Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, Av. Carlos Oliveira Campos - Castelo da Maia, 4475-690, Maia, Portugal.
Department of Nephrology, Curry Cabral Hospital, Lisbon, Portugal.
BMC Nephrol. 2020 Aug 8;21(1):334. doi: 10.1186/s12882-020-01999-z.
Chronic Kidney Disease (CKD) patients frequently develop life-impairing bone mineral disorders. Despite the reported impact of exercise on bone health, systematic reviews of the evidence are lacking. This review examines the association of both physical activity (PA) and the effects of different exercise interventions with bone outcomes in CKD.
English-language publications in EBSCO, Web of Science and Scopus were searched up to May 2019, from which observational and experimental studies examining the relation between PA and the effect of regular exercise on bone-imaging or -outcomes in CKD stage 3-5 adults were included. All data were extracted and recorded using a spreadsheet by two review authors. The evidence quality was rated using the Cochrane risk of bias tool and a modified Newcastle-Ottawa scale.
Six observational (4 cross-sectional, 2 longitudinal) and seven experimental (2 aerobic-, 5 resistance-exercise trials) studies were included, with an overall sample size of 367 and 215 patients, respectively. Judged risk of bias was low and unclear in most observational and experimental studies, respectively. PA was positively associated with bone mineral density at lumbar spine, femoral neck and total body, but not with bone biomarkers. Resistance exercise seems to improve bone mass at femoral neck and proximal femur, with improved bone formation and inhibited bone resorption observed, despite the inconsistency of results amongst different studies.
There is partial evidence supporting (i) a positive relation of PA and bone outcomes, and (ii) positive effects of resistance exercise on bone health in CKD. Prospective population studies and long-term RCT trials exploring different exercise modalities measuring bone-related parameters as endpoint are currently lacking.
慢性肾脏病（CKD）患者常发生影响生活的矿物质骨异常。尽管有运动对骨骼健康影响的报告，但缺乏系统评价证据。本综述检查了体力活动（PA）和不同运动干预对 CKD 患者骨骼结局的影响与骨骼结局的关系。
检索了 EBSCO、Web of Science 和 Scopus 中的英文文献，检索时间截至 2019 年 5 月，纳入了观察性和实验性研究，这些研究检查了 PA 与 CKD 3-5 期成人常规运动对骨骼成像或结局的影响之间的关系。两名综述作者使用电子表格提取和记录所有数据。使用 Cochrane 偏倚风险工具和改良的 Newcastle-Ottawa 量表对证据质量进行评级。
纳入了 6 项观察性研究（4 项横断面研究，2 项纵向研究）和 7 项实验性研究（2 项有氧运动试验，5 项抗阻运动试验），总样本量分别为 367 例和 215 例。大多数观察性和实验性研究的判断偏倚风险低或不明确。PA 与腰椎、股骨颈和全身骨密度呈正相关，但与骨生物标志物无关。抗阻运动似乎可以改善股骨颈和近端股骨的骨量，观察到骨形成增加和骨吸收抑制，但不同研究结果不一致。
有部分证据支持（i）PA 与骨骼结局之间存在正相关，（ii）抗阻运动对 CKD 患者骨骼健康的积极影响。目前缺乏探索不同运动方式、以骨骼相关参数为终点的前瞻性人群研究和长期 RCT 试验。
