Gould Douglas W, Graham-Brown Matthew P M, Watson Emma L, Viana João L, Smith Alice C
Leicester Kidney Exercise Team, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.
Nephrology (Carlton). 2014 Sep;19(9):519-27. doi: 10.1111/nep.12285.
Chronic kidney disease (CKD) is strongly associated with cardiovascular disease and muscle wasting, arising from numerous factors associated with declining renal function and lifestyle factors. Exercise has the ability to impact beneficially on the comorbidities associated with CKD and is accepted as an important intervention in the treatment, prevention and rehabilitation of other chronic diseases, however, the role of exercise in CKD is overlooked, with the provision of rehabilitation programmes well behind those of cardiology and respiratory services. Whilst there is now a large evidence base demonstrating the efficacy and safety of exercise training interventions in patients receiving dialysis, and this is now becoming incorporated into clinical guidelines for treatment of dialysis patients, there is a paucity of research evaluating the effectiveness of exercise in patients with CKD who are not on dialysis. Despite this, existing studies indicate that exercise can improve physical functioning and impact positively on the mediators of co-morbid diseases and upstream factors associated with progression of renal disease. Although preliminary evidence appears positive, more research is required to identify the best modes, frequency and intensities of exercise in order to optimise exercise prescription in pre-dialysis CKD patients. This review summarizes what is known about the main effects of exercise in pre-dialysis CKD patients, discusses the potential of exercise in the rehabilitation and treatment of disease and highlights the need for further research.
慢性肾脏病（CKD）与心血管疾病和肌肉萎缩密切相关，其成因众多，涉及肾功能下降相关因素以及生活方式因素。运动能够对与CKD相关的合并症产生有益影响，并且在其他慢性疾病的治疗、预防及康复中被视为一项重要干预措施。然而，运动在CKD中的作用却被忽视了，其康复项目的提供远远落后于心内科和呼吸科服务。虽然目前有大量证据表明运动训练干预对接受透析的患者有效且安全，并且这已被纳入透析患者的临床治疗指南，但对于未接受透析的CKD患者运动效果的研究却很匮乏。尽管如此，现有研究表明运动可以改善身体机能，并对合并症的介导因素以及与肾病进展相关的上游因素产生积极影响。虽然初步证据看起来是积极的，但仍需要更多研究来确定最佳的运动方式、频率和强度，以便为透析前CKD患者优化运动处方。本综述总结了目前已知的运动对透析前CKD患者的主要影响，讨论了运动在疾病康复和治疗中的潜力，并强调了进一步研究的必要性。
