School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia; Cardiology Department, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom.
School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia; School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia.
Auton Neurosci. 2020 Mar;224:102642. doi: 10.1016/j.autneu.2020.102642. Epub 2020 Jan 28.
Patients with chronic kidney disease (CKD) are at a high risk of future autonomic dysfunction and cardiovascular disease. The aim of this study was to examine the effects of a 12-month lifestyle intervention (LI) involving regular aerobic exercise on cardiac autonomic function in CKD patients.
Pooled exploratory analysis.
113 eligible patients with stage 3-4 CKD (eGFR 25-60 ml/min/1.75m) participated in a LI program, including an 8-week individualised gym-based exercise program followed by a 10-month home-based program. The control (CON) group underwent standard nephrological care. The following parameters were assessed prior to and following the 12-month study period: cardiorespiratory fitness (VOpeak) from a graded exercise test; cardiac autonomic function from time, frequency, and non-linear measures of heart rate variability (HRV), heart rate (HR) recovery following peak exercise, and chronotropic competence during exercise.
Compared to the CON group, the LI group significantly increased VOpeak (CON = -1.0 vs. LI = +1.8 ml/kg/min, p < 0.01) while there was no significant improvement in any HRV measure (p = 0.85), HR recovery (p = 0.38) or chronotropic competence (p = 0.28). Changes in relative VOpeak were significantly associated with changes in a non-linear HRV measure, α1 (p < 0.01), independent of age and eGFR (r = 0.196, p = 0.03).
Despite the significant increase in cardiorespiratory fitness for the LI group, there were no changes in cardiac autonomic function. However, α1 may be a sensitive measure to assess VOpeak changes in this clinical cohort. Further research is required to investigate the role of different modalities of exercise training to enhance cardiac autonomic function in patients with CKD.
患有慢性肾脏病（CKD）的患者未来发生自主神经功能障碍和心血管疾病的风险较高。本研究旨在探讨为期 12 个月的生活方式干预（LI）对 CKD 患者心脏自主神经功能的影响，该干预包括定期进行有氧运动。
汇总的探索性分析。
113 名符合条件的 3-4 期 CKD 患者（eGFR 25-60 ml/min/1.75m）参加了 LI 计划，该计划包括 8 周的个体化健身房锻炼计划，然后是 10 个月的家庭计划。对照组（CON）接受标准肾脏科护理。在 12 个月的研究期间之前和之后评估了以下参数：从分级运动试验中得出的心肺适应能力（VOpeak）；心率变异性（HRV）的时间、频率和非线性指标、运动后心率恢复以及运动期间的变时性能力来评估心脏自主神经功能。
与 CON 组相比，LI 组的 VOpeak 显著增加（CON = -1.0 与 LI = +1.8 ml/kg/min，p < 0.01），而任何 HRV 指标均无显著改善（p = 0.85），心率恢复（p = 0.38）或变时性能力（p = 0.28）。相对 VOpeak 的变化与非线性 HRV 指标α1 的变化显著相关（p < 0.01），与年龄和 eGFR 无关（r = 0.196，p = 0.03）。
尽管 LI 组的心肺适应能力显著提高，但心脏自主神经功能没有变化。然而，α1 可能是评估该临床队列中 VOpeak 变化的敏感指标。需要进一步研究不同运动训练方式对增强 CKD 患者心脏自主神经功能的作用。
