Song Yangyang, Chen Lei, Wang Meng, He Quan, Xue Jinhong, Jiang Hongli
Dialysis Department of Nephrology Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Front Physiol. 2022 Sep 19;13:945465. doi: 10.3389/fphys.2022.945465. eCollection 2022.
Physical inactivity is highly prevalent in patients with hemodialysis, and a large body of evidence reported the positive effect of different exercise modalities on their health outcomes. However, the effective dosage of exercise for hemodialysis patients still requires verification. We aimed to determine the most effective exercise intensity and modality for improvements in physical function, blood pressure control, dialysis adequacy, and health-related quality of life for hemodialysis patients. Systematic review with network meta-analysis of randomized trials. Five electronic databases (PubMed, EMBASE, Web of Science, Cochrane CENTRAL, and Scopus) were searched for randomized controlled trials. Data extraction and quality appraisal were conducted by two authors independently. Data were analyzed by the R (version.3.6.2) and the Stata (version.15.0). We included 1893 patients involving four exercise modalities and six exercise intensities. Combined training (aerobic exercise plus resistance exercise) has been the top-ranking exercise modality for improving the 6-min walk test (6MWT) (surface under the cumulative ranking curve analysis (SUCRA) score, 90.63), systolic blood pressure control (SUCRA score, 77.35), and diastolic pressure control (SUCRA score, 90.56). Moreover, the top-ranking exercise intensity was moderate-vigorous for 6MWT (SUCRA score, 82.36), systolic blood pressure (SUCRA score, 77.43), and diastolic blood pressure (SUCRA score, 83.75). Regarding dialysis adequacy and health-related quality of life, we found no exercise modality or intensity superior to the placebo. This network meta-analysis indicated that combined training and moderate-vigorous intensity might be the most effective interventions to improve 6MWT and blood pressure control. This finding helps further guide clinical exercise prescriptions for hemodialysis patients. : [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021268535].
血液透析患者身体活动不足的情况非常普遍，大量证据表明不同运动方式对他们的健康状况有积极影响。然而，血液透析患者运动的有效剂量仍需验证。我们旨在确定最有效的运动强度和方式，以改善血液透析患者的身体功能、血压控制、透析充分性以及与健康相关的生活质量。对随机试验进行系统评价和网状Meta分析。检索了五个电子数据库（PubMed、EMBASE、Web of Science、Cochrane CENTRAL和Scopus）以查找随机对照试验。由两位作者独立进行数据提取和质量评估。使用R（版本3.6.2）和Stata（版本15.0）进行数据分析。我们纳入了1893名患者，涉及四种运动方式和六种运动强度。联合训练（有氧运动加抗阻运动）在改善6分钟步行试验（6MWT）（累积排序曲线下面积分析（SUCRA）得分，90.63）、收缩压控制（SUCRA得分，77.35）和舒张压控制（SUCRA得分，90.56）方面一直是排名第一的运动方式。此外，在6MWT（SUCRA得分，82.36）、收缩压（SUCRA得分，77.43）和舒张压（SUCRA得分，83.75）方面，排名第一的运动强度是中等强度到高强度。关于透析充分性和与健康相关的生活质量，我们没有发现哪种运动方式或强度优于安慰剂。这项网状Meta分析表明，联合训练和中等强度到高强度可能是改善6MWT和血压控制的最有效干预措施。这一发现有助于进一步指导血液透析患者的临床运动处方。：[https://www.crd.york.ac.uk/PROSPERO/]，标识符[CRD42021268535]
