Cappy C S, Jablonka J, Schroeder E T
University Dialysis Center-Dialysis Clinic Incorporated, Syracuse, NY 13210, USA.
J Ren Nutr. 1999 Apr;9(2):63-70. doi: 10.1016/s1051-2276(99)90002-x.
To assess the effects of participation in an intradialytic exercise program using commonly available measures of physical performance and parameters of nutrition assessment. SESIGN: Performance testing and nutrition assessment were completed on hemodialysis patients who participated in an in-center, intradialytic exercise program. Data were collected at initiation and after 3, 6, and 12 months of participation. One-tailed, paired t-test was used for statistical assessment.
Free-standing, outpatient dialysis center with an average of 130 patients on staff-assisted hemodialysis.
Data were collected on 16 patients who completed 3 months in the program, 6 patients who completed 6 months in the program, and 4 patients who completed 12 months in the program.
Patients participated in a progressive, self-paced exercise program including cycling before or during hemodialysis, or walking on a treadmill before hemodialysis. In addition to this, patients also had the option of doing stretching and/or light weight exercises during hemodialysis.
Performance tests included 60-second sit-stand, 28-ft slow and brisk walk, 60-second stair climb, and 60-second leg lifts. Nutrition assessment included changes in estimated dry weight, hemoglobin, hematocrit, serum glucose, calcium, phosphorus, albumin, Kt/V, normalized protein catabolic rate (nPCR), average monthly interdialytic weight gain, and monthly mean predialysis and postdialysis blood pressure. Glycohemoglobin was assessed in diabetic patients. Patients' charts were reviewed for episodes of intradialytic cramping and hypotension.
All patients showed improvement in measures of physical performance at 3, 6, and 12 months. Mean phosphorus decreased from 1.94 +/- 0.45 mmol (6.02 +/- 1.4 mg/dL) by 11% at 3 months (P = 0.05) and by 26% at 12 months (P < 0.02). Patients who exercised for 12 months experienced a mean 16% reduction in blood glucose. Mean glucose levels for 7 diabetic patients decreased from 12.35 +/- 5.8 mmol/L (224.1 +/- 105) to 11. 66 +/- 1.9 mmol/L (211.7 +/- 34 mg/dL); however, this was not statistically significant. Mean glycohemoglobin levels for diabetic patients did not change significantly. Increases were seen in Kt/V, estimated dry weight, and serum albumin; however, these were not statistically significant. Decreases were noted in mean predialysis and postdialysis blood pressures and average interdialytic weight gains at 3, 6, and 12 months.
A formal intradialytic exercise regimen can produce objective evidence of improvement in physical performance and some measures of nutritional well-being over 3 to 12 months. Further research is needed to determine if these changes are a result of exercise alone or increased compliance with the medical and dietary regimen.
使用常见的身体机能测量方法和营养评估参数，评估参与透析期间运动计划的效果。
对参与中心内透析期间运动计划的血液透析患者进行机能测试和营养评估。在参与计划开始时以及参与3个月、6个月和12个月后收集数据。采用单尾配对t检验进行统计学评估。
独立的门诊透析中心，平均有130名患者接受工作人员辅助的血液透析。
收集了16名完成3个月计划的患者、6名完成6个月计划的患者和4名完成12个月计划的患者的数据。
患者参与一个循序渐进、自主节奏的运动计划，包括在血液透析前或透析期间骑自行车，或在血液透析前在跑步机上行走。除此之外，患者还可以选择在血液透析期间进行伸展和/或轻度举重运动。
机能测试包括60秒坐立试验、28英尺慢走和快走、60秒爬楼梯以及60秒抬腿试验。营养评估包括估计干体重、血红蛋白、血细胞比容、血清葡萄糖、钙、磷、白蛋白、Kt/V、标准化蛋白分解代谢率（nPCR）、平均每月透析间期体重增加以及每月平均透析前和透析后血压的变化。对糖尿病患者评估糖化血红蛋白。查阅患者病历以了解透析期间痉挛和低血压发作情况。
所有患者在3个月、6个月和12个月时身体机能测量指标均有改善。平均磷在3个月时从1.94±0.45 mmol（6.02±1.4 mg/dL）下降了11%（P = 0.05），在12个月时下降了26%（P < 0.02）。运动12个月的患者血糖平均降低了16%。7名糖尿病患者的平均血糖水平从12.35±5.8 mmol/L（224.1±105）降至11.66±1.9 mmol/L（211.7±34 mg/dL）；然而，这在统计学上无显著意义。糖尿病患者的平均糖化血红蛋白水平无显著变化。Kt/V、估计干体重和血清白蛋白有所增加；然而，这些在统计学上无显著意义。在3个月、6个月和12个月时，透析前和透析后的平均血压以及平均透析间期体重增加有所下降。
一个正式的透析期间运动方案在3至12个月内可产生身体机能改善和一些营养状况指标改善的客观证据。需要进一步研究以确定这些变化是仅由运动导致还是因对医疗和饮食方案的依从性增加所致。
