Schools of Human Movement Studies, University of Queensland, Australia.
Clin J Am Soc Nephrol. 2013 Sep;8(9):1494-501. doi: 10.2215/CJN.10141012. Epub 2013 Aug 22.
CKD is associated with poor cardiorespiratory fitness (CRF). This predefined substudy determined the effect of exercise training and lifestyle intervention on CRF and explored the effect on cardiovascular risk factors and cardiac and vascular function.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Between February 2008 and March 2010, 90 patients with stage 3-4 CKD were screened with an exercise stress echocardiogram before enrollment. Patients (n=83) were randomized to standard care (control) or lifestyle intervention. The lifestyle intervention included multidisciplinary care (CKD clinic), a lifestyle program, and aerobic and resistance exercise training for 12 months. CRF (peak Vo2), left ventricular function, arterial stiffness, anthropometric, and biochemical data were collected at baseline and 12 months.
Ten percent of randomized patients had subclinical myocardial ischemia at screening and completed the study without incident. There was no baseline difference among 72 patients who completed follow-up (36 in the lifestyle intervention group and 36 in the control group). The intervention increased peak Vo2 (2.8±0.7 ml/kg per minute versus -0.3±0.9 ml/kg per minute; P=0.004). There was small weight loss (-1.8±4.2 kg versus 0.7±3.7 kg; P=0.02) but no change in BP or lipids. Diastolic function improved (increased e' of 0.75±1.16 cm/s versus -0.47±1.0 cm/s; P=0.001) but systolic function was well preserved and did not change. The change in arterial elastance was attenuated (0.11±0.76 mmHg/ml versus 0.76±0.96 mmHg/ml; P=0.01). Δ peak Vo2 was associated with group allocation and improved body composition.
Exercise training and lifestyle intervention in patients with CKD produces improvements in CRF, body composition, and diastolic function.
CKD 与心肺适能（CRF）差有关。本预先设定的子研究旨在确定运动训练和生活方式干预对 CRF 的影响，并探讨其对心血管危险因素及心脏和血管功能的影响。
设计、设置、参与者和测量：2008 年 2 月至 2010 年 3 月，90 名 3-4 期 CKD 患者接受运动应激超声心动图筛查，之后入组。患者（n=83）随机分为标准治疗（对照组）或生活方式干预组。生活方式干预包括多学科护理（CKD 诊所）、生活方式方案以及 12 个月的有氧运动和抗阻运动训练。在基线和 12 个月时收集 CRF（峰值 Vo2）、左心室功能、动脉僵硬度、人体测量和生化数据。
筛查时有 10%的随机患者存在亚临床心肌缺血，且无不良事件完成研究。在完成随访的 72 名患者（生活方式干预组 36 名，对照组 36 名）中，无基线差异。干预组的峰值 Vo2 增加（2.8±0.7 ml/kg 每分钟比-0.3±0.9 ml/kg 每分钟；P=0.004）。体重略有减轻（-1.8±4.2 千克比 0.7±3.7 千克；P=0.02），但血压或血脂无变化。舒张功能改善（e'增加 0.75±1.16 cm/s 比-0.47±1.0 cm/s；P=0.001），但收缩功能保持良好且无变化。动脉弹性改变减弱（0.11±0.76 mmHg/ml 比 0.76±0.96 mmHg/ml；P=0.01）。峰值 Vo2 的变化与分组分配和身体成分的改善相关。
CKD 患者的运动训练和生活方式干预可提高 CRF、身体成分和舒张功能。
