The Effect of progressive muscle relaxation and physical exercises on subjective well-being and fatigue of patients receiving hemodialysis: a randomized clinical trial

Patients receiving hemodialysis (HD) often experience fatigue and reduced quality of life due to the chronic physical and psychological burden of treatment. Non-pharmacological interventions, such as Progressive Muscle Relaxation (PMR) and Physical Exercise (PE), show promise in alleviating these symptoms. This study aimed to compare the effects of PMR and PE on subjective well-being and fatigue in patients with HD. An individually randomized parallel-group trial was conducted with 66 patients receiving hemodialysis recruited from two centers in Mashhad, Iran. Participants were randomly assigned to either the PMR group (n = 34) or the PE group (n = 32). The PMR group received structured relaxation training, while the PE group performed selected stretching and balance exercises over four weeks. Outcomes were assessed using the Multidimensional Fatigue Inventory (MFI) and the Subjective Well-being Scale (SWS) before and after the intervention. Both interventions led to highly significant improvements in all domains of subjective well-being (emotional, psychological, and social) and the Total Subjective Well-being score from baseline (p < 0.001). Crucially, the PMR group achieved a significantly higher Total Subjective Well-being score post-intervention compared to the PE group (p = 0.03; Cohen's d = 0.57). Fatigue levels also decreased significantly in both groups (p < 0.001), although the difference between the PMR and PE groups was not statistically significant (p = 0.12). Furthermore, demographic factors, including employment status and HD frequency, significantly influenced total well-being. Both PMR and PE are practical and viable non-pharmacological strategies for enhancing subjective well-being and reducing fatigue in patients with HD. However, the PMR intervention demonstrated a superior effect on the overall subjective well-being score. Future studies should investigate the combination of these approaches for optimal patient rehabilitation.Trial Registration: This study was registered in the Iranian Registry of Clinical Trials (IRCT) with the unique identifier IRCT20201227049856N1 on 2021-02-15. The trial record can be accessed on the official IRCT website: https://irct.behdasht.gov.ir/trial/53463 .