Department of Infection, Immunity and Inflammation, University of Leicester , Leicester , United Kingdom.
Department of Clinical Medicine, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, Brazil.
Am J Physiol Renal Physiol. 2018 Jun 1;314(6):F1188-F1196. doi: 10.1152/ajprenal.00012.2018. Epub 2018 Feb 7.
There is a growing consensus that patients with chronic kidney disease (CKD) should engage in regular exercise, but there is a lack of formal guidelines. In this report, we determined whether combined aerobic and resistance exercise would elicit superior physiological gains, in particular muscular strength, compared with aerobic training alone in nondialysis CKD. Nondialysis patients with CKD stages 3b-5 were randomly allocated to aerobic exercise {AE, n = 21; 9 men; median age 63 [interquartile range (IQR) 58-71] yr; median estimated glomerular filtration rate (eGFR) 24 (IQR 20-30) ml·min·1.73 m} or combined exercise [CE, n = 20, 9 men, median age 63 (IQR 51-69) yr, median eGFR 27 (IQR 22-32) ml·min·1.73 m], preceded by a 6-wk run-in control period. Patients then underwent 12 wk of supervised AE (treadmill, rowing, or cycling exercise) or CE training (as AE plus leg extension and leg press exercise) performed three times per week. Outcome assessments of knee extensor muscle strength, quadriceps muscle volume, exercise capacity, and central hemodynamics were performed at baseline, following the 6-wk control period, and at the end of the intervention. AE and CE resulted in significant increases in knee extensor strength of 16 ± 19% (mean ± SD; P = 0.001) and 48 ± 37% ( P < 0.001), respectively, which were greater after CE ( P = 0.02). AE and CE resulted in 5 ± 7% ( P = 0.04) and 9 ± 7% ( P < 0.001) increases in quadriceps volume, respectively ( P < 0.001), which were greater after CE ( P = 0.01). Both AE and CE increased distance walked in the incremental shuttle walk test [28 ± 44 m ( P = 0.01) and 32 ± 45 m ( P = 0.01), respectively]. In nondialysis CKD, the addition of resistance exercise to aerobic exercise confers greater increases in muscle mass and strength than aerobic exercise alone.
越来越多的共识认为，慢性肾脏病（CKD）患者应定期进行运动，但目前缺乏正式的指南。在本报告中，我们旨在确定与单纯有氧运动相比，联合有氧和抗阻运动是否会引起更好的生理获益，尤其是肌肉力量，用于非透析 CKD。非透析 CKD 患者被随机分配到有氧运动组（AE，n=21；9 名男性；中位年龄 63[四分位距（IQR）58-71]岁；中位估算肾小球滤过率（eGFR）24（IQR 20-30）ml·min·1.73 m）或联合运动组[CE，n=20；9 名男性；中位年龄 63（IQR 51-69）岁；中位 eGFR 27（IQR 22-32）ml·min·1.73 m]，之前进行了 6 周的适应性对照期。然后，患者接受每周 3 次的监督有氧运动（跑步机、划船或自行车运动）或联合运动训练（如有氧运动加腿部伸展和腿部按压运动），共 12 周。在基线、6 周对照期结束和干预结束时，对膝关节伸肌肌力、股四头肌体积、运动能力和中心血液动力学进行了评估。AE 和 CE 分别导致膝关节伸肌力量显著增加 16±19%（平均值±标准差；P=0.001）和 48±37%（P<0.001），CE 后的增加更明显（P=0.02）。AE 和 CE 分别导致股四头肌体积增加 5±7%（P=0.04）和 9±7%（P<0.001）（P<0.001），CE 后的增加更明显（P=0.01）。AE 和 CE 均增加了递增穿梭步行试验中的步行距离[28±44 m（P=0.01）和 32±45 m（P=0.01）]。在非透析 CKD 中，与单纯有氧运动相比，抗阻运动的加入可使肌肉质量和力量增加更大。
