indeed safest modes of exercise) cannot currently be made based on the available evidence.

Deschamps correctly pointed out that clinicians remain reluctant to ‘prescribe’ exercise for HD patients despite...