Effect of core stability exercise training on activities of daily living, fatigue level and balance in haemodialysis patients: A randomised controlled study.

The paper never says whether the people assessing balance, daily activities or cognition knew which group each patient was in. Fatigue and the Barthel Index are partly self-reported, so knowing they were in the extra-exercise group could have inflated the study group's scores. Both groups exercised and both improved. The only thing tested was whether adding core stability work to breathing helped, so this trial says nothing about exercise versus no exercise in dialysis patients. The study group spent 30 to 45 minutes longer training each session than the control group, so the extra benefit cannot be separated from the extra training time and therapist attention. There is no follow-up after the 12 weeks, so it is not known whether the gains survive once the programme stops. It was a single centre in Egypt, only patients aged 50 to 65 were included, and people with a BMI of 30 or higher, heart or lung disease, dementia or unstable medical conditions were excluded. The results do not apply to frailer or more multimorbid dialysis patients. No dropouts are reported, even though 30 patients per group were recruited to allow for them, so it is unclear whether all 60 finished the programme. The Discussion offers mechanisms, such as strengthening the deep trunk muscles and switching on the parasympathetic nervous system, that were not measured in this trial. The stated aims describe cognition as a secondary outcome, but the analysis section calls all four outcomes primary.

The authors state that the research received no external funding and that they have no conflict of interest to declare. The trial was approved by the Faculty of Physical Therapy Research Ethics Committee at Delta University, Egypt, and registered on clinicaltrials.gov (NCT06445647).

Do not read this as proof that core stability training is the active ingredient. The control group did breathing exercises only, so the study group also did 30 to 45 minutes more exercise per session, and the extra benefit may come from that extra training time and attention rather than from the core stability work itself. And because both groups exercised and both improved, this trial says nothing about exercise compared with no exercise.