Abstract
<title>Abstract</title> <p> <bold>Background:</bold> Patients undergoing maintenance hemodialysis frequently experience reduced happiness, appetite disturbances, and poor clinical outcomes. Nurses play a key role in implementing supportive interventions during dialysis sessions. This study evaluated the effects of a nurse-supervised intradialytic isotonic exercise program on happiness, appetite, and dialysis adequacy in patients undergoing hemodialysis. <bold>Methods:</bold> In this parallel-group randomized controlled trial, 96 patients receiving maintenance hemodialysis were randomly assigned to either an intervention group (n = 48) or a control group (n = 48). The intervention group performed nurse-supervised intradialytic isotonic exercises for 30 minutes, three times weekly, for eight weeks, whereas the control group received routine care. Happiness was measured using the Oxford Happiness Inventory, appetite using the Simplified Nutritional Appetite Questionnaire, and dialysis adequacy using Kt/V. Analysis of covariance was used to compare post-intervention outcomes while controlling for baseline values. <bold>Clinical trial number:</bold> Iranian Registry of Clinical Trials (IRCT20150724023314N6), registered on July 30, 2025. Available at: https://irct.ir/trial/85160. <bold>Results:</bold> Eighty-two participants completed the study (intervention = 40, control = 42). After adjustment for baseline scores, happiness was significantly higher in the intervention group than in the control group (adjusted mean difference = 7.93, 95% CI: 1.46–14.39; p = 0.017). No significant between-group differences were observed for appetite (p = 0.444) or dialysis adequacy (p = 0.757). <bold>Conclusions:</bold> A nurse-supervised intradialytic isotonic exercise program improved happiness among patients undergoing hemodialysis but did not significantly affect appetite or dialysis adequacy. Incorporating structured exercise into routine nursing care may provide a feasible and low-cost approach to promoting emotional well-being in this population. </p>