The Effect of Intradialytic Exercise on Postural Abnormalities

Inclusion Criteria: * Age 18-80 years * Diagnosed with ESRD and receiving stable maintenance hemodialysis for at least 3 months at the participating center, with a dialysis frequency of three sessions per week * Confirmed presence of at least one postural abnormality (hyperkyphosis ≥53° in women or ≥55° in men, or CVA \<53°) assessed at screening * Written informed consent obtained, indicating decision-making capacity and willingness to participate * Medical clearance from attending nephrologist to participate in supervised exercise during dialysis * Ability to sit upright in a dialysis chair and perform seated or supported standing exercises * Ability to communicate in Persian and understand study instructions Exclusion Criteria: * Unstable cardiovascular status, including recent (within 3 months) myocardial infarction, unstable angina, decompensated congestive heart failure (NYHA Class III-IV), or uncontrolled arrhythmia * Active infection, acute febrile illness, or acute medical condition requiring hospitalization * Hemodynamic instability defined as systolic blood pressure \<90 mmHg or \>200 mmHg, or severe orthostatic hypotension, at screening or prior to exercise sessions * Uncontrolled diabetes mellitus with labile glycemic control (blood glucose \<4 mmol/L or \>22 mmol/L at dialysis session start) * Severe musculoskeletal pain at rest or with minimal activity (Numeric Pain Rating Scale ≥7/10) that would preclude exercise participation * Inability to perform seated …