The effect of intradialytic exercise and classical music therapy on comfort in hemodialysis patients: A quasi-experimental study
DOI:
https://doi.org/10.63868/npjn.v2i1.78Keywords:
Chronic Kidney Disease; Hemodialysis; Intradialytic Exercise; Music Therapy; Patient ComfortAbstract
Background: Hemodialysis is the primary treatment for patients with stage 5 chronic kidney disease (CKD). However, patients often face complications during the procedure, such as intradialytic hypertension, which can significantly reduce their comfort and increase morbidity and mortality rates. Safe and non-pharmacological interventions, including intradialytic exercise and classical music therapy, have emerged as promising strategies to alleviate these complications and improve patient well-being.
Objective: This study aimed to assess the combined effect of intradialytic exercise and classical music therapy on the comfort levels of hemodialysis patients.
Methods: A quasi-experimental pretest-posttest design with a control group was utilised. A total of 36 patients were recruited through purposive sampling and evenly assigned to two groups: an intervention group (n = 18) and a control group (n = 18). The intervention group received combined 30-minute sessions of intradialytic exercise and classical music therapy twice a week for four consecutive weeks. Comfort was assessed using a modified Zung Self-Rating Anxiety Scale for physiological and psychological comfort, and a modified Multidimensional Scale of Perceived Social Support for social comfort. Statistical analyses were performed using the Wilcoxon signed-rank test and the Mann-Whitney U test.U test.
Results: The intervention group showed a statistically significant improvement in both physiological comfort (p = 0.023) and psychological comfort (p = 0.002) following the therapies. However, no significant improvement was observed in the social comfort domain (p = 0.463).
Conclusion: The combination of intradialytic exercise and classical music therapy may improve the physiological and psychological comfort of CKD patients undergoing hemodialysis. This approach shows potential as an applicable, cost-effective, and easily accessible nursing intervention in clinical hemodialysis settings, although it does not significantly improve social comfort. However, given the quasi-experimental design and the small sample size, further research is needed to confirm these causal effects.
References
Adejumo, O. A., Edeki, I. R., Oyedepo, D. S., Yisau, O. E., Ige, O. O., Edeki, I. R., Moussa, A. S., Palencia, H., Noubiap, J. J., & Ekrikpo, U. E. (2024). The prevalence and risk of mortality associated with intradialytic hypertension among patients with end-stage kidney disease on haemodialysis: A systematic review and meta-analysis. PLOS ONE, 19(6), Article e0304633. https://doi.org/10.1371/journal.pone.0304633
Bikbov, B., Purcell, C., Levey, A. S., Smith, M., Abdoli, A., Abebe, M., Adebayo, O. M., Afarideh, M., Agarwal, S. K., Agudelo-Botero, M., Ahmadian, E., Al-Aly, Z., Alipour, V., Almasi-Hashiani, A., Al-Raddadi, R. M., Alvis-Guzman, N., Amini, S., Andrei, T., Andrei, C. L., … Vos, T. (2020). Global, regional, and national burden of chronic kidney disease, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 395(10225), 709–733. https://doi.org/10.1016/S0140-6736(20)30045-3
Carrero, J. J., Hecking, M., Chesnaye, N. C., & Jager, K. J. (2018). Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease. Nature Reviews Nephrology, 14(3), 151–164. https://doi.org/10.1038/nrneph.2017.181
Dahlan, M. S. (2008). Deskriptif, bivariat, dan multivariat dilengkapi aplikasi dengan menggunakan SPSS. Salemba Medika.
Georgianos, P. I., & Agarwal, R. (2018). Blood pressure control in conventional hemodialysis. Seminars in Dialysis, 31(6), 557–562. https://doi.org/10.1111/sdi.12741
Georgianos, P. I., Sarafidis, P., & Zoccali, C. (2015). Intradialysis hypertension in end-stage renal disease patients: Clinical epidemiology, pathogenesis, and treatment. Hypertension, 66(3), 456–463. https://doi.org/10.1161/HYPERTENSIONAHA.115.05858
Gomes, B. T., Costa, A., & Mazzali, M. (2023). Dialysis headache: Prevalence and clinical presentation in hemodialysis and kidney transplant patients. Revista Headache Medicine, 13(4), 265–270. https://doi.org/10.48208/headachemed.2022.32
Hidayati, W. (2015). Mengontrol tekanan darah dengan intradialytic exercise pada pasien yang menjalani hemodialisis. Dalam 3rd Adult Nursing Practice: Using Evidence in Care "Holistic Nursing in Emergency and Disaster: Issue and Future" (hlm. 51–80).
