Clarkson Matthew J, Bennett Paul N, Fraser Steve F, Warmington Stuart A
Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria , Australia.
Medical and Clinical Affairs, Satellite Healthcare, Adelaide, South Australia , Australia.
Am J Physiol Renal Physiol. 2019 May 1;316(5):F856-F872. doi: 10.1152/ajprenal.00317.2018. Epub 2019 Feb 13.
Patients with end-stage kidney disease on dialysis have increased mortality and reduced physical activity, contributing to impaired physical function. Although exercise programs have demonstrated a positive effect on physiological outcomes such as cardiovascular function and strength, there is a reduced focus on physical function. The aim of this review was to determine whether exercise programs improve objective measures of physical function indicative of activities of daily living for patients with end-stage kidney disease on dialysis. A systematic search of Medline, Embase, the Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature identified 27 randomized control trials. Only randomized control trials using an exercise intervention or significant muscular activation in the intervention, a usual care, nonexercising control group, and at least one objective measure of physical function were included. Participants were ≥18 yr of age, with end-stage kidney disease, undergoing hemo- or peritoneal dialysis. Systematic review of the literature and quality assessment of the included studies used the Cochrane Collaboration's tool for assessing risk bias. A meta-analysis was completed for the 6-min walk test. Data from 27 studies with 1,156 participants showed that exercise, regardless of modality, generally increased 6-min walk test distance, sit-to-stand time or repetitions, and grip strength as well as step and stair climb times or repetitions, dynamic mobility, and short physical performance battery scores. From the evidence available, exercise, regardless of modality, improved objective measures of physical function for end-stage kidney disease patients undergoing dialysis. It is acknowledged that further well-designed randomized control trials are required.
接受透析治疗的终末期肾病患者死亡率增加且身体活动减少，导致身体功能受损。尽管运动计划已证明对心血管功能和力量等生理指标有积极影响，但对身体功能的关注较少。本综述的目的是确定运动计划是否能改善接受透析治疗的终末期肾病患者日常生活活动中身体功能的客观指标。对Medline、Embase、Cochrane对照试验中央注册库和护理及联合健康文献累积索引进行系统检索，共识别出27项随机对照试验。仅纳入了使用运动干预或干预中有显著肌肉激活、常规护理、非运动对照组以及至少一项身体功能客观指标的随机对照试验。参与者年龄≥18岁，患有终末期肾病，正在接受血液透析或腹膜透析。对文献进行系统综述，并使用Cochrane协作网的工具对纳入研究进行风险偏倚评估。对6分钟步行试验进行了荟萃分析。来自27项研究的1156名参与者的数据表明，无论运动方式如何，运动通常会增加6分钟步行试验距离、坐立时间或重复次数、握力以及步幅和爬楼梯时间或重复次数、动态活动能力和简短体能测试得分。根据现有证据，无论运动方式如何，运动都能改善接受透析治疗的终末期肾病患者身体功能的客观指标。公认还需要进一步设计良好的随机对照试验。
