Sawant Anuradha, House Andrew A, Overend Tom J
Graduate Program in Health and Rehabilitation Sciences, Physical Therapy Field, Western University ; University Hospital Campus.
Western University Division of Nephrology, London Health Sciences Centre.
Physiother Can. 2014 Winter;66(1):44-53. doi: 10.3138/ptc.2012-59.
The primary purpose of this systematic review was to evaluate the anabolic effect of exercise intervention in adults with end-stage renal disease on hemodialysis (HD). The secondary objectives were to evaluate the influences of participant characteristics and exercise parameters on changes in muscle size.
Electronic databases (Cochrane, CINAHL, EMBASE, PEDro, PubMed and SCOPUS) were searched from inception to November 2012. Randomized clinical trials published in English that included adults on HD undergoing an exercise intervention where muscle mass was measured as an outcome were included in this review. Two reviewers independently selected the studies, extracted data, and assessed risk of bias within the included studies. RESULTS were then combined by meta-analysis. The effect of exercises was determined using a standardized mean difference (SMD), expressed as Hedges' g, computed using a random effects model.
Seven SMDs extracted from five studies were included for final analysis. Strength training was used in all studies; one study used aerobic and mixed strength and aerobic training with two subgroups of participants. The overall effect of exercise on muscle mass was statistically significant (SMD: 0.272; 95% CI, 0.020-0.525).
Our results confirm a small but significant effect of strengthening exercise as an anabolic intervention to increase muscle mass. Exercise training should be included in routine management of people on maintenance HD. Although current results indicate that one in nine people on HD is likely to benefit from exercise intervention, parameters influencing these results require further research.
本系统评价的主要目的是评估运动干预对接受血液透析（HD）的终末期肾病成人的合成代谢作用。次要目的是评估参与者特征和运动参数对肌肉大小变化的影响。
检索了从数据库建立至2012年11月的电子数据库（Cochrane、CINAHL、EMBASE、PEDro、PubMed和SCOPUS）。纳入本评价的是发表于英文的随机临床试验，试验对象为接受运动干预的HD成人，且将肌肉质量作为一项结局指标进行测量。两名评价者独立选择研究、提取数据并评估纳入研究中的偏倚风险。然后通过荟萃分析合并结果。使用标准化均数差（SMD）确定运动效果，以Hedges' g表示，采用随机效应模型计算。
最终分析纳入了从5项研究中提取的7个SMD。所有研究均采用了力量训练；1项研究采用了有氧运动以及力量与有氧运动相结合的方式，并将参与者分为两个亚组。运动对肌肉质量的总体影响具有统计学意义（SMD：0.272；95%CI，0.020 - 0.525）。
我们的结果证实，强化运动作为一种合成代谢干预措施对增加肌肉质量具有小但显著的效果。运动训练应纳入维持性HD患者的常规管理中。尽管目前的结果表明，每9名HD患者中有1人可能从运动干预中获益，但影响这些结果的参数仍需进一步研究。
