{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:45:25Z","timestamp":1792035925619,"version":"4.4.0"},"reference-count":42,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004912","name":"Sichuan University","doi-asserted-by":"publisher","award":["Q21013"],"award-info":[{"award-number":["Q21013"]}],"id":[{"id":"10.13039\/501100004912","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hemodialysis International"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Exercise has been increasingly recognized as a safe and effective adjunct therapy for improving physiological and biochemical outcomes in dialysis patients. However, its specific impact on parathyroid hormone (PTH) regulation remains uncertain. This systematic review and meta\u2010analysis aimed to determine the effect of exercise interventions on PTH levels in adults undergoing dialysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search of PubMed, Scopus, Embase, Web of Science, and Google Scholar databases was conducted up to October 31, 2025, without language or date restrictions. Eligible interventional studies compared exercise\u2010based programs with standard dialysis care and reported quantitative PTH outcomes. Methodological quality was assessed using RoB 2.0 for randomized controlled trials and ROBINS\u2010I for non\u2010randomized trials. Pooled standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated using a random\u2010effects model, with subgroup, sensitivity, and publication bias analyses performed to assess the robustness of results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine eligible studies involving 438 dialysis patients were analyzed. Pooled results showed a significant reduction in PTH levels in the exercise groups compared with controls (SMD\u2009=\u2009\u22120.70; 95% CI: \u22121.00 to \u22120.40;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). This effect remained consistent across study designs, randomized controlled trials (SMD\u2009=\u2009\u22120.68) and non\u2010randomized trials (SMD\u2009=\u2009\u22120.72), and across both short\u2010term (\u2264\u200912\u2009weeks; SMD\u2009=\u2009\u22120.71; 95% CI: \u22120.99 to \u22120.42) and long\u2010term (&gt;\u200912\u2009weeks; SMD\u2009=\u2009\u22120.81; 95% CI: \u22121.37 to \u22120.25) interventions, with no significant subgroup difference. Sensitivity analysis confirmed that no single study significantly altered the pooled effect size, and funnel plot assessment with Egger's test indicated no publication bias (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.181). Several individual trials also reported concurrent improvements in serum calcium and phosphate balance following exercise.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Exercise interventions significantly lower PTH levels in dialysis patients and may be integrated as a non\u2010pharmacological adjunct to conventional secondary hyperparathyroidism management. Implementing structured physical activity during dialysis sessions can help improve mineral balance and endocrine stability. Further large\u2010scale, multicenter randomized controlled trials with standardized protocols and longer follow\u2010up periods are warranted to establish optimal exercise regimens for this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hdi.70071","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T07:21:03Z","timestamp":1773386463000},"page":"463-477","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Exercise on Parathyroid Hormone Levels in Dialysis Patients: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"30","author":[{"given":"Zhong","family":"Li","sequence":"first","affiliation":[{"name":"Department of Nephrology, West China Fourth Hospital Sichuan University  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaxin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nephrology, West China Fourth Hospital Sichuan University  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoling","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Nephrology, West China Fourth Hospital Sichuan University  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menglin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nephrology, West China Fourth Hospital Sichuan University  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1543-4340","authenticated-orcid":false,"given":"Nujia","family":"You","sequence":"additional","affiliation":[{"name":"Department of Nephrology, West China Fourth Hospital Sichuan University  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linshen","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Nephrology, West China Fourth Hospital Sichuan University  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"e_1_2_12_2_1","article-title":"Dialysis: A Review of the Mechanisms Underlying Complications in the Management of Chronic Renal Failure","volume":"9","author":"Vadakedath S.","year":"2017","journal-title":"Cureus"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfac010"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0260929"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-025-03952-4"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-022-00542-7"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S156356"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.17824"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mpmed.2022.12.004"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1797.8.s.9.x"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1505292"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinme.2024.100238"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.10390917"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/sdi.12772"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2025.116696"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/000313481808400638"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-023-03327-7"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s43166-021-00071-4"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/1744-9987.13481"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-021-01626-4"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/bioinformatics\/btw331"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.27337.1"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-024-02356-6"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_2_12_25_1","article-title":"Revised Cochrane Risk of Bias Tool for Randomized Trials (RoB 2.0): Additional Considerations for Cluster\u2010Randomized Trials","volume":"10","author":"Eldridge S. 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