Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada.
Clin J Am Soc Nephrol. 2021 Apr 7;16(4):560-574. doi: 10.2215/CJN.15080920. Epub 2021 Mar 25.
Hemodialysis is associated with a high symptom burden that impairs health-related quality of life and functional status. Effective symptom management is a priority for individuals receiving hemodialysis. Aerobic exercise may be an effective, nonpharmacologic treatment for specific hemodialysis-related symptoms. This systematic review investigated the effect of aerobic exercise on hemodialysis-related symptoms in adults with kidney failure undergoing maintenance hemodialysis.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We searched MEDLINE, PubMed, Cochrane CENTRAL, CINAHL, PsycINFO, SPORTDiscus, EMBASE, PEDro, and Scopus databases from 1960 or inception until April 15, 2020 for randomized controlled trials investigating the effect of aerobic exercise on hemodialysis-related symptoms, identified as prespecified primary or secondary outcomes, as compared with controls in adults on maintenance hemodialysis. We identified restless legs syndrome as the primary outcome.
Of 3048 studies identified, 15 randomized controlled trials met the eligibility criteria. These studies investigated the effect of aerobic exercise on restless legs syndrome (two studies), sleep disturbance (four studies), anxiety (four studies), depression (nine studies), muscle cramping (one study), and fatigue (one study). Exercise interventions were intradialytic in ten studies and outside of hemodialysis in five studies. Heterogenous interventions and outcomes and moderate to high risk of bias precluded meta-analysis for most symptoms. Aerobic exercise demonstrated improvement in symptoms of restless legs syndrome, muscle cramping, and fatigue, as compared with nonexercise controls. Meta-analysis of depressive symptoms in studies using the Beck Depression Inventory demonstrated a greater reduction in Beck Depression Inventory score with exercise as compared with control (mean difference -7.57; 95% confidence interval, -8.25 to -6.89).
Our review suggests that in adults on maintenance hemodialysis, aerobic exercise improves several hemodialysis-related symptoms, including restless legs syndrome, symptoms of depression, muscle cramping, and fatigue. However, the use of validated outcome measures with demonstrated reliability and responsiveness in more diverse hemodialysis populations is required to fully characterize the effect of this intervention.
PROSPERO #CRD42017056658.
血液透析会导致较高的症状负担，从而损害健康相关的生活质量和功能状态。对接受血液透析的个体而言，有效的症状管理是当务之急。有氧运动可能是一种针对特定血液透析相关症状的有效、非药物治疗方法。本系统评价旨在调查有氧运动对接受维持性血液透析的肾衰竭成人的血液透析相关症状的影响。
设计、地点、参与者和测量方法：我们检索了 MEDLINE、PubMed、Cochrane 中心、CINAHL、PsycINFO、SPORTDiscus、EMBASE、PEDro 和 Scopus 数据库，从 1960 年或建库起至 2020 年 4 月 15 日，以调查有氧运动对血液透析相关症状（定义为预先设定的主要或次要结局）的影响的随机对照试验，这些研究将接受维持性血液透析的成年人作为对照组。我们将不宁腿综合征确定为主要结局。
在 3048 项研究中，有 15 项随机对照试验符合入选标准。这些研究调查了有氧运动对不宁腿综合征（两项研究）、睡眠障碍（四项研究）、焦虑（四项研究）、抑郁（九项研究）、肌肉痉挛（一项研究）和疲劳（一项研究）的影响。10 项研究中的运动干预是在透析期间进行的，5 项研究中的运动干预是在血液透析之外进行的。由于干预措施和结局存在异质性，以及偏倚风险较高，大多数症状均无法进行荟萃分析。与非运动对照组相比，有氧运动可改善不宁腿综合征、肌肉痉挛和疲劳等症状。使用贝克抑郁量表进行的抑郁症状的荟萃分析表明，与对照组相比，运动组的贝克抑郁量表评分降低更多（平均差值-7.57；95%置信区间，-8.25 至-6.89）。
我们的综述表明，在接受维持性血液透析的成年人中，有氧运动可改善多种血液透析相关症状，包括不宁腿综合征、抑郁症状、肌肉痉挛和疲劳。然而，需要在更广泛的血液透析人群中使用具有可靠性和反应性的已验证的结局测量方法，以充分描述该干预措施的效果。
PROSPERO #CRD42017056658。
