Giannaki Christoforos D, Hadjigeorgiou Georgios M, Karatzaferi Christina, Maridaki Maria D, Koutedakis Yiannis, Founta Paraskevi, Tsianas Nikolaos, Stefanidis Ioannis, Sakkas Giorgos K
Department of Life & Health Sciences, University of Nicosia, Nicosia, Cyprus.
Nephrol Dial Transplant. 2013 Nov;28(11):2834-40. doi: 10.1093/ndt/gft288. Epub 2013 Aug 8.
Uraemic restless legs syndrome (RLS) affects a significant proportion of patients receiving haemodialysis (HD) therapy. Exercise training has been shown to improve RLS symptoms in uraemic RLS patients; however, the mechanism of exercise-induced changes in RLS severity is still unknown. The aim of the current randomized controlled exercise trial was to investigate whether the reduction of RLS severity, often seen after training, is due to expected systemic exercise adaptations or it is mainly due to the relief that leg movements confer during exercise training on a cycle ergometer. This is the first randomized controlled exercise study in uraemic RLS patients.
Twenty-four RLS HD patients were randomly assigned to two groups: the progressive exercise training group (n = 12) and the control exercise with no resistance group (n = 12). The exercise session in both groups included intradialytic cycling for 45 min at 50 rpm. However, only in the progressive exercise training group was resistance applied, at 60-65% of maximum exercise capacity, which was reassessed every 4 weeks to account for the patients' improvement. The severity of RLS symptoms was evaluated using the IRLSSG severity scale, functional capacity by a battery of tests, while sleep quality, depression levels and daily sleepiness status were assessed via validated questionnaires, before and after the intervention period.
All patients completed the exercise programme with no adverse effects. RLS symptom severity declined by 58% (P = 0.003) in the progressive exercise training group, while a no statistically significant decline was observed in the control group (17% change, P = 0.124). Exercise training was also effective in terms of improving functional capacity (P = 0.04), sleep quality (P = 0.038) and depression score (P = 0.000) in HD patients, while no significant changes were observed in the control group. After 6 months of the intervention, RLS severity (P = 0.017), depression score (P = 0.002) and daily sleepiness status (P = 0.05) appeared to be significantly better in the progressive exercise group compared with the control group.
A 6-month intradialytic progressive exercise training programme appears to be a safe and effective approach in reducing RLS symptom severity in HD patients. It seems that exercise-induced adaptations to the whole body are mostly responsible for the reduction in RLS severity score, since the exercise with no applied resistance protocol failed to improve the RLS severity status of the patients.
尿毒症不安腿综合征（RLS）影响着很大一部分接受血液透析（HD）治疗的患者。运动训练已被证明可改善尿毒症RLS患者的RLS症状；然而，运动引起的RLS严重程度变化的机制仍不清楚。当前这项随机对照运动试验的目的是研究训练后常见的RLS严重程度降低是由于预期的全身运动适应性变化，还是主要由于在周期测力计上进行运动训练时腿部运动带来的缓解。这是第一项针对尿毒症RLS患者的随机对照运动研究。
24例患有RLS的HD患者被随机分为两组：渐进性运动训练组（n = 12）和无阻力对照运动组（n = 12）。两组的运动环节均包括在透析期间以每分钟50转的速度进行45分钟的骑自行车运动。然而，只有渐进性运动训练组施加了阻力，阻力为最大运动能力的60 - 65%，每4周重新评估一次以考虑患者的改善情况。在干预期前后，使用国际不安腿综合征研究组（IRLSSG）严重程度量表评估RLS症状的严重程度，通过一系列测试评估功能能力，同时通过经过验证的问卷评估睡眠质量、抑郁水平和每日嗜睡状态。
所有患者均完成了运动计划，且无不良反应。渐进性运动训练组的RLS症状严重程度下降了58%（P = 0.003），而对照组未观察到具有统计学意义的下降（变化17%，P = 0.124）。运动训练在改善HD患者的功能能力（P = 0.04）、睡眠质量（P = 0.038）和抑郁评分（P = 0.000）方面也有效，而对照组未观察到显著变化。干预6个月后，与对照组相比，渐进性运动组的RLS严重程度（P = 0.017）、抑郁评分（P = 0.002）和每日嗜睡状态（P = 0.05）似乎明显更好。
为期6个月的透析期间渐进性运动训练计划似乎是降低HD患者RLS症状严重程度的一种安全有效的方法。似乎运动引起的全身适应性变化是RLS严重程度评分降低的主要原因，因为无阻力运动方案未能改善患者的RLS严重程度状况。
