School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
Adv Chronic Kidney Dis. 2009 Nov;16(6):459-81. doi: 10.1053/j.ackd.2009.08.009.
This review examined published reports of the impact of extradialytic and intradialytic exercise programs on physiologic aerobic exercise capacity, functional exercise endurance, and cardiovascular outcomes in individuals with ESKD. Studies spanning 30 years from the first published report of exercise in the ESKD population were reviewed. Studies conducted in the first half of the publication record focused on the efficacy of exercise training programs performed "off"-dialysis with respect to the modification of traditional cardiovascular risk factors, aerobic capacity, and its underlying determinants. In the latter half of the record, there had been a shift to include other client-centered goals such as physical function and quality of life. There is evidence that both intra- and extradialytic programs can significantly enhance aerobic exercise capacity, but moderate-intensity extradialytic programs may result in greater gains in those individuals who initially have extremely poor aerobic capacity. Functionally, substantive improvements in exercise endurance in excess of the minimum clinical significant difference can occur following either low- or moderate-intensity exercise regardless of the initial level of performance. Reductions in blood pressure and enhanced vascular functioning reported after predominantly intradialytic exercise programs suggest that either low- or moderate-intensity exercise programs can confer cardiovascular benefit. Regardless of prescription model, there was an overall lack of evidence regarding the impact of exercise-induced changes in exercise capacity, endurance, and cardiovascular function on a number of relevant health outcomes (survival, morbidity, and cardiovascular risk), and, more importantly, there is no evidence on the long-term impact of exercise and/or physical activity interventions on these health outcomes.
本综述考察了已发表的报告，这些报告评估了析外和析内运动方案对终末期肾病患者生理有氧运动能力、功能运动耐力和心血管结局的影响。综述涵盖了 30 年来的研究，最早的研究报告发表于终末期肾病患者中开展运动的初期。在研究记录的前半部分，重点研究了在透析以外进行运动训练方案的疗效，这些方案旨在改变传统心血管风险因素、有氧能力及其潜在决定因素。在记录的后半部分，研究方向发生了转变，纳入了其他以患者为中心的目标，如身体机能和生活质量。有证据表明，析内和析外方案都可以显著提高有氧运动能力，但对于最初有氧能力极差的患者，中等强度的析外方案可能会带来更大的收益。在功能上，无论初始表现水平如何，无论是低强度还是中等强度的运动，都可以实现超过最小临床显著差异的运动耐力实质性改善。主要在透析内进行的运动方案报告的血压降低和血管功能增强表明，无论是低强度还是中等强度的运动方案都可以带来心血管益处。无论处方模式如何，关于运动引起的运动能力、耐力和心血管功能变化对许多相关健康结果（生存、发病率和心血管风险）的影响，总体缺乏证据，更重要的是，关于运动和/或体育活动干预对这些健康结果的长期影响，目前尚无证据。
