慢性肾脏病患规律运动可强化心脏健康


  【24drs.com】慢性肾脏病(CKD)患者的体适能一般会渐渐衰退,但在线刊载于10月5日考科蓝实证医学资料库(Cochrane Database of Systematic Reviews)的一篇新统合分析提出证据指出,规律运动可显著改善体适能、心血管测量数据、营养参数与健康相关的生活质量。这项结果适合各类病患,从早期慢性肾脏病到透析患者或接受肾脏移植者都适用。
  
  瑞典斯德哥尔摩Karolinska研究中心医学与临床科学系的Susanne Heiwe博士和Stefan H. Jacobson博士回顾文献指出,给CKD病患的运动处方建议是:在监督之下进行4-6个月的规律运动(每周3次)、高强度混合心血管与耐力训练持续30-90分钟,为了维持最大效果,病患必须持续规律运动。
  
  体适能方面有许多改善,特别是有氧活动能力(24篇研究、847名研究对象;标准平均差(SMD),-0.56;95%信心区间[CI],-0.70至-0.42)与行走能力(7篇研究、191名研究对象;SMD,-0.36;95% CI,-0.65至-0.06)尤其显著。
  
  各项心血管数据也有明显效益:
  * 休息时的舒张压:11篇研究、419名研究对象(平均差异[MD],2.32 mm Hg;95% CI,0.59 - 4.05 mm Hg);
  * 休息时的收缩压:9篇研究、347名研究对象(MD,6.08 mm Hg;95% CI,2.15 - 10.12 mm Hg);
  * 心律:11篇研究、229名研究对象(MD,6 bpm;95% CI,10 - 2 bpm);
  * 营养参数包括:
   白蛋白:3篇研究、111名研究对象(MD,-2.28 g/L;95% CI,-4.25至0.32 g/L);
   前白蛋白:3篇研究、111名研究对象(MD,-44.02 mg Cl;95% CI,-71.52 至16.53 mg Cl);
   热量摄取:4篇研究、97名研究对象(SMD,-0.47;95% CI,-0.88至-0.05);
  * 健康相关的生活质量。
  
  不论运动类型、强度、介入期间或监督,可显著改善高密度脂蛋白胆固醇(4篇研究、166名研究对象;MD -0.14 mmol/L MD;95% CI,-23 - 0.04 mmol/L;P = .005),但是,三酸甘油脂、总胆固醇、空腹血糖则无显著改变。
  
  作者们查找了Cochrane Renal Group的专属资料库,涵盖各种语言的研究文献。他们选择了纳入CKD或肾脏移植成人病患进行至少8周体能运动计画的随机控制试验,排除介入持续不到8周、仅建议增加体能活动、未进行共同介入或两组都有做的研究。
  
  这篇回顾纳入了45篇随机试验,共有1,863名病患,其中,32 篇符合统合分析规范;这些研究的介入方式涵盖各种运动处方,包括心血管训练、混合心血管与耐力训练、仅有耐力训练与瑜珈。符合纳入的条件包括,运动处方必须持续至少20分钟,研究者纳入分析的包括高强度与低强度运动,以及受监督与未受监督的处方。报告运动顺从性的14篇研究中,11篇研究发现高顺从性,1篇有中度顺从性,低顺从性则无,只有1篇研究提到运动相关的伤害。
  
  研究者发现许多方面的研究基础不够,包括肌肉耐力、肌肉型态与型态测量、生理功能(例如登梯)、其它心血管方面(例如心律不整)、肌肉量、全身发炎、日常生活的体能活动、忧郁、脂质、葡萄糖代谢、退出率、顺从性、副作用和死亡率。此外,作者们建议,比较运动和药物治疗(例如statin类药物)的效果,研究优势在于提出心血管运动,后续研究应注重耐力训练的效果,不论是单独或并用心血管运动训练。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6626&x_classno=0&x_chkdelpoint=Y
  

Regular Exercise Can Boost Health in Patients With CKD

By Laura Newman
Medscape Medical News

October 7, 2011 — Declining physical fitness is common among people with chronic kidney disease (CKD), but a new meta-analysis published online October 5 in the Cochrane Database of Systematic Reviews provides evidence showing that regular exercise can significantly improve physical fitness, cardiovascular measures, some nutritional parameters, and health-related quality of life. The results apply to patients across the spectrum, from those with early chronic kidney disease lasting more than 3 months, to those on dialysis, to those who received kidney transplants.