Iatridi, F., Theodorakopoulou, M., Papagianni, A., & Sarafidis, P. (2022). Management of intradialytic hypertension: Current evidence and future perspectives. Journal of Hypertension, 40, 2120–2129. https://doi.org/10.1097/HJH.0000000000003247
Inayama, E., Yamada, Y., Kishida, M., Kitamura, M., Nishino, T., Ota, K., Takahashi, K., Shintani, A., & Ikenoue, T. (2022). Effect of Music in Reducing Pain during Hemodialysis Access Cannulation. Clinical Journal of The American Society of Nephrology, 17, 1337–1345. https://doi.org/10.2215/CJN.00360122
Kanbay, M., Ertuglu, L. A., Afsar, B., Ozdogan, E., Siriopol, D., Covic, A., Basile, C., & Ortiz, A. (2020). An update review of intradialytic hypotension: Concept, risk factors, clinical implications and management. NDT Plus, 13(6), 981–993. https://doi.org/10.1093/CKJ/SFAA078
Lakshmi, Y. A., Sasikala, D., & Varughese, S. (2024). The effect of intradialytic aerobic exercise on dialysis parameters and fatigue in hemodialysis patients: A non-randomized interventional study. Cureus, 16(6), Article e62498. https://doi.org/10.7759/cureus.62498
Laloan, R. M. (2025). Efek Terapi Musik Klasik Terhadap Stabilitas Hemodinamik: Tinjauan Literatur Sistematis. Jurnal Kesehatan Jompa, 4(1), 103–116. https://doi.org/10.57218/jkj.vol4.iss1.1393
Lin, F., Chen, L., & Gao, Y. (2024). Music therapy in hemodialysis patients: Systematic review and meta-analysis. Complementary Therapies in Medicine, 86, Article 103090. https://doi.org/10.1016/j.ctim.2024.103090
Mitsiou, M., Dimitros, E., Roumeliotis, S., Liakopoulos, V., Kouidi, E., & Deligiannis, A. (2022). Effects of a Combined Intradialytic Exercise Training Program and Music on Cardiac Autonomic Nervous System Activity in Hemodialysis Patients. Reproductive and Developmental Biology, 12(8), 1276. https://doi.org/10.3390/life12081276
Nopriani, Y., & Xesti, E. (2025). Pengaruh intervensi terapi musik klasik terhadap tekanan darah dan kualitas tidur pada lansia penderita hipertensi diruang hemodialisa. Kesehatan Dan Pembangunan, 15(2), 172–177. https://doi.org/10.52047/jkp.v15i2.412
Polit, D. F., & Beck, C. T. (2020). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Lippincott Williams & Wilkins.
Prasad, B., Hemmett, J., & Suri, R. S. (2022). Five things to know about intradialytic hypertension. Canadian Journal of Kidney Health and Disease, 9. https://doi.org/10.1177/20543581221106657
Pu, J., Jiang, Z., Wu, W., Li, L., Zhang, L., Li, Y., Liu, Q., & Ou, S. (2019). Efficacy and safety of intradialytic exercise in haemodialysis patients: A systematic review and meta-analysis. BMJ Open, 9(1), Article e020633. https://doi.org/10.1136/bmjopen-2017-020633
Pu, J., Jiang, Z., Wu, W., Li, L., Zhang, L., Li, Y., Liu, Q., Ou, S., Kim, S., & Jeong, H. (2021). Effects of patient-selected music listening on the pain and anxiety of patients undergoing hemodialysis: A randomized controlled trial. BMJ Open, 9(11), Article e020633. https://doi.org/10.1136/bmjopen-2017-020633
Sarayar, C., Mulyadi, & Palandeng, H. (2013). Pengaruh musik klasik terhadap penurunan tekanan darah pada pasien pra-hemodialisis di ruang dahlia BLUD RSUP. Prof. Dr. R. D. Kandou Manado. Jurnal Keperawatan Unsrat, 1(1).
Sav, M. Y., Sav, T., Senocak, E., & Sav, N. M. (2014). Hemodialysis-related headache. Hemodialysis International, 18(4), 725–729. https://doi.org/10.1111/HDI.12171
Sheshadri, A., Kittiskulnam, P., Lazar, A. A., & Johansen, K. L. (2019). Timing of intradialytic exercise and its association with intradialytic hypotension. Clinical Journal of the American Society of Nephrology, 14(4), 555–561
Sułowicz, W., & Radziszewski, A. (2007). Dialysis-induced hypotension—A serious clinical problem in renal replacement therapy. Medicinski Pregled, 14–20. https://pubmed.ncbi.nlm.nih.gov/18928150/
Taylor, D. M., Fraser, S. D. S., Bradley, J. A., Bradley, C., Draper, H., Metcalfe, W., Oniscu, G. C., Tomson, C. R. V., Ravanan, R., & Roderick, P. J. (2017). A systematic review of the prevalence and associations of limited health literacy in CKD. Clinical Journal of the American Society of Nephrology, 12(7), 1070–1084. https://doi.org/10.2215/CJN.12921216
Verrelli, D., Sharma, A., Alexiuk, J., Tays, Q., Rossum, K., Sharma, M., Ford, E., Iansavitchene, A., Al-Jaishi, A. A., Whitlock, R., McIntyre, C. W., Garg, A. X., & Bohm, C. (2024). Effect of intradialytic exercise on cardiovascular outcomes in maintenance hemodialysis: A systematic review and meta-analysis. Kidney360, 5(3), 390–413. https://doi.org/10.34067/KID.0000000000000361
Zhu, X., & Peng, J. (2024). Comment on ‘Effects of music intervention on physical and psychological problems in adults receiving haemodialysis treatment: A systematic review and meta-analysis.’ Journal of Clinical Nursing, 34(8). https://doi.org/10.1111/jocn.17573
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52(1), 30–41. https://doi.org/10.1207/s15327752jpa5201_2
Zung, W. W. K. (1971). A rating instrument for anxiety disorders. Psychosomatics, 12(6), 371–379. https://doi.org/10.1016/S0033-3182(71)71479-0
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Nia Firdianty

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

