Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,
Am J Nephrol. 2020;51(11):919-929. doi: 10.1159/000511685. Epub 2020 Nov 18.
For patients with CKD, evidence on the optimal dose of physical activity and possible harm with excessive exercise is limited. This study aimed to analyze the dose-response association between leisure-time physical activity (LTPA) and mortality in those with CKD and explore the optimal dose or possible harm associated with increased levels of LTPA.
4,604 participants with CKD from the 1999 to 2012 National Health and Nutrition Examination Surveys with linked mortality data obtained through 2015 were classified into 6 groups: 0, 1-149, 150-299, 300-599, 600-899, and ≥900 min/week based on the total duration of the self-reported LTPA. Multivariable-adjusted Cox proportional hazards models were used to examine dose-response associations between LTPA and mortality.
During the median follow-up of 114 months, 1,449 (31%) all-cause deaths were recorded. Compared to the inactive group (0 min/week), we observed a 22% lower risk of all-cause mortality (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.63-0.97) among participants who performed 1-149 min per week for LTPA. The corresponding HRs and 95% CIs for all-cause mortality for 150-299 and 300-599 min/week of LTPA were 0.79 (0.64-0.97) and 0.74 (0.56-0.98). The benefit appeared to reach a threshold of a 43% (HR, 0.57; 95% CI, 0.36-0.91) lower risk of all-cause mortality among individuals performing 600-899 min/week for LTPA. Importantly, for ≥900 min/week of LTPA, the continued benefits were observed (HR, 0.62; 95% CI, 0.44-0.87).
LTPA was associated with lower mortality in those with CKD. The optimal dose was observed at the LTPA level of approximately 600-899 min/week, and there were still benefits rather than the excess risk with LTPA levels as high as ≥900 min/week. Therefore, clinicians should encourage inactive CKD patients to perform LTPA and do not need to discourage CKD patients who already adhere to long-term physical activity.
对于慢性肾脏病 (CKD) 患者，体力活动最佳剂量以及过度运动可能带来的危害的证据有限。本研究旨在分析休闲时间体力活动 (LTPA) 与 CKD 患者死亡率之间的剂量反应关系，并探讨与 LTPA 水平增加相关的最佳剂量或可能的危害。
1999 年至 2012 年，共有 4604 名 CKD 患者参与了全国健康与营养调查，并通过 2015 年获得了与死亡率相关的数据。根据自我报告的 LTPA 总持续时间，将这些患者分为 6 组：0、1-149、150-299、300-599、600-899 和≥900 分钟/周。使用多变量调整的 Cox 比例风险模型来检验 LTPA 与死亡率之间的剂量反应关系。
在中位随访 114 个月期间，记录到 1449 例（31%）全因死亡。与不活动组（0 分钟/周）相比，每周进行 1-149 分钟 LTPA 的患者全因死亡率风险降低 22%（风险比 [HR]，0.78；95%置信区间 [CI]，0.63-0.97）。每周进行 150-299 和 300-599 分钟 LTPA 的患者的全因死亡率相应的 HR 和 95%CI 分别为 0.79（0.64-0.97）和 0.74（0.56-0.98）。每周进行 600-899 分钟 LTPA 的个体全因死亡率风险降低 43%（HR，0.57；95%CI，0.36-0.91），这一获益似乎达到了一个阈值。重要的是，每周进行 LTPA≥900 分钟仍观察到持续获益（HR，0.62；95%CI，0.44-0.87）。
CKD 患者的 LTPA 与较低的死亡率相关。最佳剂量约为每周 600-899 分钟，而每周进行 LTPA≥900 分钟仍有获益，而不是过度运动带来的风险增加。因此，临床医生应鼓励不活跃的 CKD 患者进行 LTPA，而不必劝阻已经长期进行体力活动的 CKD 患者。