Susanne Heiwe, PhD, and Stefan H. Jacobson, MD, PhD, from the Department of Medicine and Clinical Sciences, Karolinska Institutet, Stockholm, Sweden, reviewed the evidence. They write: "[I]n adults with CKD the following exercise regimen is recommended: four to six months supervised, regular (three sessions/week), high intensity mixed cardiovascular and resistance training lasting 30 to 90 minutes. To maintain this peak effect the patient has to continue with the regular exercise training intervention."

Improvement in several areas of physical fitness, particularly aerobic capacity (24 studies, 847 participants; standardized mean difference (SMD), ?0.56; 95% confidence interval [CI], ?0.70 to ?0.42) and walking capacity (7 studies, 191 participants; SMD, ?0.36; 95% CI, ?0.65 to ?0.06) was striking.

Cardiovascular benefits were also demonstrated for the following dimensions:

  • resting diastolic blood pressure: 11 studies, 419 participants (mean difference method [MD], 2.32 mm Hg; 95% CI, 0.59 - 4.05 mm Hg);
  • resting systolic blood pressure: 9 studies, 347 participants (MD, 6.08 mm Hg; 95% CI, 2.15 - 10.12 mm Hg);
  • heart rate, 11 studies, 229 participants (MD, 6 bpm; 95% CI, 10 - 2 bpm);
  • some nutritional parameters:
    • albumin: 3 studies, 111 participants (MD, ?2.28 g/L; 95% CI, ?4.25 to 0.32 g/L);
    • prealbumin: 3 studies, 111 participants (MD, ?44.02 mg Cl; 95% CI, ?71.52 to 16.53 mg Cl;
    • energy intake: 4 studies, 97 participants (SMD, ?0.47; 95% CI, ?0.88 to ?0.05);
  • and health-related quality of life.

Statistically significant improvement in high-density lipoprotein cholesterol was shown with regular exercise, regardless of type, intensity, length of intervention, or supervision (4 studies, 166 participants; MD ?0.14 mmol/L MD; 95% CI, ?23 - 0.04 mmol/L; P = .005), but there were no significant changes in triglycerides, total cholesterol, or fasting blood glucose.

The authors searched the Cochrane Renal Group's specialized register, which encompasses studies in all languages. They selected reviews of any randomized controlled trial that enrolled adults with CKD or kidney transplant in physical exercise programs for a minimum of 8 weeks. They excluded studies involving interventions that lasted less than 8 weeks, those only advising an increase in physical activity, and studies in which co-interventions were not applied or given to both groups.

Forty-five studies that randomly assigned 1863 patients to groups were included in this review. Of these, 32 satisfied criteria for meta-analysis. Interventions in those studies covered a range of exercise regimens, including cardiovascular training, mixed cardiovascular and resistance training, resistance-only training, and yoga. To be included in the review, the exercise regimen had to be at least 20 minutes long, but the investigators included studies on both high- and low-intensity exercise and studies on both supervised and unsupervised regimens

Of 14 studies reporting compliance with exercise, 11 studies found high compliance, 1 had moderate compliance, and none reported low compliance. Only 1 study reported exercise-induced injuries.

The investigators flagged several areas as having an insufficient research base. These include attention to muscular endurance, muscle morphology and morphometrics, physical function (such as stair climbing), other cardiovascular dimensions (eg, arrhythmias), muscle mass, systemic inflammation, level of physical activity in daily living, depression, lipids, glucose metabolism, drop-out rates, compliance, adverse events, and mortality. In addition, the authors recommend study of the effects of exercise vs drug treatment (eg, statins), or as a compliment to statins. The preponderance of research has addressed cardiovascular exercise, and the authors state that future research should give a high priority to assessing the effects of resistance training interventions, either alone or in combination with cardiovascular exercise training.

The authors have disclosed no relevant financial relationships.

Cochr Datab System Rev. Published online October 5, 2011.

    
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