Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA.
Am J Nephrol. 2021;52(5):420-428. doi: 10.1159/000516130. Epub 2021 May 12.
A randomized, controlled trial of a pedometer-based walking intervention with weekly activity goals led to increased walking among dialysis patients. We examined whether impairment per cognitive function screening is associated with adherence and performance in the intervention.
Thirty dialysis patients were randomly assigned to a 3-month pedometer-based intervention with weekly goals. Participants were administered the Telephone Interview of Cognitive Status (TICS), a test of global mental status. We examined the association of levels of impairment on the TICS (≥33: unimpaired, 26-32: ambiguous impairment, 21-25: mild cognitive impairment [MCI]) with adherence, achieving weekly goals, and increasing steps, physical performance (Short Physical Performance Battery, SPPB), and self-reported physical function (PF) through multivariable linear mixed-model and logistic regression analyses adjusted for age, sex, BMI, dialysis modality, baseline steps, baseline SPPB, and stroke status.
One-third of participants were unimpaired, and 13% had MCI. Participants with worse results on cognitive function screening missed more calls and completed fewer weekly goals than participants with better results. During the intervention, a worse result on cognitive function screening was associated with smaller increases in steps compared to those without impairment: (ambiguous: -620 [95% CI -174, -1,415], MCI: -1,653 [95% CI -120, -3,187]); less improvement in SPPB (ambiguous: -0.22 points [95% CI -0.08, -0.44], MCI: -0.45 [95% CI -0.13, -0.77]); and less improvement in PF (ambiguous: -4.0 points [95% CI -12.2, 4.1], MCI: -14.0 [95% CI -24.9, -3.1]). During the postintervention period, a worse result on cognitive function screening was associated with smaller increases in SPPB (ambiguous: -0.54 [95% CI -1.27, 0.19], MCI: -0.97 [95% CI -0.37, -1.58]) and PF (ambiguous: -3.3 [95% CI -6.5, -0.04], MCI: -10.5 [95% CI -18.7, -2.3]).
DISCUSSION/CONCLUSION: Participants with worse results on cognitive function screening had worse adherence and derived less benefit from this pedometer-based intervention. Future exercise interventions should be developed incorporating methods to address cognitive impairment, for example, by including caregivers when planning such interventions.
一项基于计步器的步行干预研究，每周设定活动目标，随机对照试验结果显示，这种方法增加了透析患者的步行量。我们研究了认知功能筛查的损伤程度是否与干预过程中的依从性和表现有关。
30 名透析患者被随机分配到基于计步器的 3 个月干预组，每周设定目标。参与者接受了电话认知状态测试（TICS），这是一种测试整体精神状态的测试。我们通过多变量线性混合模型和逻辑回归分析，检查 TICS 上损伤程度（≥33：无损伤，26-32：模糊损伤，21-25：轻度认知障碍[MCI]）与依从性、实现每周目标以及增加步数、身体表现（简短身体表现电池，SPPB）和自我报告的身体功能（PF）之间的关系，调整了年龄、性别、BMI、透析方式、基线步数、基线 SPPB 和中风状况。
三分之一的参与者没有损伤，13%的参与者有 MCI。认知功能筛查结果较差的参与者比结果较好的参与者错过的电话更多，完成的每周目标更少。在干预期间，认知功能筛查结果较差与步数增加较少相关：（模糊：-620[95%CI-174，-1,415]，MCI：-1,653[95%CI-120，-3,187]）；SPPB 改善较小（模糊：-0.22 点[95%CI-0.08，-0.44]，MCI：-0.45[95%CI-0.13，-0.77]）；PF 改善较小（模糊：-4.0 点[95%CI-12.2，4.1]，MCI：-14.0[95%CI-24.9，-3.1]）。在干预后期间，认知功能筛查结果较差与 SPPB（模糊：-0.54[95%CI-1.27，0.19]，MCI：-0.97[95%CI-0.37，-1.58]）和 PF（模糊：-3.3[95%CI-6.5，-0.04]，MCI：-10.5[95%CI-18.7，-2.3]）的改善较小有关。
讨论/结论：认知功能筛查结果较差的参与者依从性较差，从基于计步器的干预中获益较少。未来的运动干预措施应制定方法来解决认知障碍问题，例如，在规划此类干预措施时包括照顾者。
