Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia.
Department of Renal Medicine, Eastern Health Clinical School, Melbourne, Victoria, Australia.
Am J Physiol Renal Physiol. 2020 Mar 1;318(3):F843-F850. doi: 10.1152/ajprenal.00576.2019. Epub 2020 Feb 18.
End-stage kidney disease is associated with reduced exercise capacity, muscle atrophy, and impaired muscle function. While these may be improved with exercise, single modalities of exercise do not traditionally elicit improvements across all required physiological domains. Blood flow-restricted exercise may improve all of these physiological domains with low intensities traditionally considered insufficient for these adaptions. Investigation of this technique appeals, but is yet to be evaluated, in patients undergoing dialysis. With the use of a progressive crossover design, 10 satellite patients undergoing hemodialysis underwent three exercise conditions over 2 wk: two bouts (10 min) of unrestricted cycling during two consecutive hemodialysis sessions (), two bouts of cycling with blood flow restriction while off hemodialysis on 2 separate days (), and two bouts of cycling with blood flow restriction during two hemodialysis sessions (). Outcomes included hemodynamic responses (heart rate and blood pressure) throughout all sessions, participant-perceived exertion and discomfort on a Borg scale, and evaluation of ultrafiltration rates and dialysis adequacy (Kt/V) obtained post hoc. Hemodynamic responses were consistent regardless of condition. Significant increases in heart rate, systolic blood pressure, and mean arterial blood pressure ( < 0.05) were observed postexercise followed by a reduction in blood pressures during the 60-min recovery (12, 5, and 11 mmHg for systolic, diastolic, and mean arterial pressures, respectively). Blood pressures returned to predialysis ranges following the recovery period. Blood flow restriction did not affect ultrafiltration achieved or Kt/V. Hemodynamic safety and tolerability of blood flow restriction during aerobic exercise on hemodialysis is comparable to standard aerobic exercise.
终末期肾病与运动能力下降、肌肉萎缩和肌肉功能受损有关。虽然运动可以改善这些情况，但传统的单一运动方式并不能在所有需要的生理领域都产生改善。血流限制运动可以通过传统上认为不足以产生这些适应的低强度来改善所有这些生理领域。这种技术的研究很有吸引力，但在接受透析的患者中尚未得到评估。使用渐进交叉设计，10 名卫星透析患者在 2 周内接受了 3 种运动条件：连续两次透析期间进行两次无限制的自行车运动（），2 次在透析日之外进行血流限制的自行车运动（），2 次在透析期间进行血流限制的自行车运动（）。结果包括所有阶段的血液动力学反应（心率和血压）、参与者在 Borg 量表上的感知用力和不适，以及事后评估超滤率和透析充分性（Kt/V）。无论条件如何，血液动力学反应都是一致的。运动后观察到心率、收缩压和平均动脉压显著升高（<0.05），在 60 分钟恢复期血压下降（收缩压、舒张压和平均动脉压分别为 12、5 和 11mmHg）。血压在恢复期后恢复到透析前范围。血流限制不影响超滤量或 Kt/V。血流限制在血液透析期间进行有氧运动的血液动力学安全性和耐受性与标准有氧运动相当。
