This pilot randomized trial will evaluate whether a structured intradialytic eye-exercise program can be delivered safely and consistently during maintenance hemodialysis and whether it shows preliminary promise for improving physical function, balance, and fall-related concern. The study is needed because hemodialysis patients commonly experience impaired physical performance, reduced balance, and fear of falling, and these problems are associated with higher fall risk; at the same time, supervised exercise during dialysis is increasingly viewed as a practical way to reach this medically complex and often sedentary population. Eye-movement and gaze-stability training has also shown benefit for balance- and fall-related outcomes in older adults and stroke survivors, but its feasibility and potential value during dialysis sessions remain uncertain.

Patients receiving maintenance hemodialysis often live with deconditioning, reduced mobility, impaired balance, and substantial fall-related concern, all of which can undermine independence and daily functioning. Recent hemodialysis research has shown that poorer physical performance and greater fear of falling are strongly associated with fall risk, while recent reviews indicate that falls in this population are common and influenced by multiple interacting factors, including physical decline and reduced activity. Supervised intradialytic exercise is a logical delivery model because it can be integrated into the dialysis session, monitored directly by clinical staff, and implemented with acceptable safety and adherence in appropriately screened patients. In parallel, eye-focused training that targets oculomotor control, gaze stability, and visual-motor coordination has improved balance, gait, and fall-related confidence in other populations, including stroke survivors and older adults, suggesting a plausible mechanism for helping patients whose balance and mobility are compromised by inactivity, frailty, and treatment-related instability. However, evidence for this approach in hemodialysis remains limited, and it is not yet known whether such a program can be delivered reliably within the practical constraints of the dialysis unit without interfering with treatment. A pilot randomized trial is therefore warranted to determine feasibility, tolerability, and safety, to identify workflow barriers, and to estimate whether the intervention shows enough promise to justify a larger definitive efficacy trial.

Inclusion Criteria

• Adults ≥18 years receiving maintenance in-center hemodialysis
• Clinically stable for brief seated intradialytic intervention
• Able to understand and follow eye-exercise instructions
• Able to provide informed consent
• Able to sit upright independently during dialysis
• Able to complete repeated outcome assessments
• Able to communicate discomfort or adverse symptoms
• Usual corrective lenses permitted if needed for visual clarity

Exclusion Criteria

• Unstable cardiac conditions (e.g., unstable angina, recent myocardial infarction, decompensated heart failure, uncontrolled arrhythmia)
• Active infection or acute medical illness
• Hemodynamic instability
• Significant cognitive or communication impairment preventing instruction-following
• Severe uncorrected visual impairment or active ocular disease
• Recent major ophthalmologic surgery
• Severe musculoskeletal or neurologic limitations preventing participation or testing
• Any condition deemed unsafe for intradialytic exercise by the treating physician or nephrologist

Individual participant data (IPD) that underlie the results reported in the published article, after deidentification are to be shared

The data will be available after the paper is published. No end date.

Not applicable. It will be accessible for public

A research project collaborator who is not informed about grouping of participants will obtain outcome measurements of the functional test. Outcome adjudicators, and data analysts will be kept blinded to the allocation. Moreover, all investigators, staff, and participants will be kept masked to outcome measurements and trial results.