Mustata Stefan, Chan Christopher, Lai Vesta, Miller Judith A
University Health Network, Toronto, Ontario, Canada.
J Am Soc Nephrol. 2004 Oct;15(10):2713-8. doi: 10.1097/01.ASN.0000140256.21892.89.
Cardiovascular disease remains the primary cause of mortality in patients who are maintained on hemodialysis. Arterial stiffness and insulin resistance are independent risk factors for cardiovascular mortality in this population. In healthy individuals, higher physical conditioning is associated with reduced arterial stiffness. Exercise reduces insulin resistance and glucose intolerance in sedentary, overweight individuals and diabetic patients. The purpose of this study was to determine the impact of an exercise program on arterial stiffness and insulin resistance in a group of patients on hemodialysis. The effect of exercise training on arterial stiffness and insulin resistance in 11 patients who were on chronic hemodialysis was evaluated. Exercise classes of 1-h duration were conducted twice weekly for 3 mo. Arterial stiffness was assessed using the radial artery pressure waveform analysis. Aerobic exercise improved arterial stiffness from 17 +/- 3 u at baseline to 12.2 +/- 3 u at the end of the intervention (P = 0.01). After 1 mo of detraining, arterial stiffness reverted to pre-exercise levels (17.3 +/- 3 u). Pulse pressure paralleled arterial stiffness changes, and the correlation between them was statistically significant (r = 0.725, P = 0.012). Insulin resistance was calculated using the homeostatic model assessment formula. Exercise at the intensity and duration used in our study had no impact on insulin resistance (P = 0.38). These findings suggest that 3 mo of aerobic exercise training improves arterial stiffness, an independent risk factor for cardiovascular mortality in patients who are on hemodialysis, and has no impact on insulin resistance. The beneficial effect on arterial stiffness dissipates within 1 mo of detraining. To obtain therapeutic benefits, an exercise program for patients who are maintained on hemodialysis should be designed to promote regular long term exercise, >3 h/wk.
心血管疾病仍然是接受血液透析患者的主要死亡原因。动脉僵硬度和胰岛素抵抗是该人群心血管死亡的独立危险因素。在健康个体中，较高的体能状态与降低的动脉僵硬度相关。运动可降低久坐不动的超重个体和糖尿病患者的胰岛素抵抗及葡萄糖不耐受。本研究的目的是确定一项运动计划对一组血液透析患者动脉僵硬度和胰岛素抵抗的影响。评估了运动训练对11例慢性血液透析患者动脉僵硬度和胰岛素抵抗的作用。每周进行两次为期1小时的运动课程，共持续3个月。使用桡动脉压力波形分析评估动脉僵硬度。有氧运动使动脉僵硬度从基线时的17±3单位改善至干预结束时的12.2±3单位（P = 0.01）。停训1个月后，动脉僵硬度恢复到运动前水平（17.3±3单位）。脉压与动脉僵硬度变化平行，二者之间的相关性具有统计学意义（r = 0.725，P = 0.012）。使用稳态模型评估公式计算胰岛素抵抗。本研究中所用强度和时长的运动对胰岛素抵抗无影响（P = 0.38）。这些发现表明，3个月的有氧运动训练可改善动脉僵硬度，这是血液透析患者心血管死亡的一个独立危险因素，且对胰岛素抵抗无影响。对动脉僵硬度的有益作用在停训1个月内消失。为获得治疗益处，应为接受血液透析的患者设计运动计划，以促进长期规律运动，每周>3小时。
