Conclusions
intradialytic NMES
The study results suggest that intradialytic NMES increases (1) functional capacity, (2) serum albumin level, (3) muscle strength in lower limb and (4) weight and BMI of HD patients. (5) Effects on VR distraction are inconclusive and must be proven in further studies. VR applications must be further optimized and expanded. (6) Large-scale follow-up studies on integrated sports programs with NMES and active training in combination with VR as distraction and motivation accelerator are needed. Cost-effectiveness should be evaluated to successfully implement integrated exercise programs in daily dialysis care. However, results strongly suggest to further assess the clinical potential of the combined NMES and VR interventions in HD patients.