Liu Yixiu, Luo Xiju, Deng Siyan, Chen Jing, Zhang Lu, Huang Ying, Hu Huagang
School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China.
Xi'an Medical University, Xi'an, Shan'xi, China.
Semin Dial. 2023 Jul-Aug;36(4):278-293. doi: 10.1111/sdi.13162. Epub 2023 Jun 14.
Exercise brings many benefits to patients undergoing maintenance hemodialysis (MHD), but the effect of combined aerobic and resistance exercise remains unclear. English and Chinese databases (PubMed, Cochrane Library, Embase, Web of Science, CNKI, VIP, Wan Fang, and CBM) were searched from inception to January 2023 to retrieve qualified randomized controlled trials. The literature selection, data extraction, and risk of bias assessment of included studies were conducted independently by two reviewers. Meta-analysis was performed using RevMan 5.3 software. A total of 23 studies with 1214 participants were included, and 17 of the interventions were conducted during dialysis. Results showed that combined aerobic and resistance exercise (CARE) improved the peak oxygen uptake, six-minute walking test, 60 s sit-to-stand test (STS), 30 s STS, dialysis adequacy, five (out of eight) domains and physical component summary of health-related quality of life (HRQOL) measured by the Medical Outcomes Study Short Form-36, blood pressure, and hemoglobin for MHD patients compared with usual care. No significant changes were found in the mental component summary of HRQOL, C-reactive protein, creatinine, potassium, sodium, calcium, and phosphate. Subgroup analysis showed that intradialytic CARE ameliorated more outcomes, except for handgrip strength and hemoglobin, than non-intradialytic ones. CARE is an effective way to improve physical function, aerobic capacity, dialysis adequacy, and HRQOL for MHD patients. Strategies should be implemented by clinicians and policymakers to motivate patients to do more exercise. Well-designed clinical trials are warranted to explore the effectiveness of non-intradialytic CARE.
运动给维持性血液透析（MHD）患者带来诸多益处，但有氧运动和抗阻运动相结合的效果仍不明确。检索了英文和中文数据库（PubMed、Cochrane图书馆、Embase、Web of Science、中国知网、维普、万方和中国生物医学文献数据库），检索时间从建库至2023年1月，以获取合格的随机对照试验。纳入研究的文献筛选、数据提取和偏倚风险评估由两名 reviewers 独立进行。使用RevMan 5.3软件进行Meta分析。共纳入23项研究，1214名参与者，其中17项干预在透析期间进行。结果显示，与常规护理相比，有氧运动和抗阻运动相结合（CARE）改善了MHD患者的峰值摄氧量、六分钟步行试验、60秒坐立试验（STS）、30秒STS、透析充分性、由医学结局研究简表36测量的健康相关生活质量（HRQOL）的八个领域中的五个领域和身体成分总结、血压和血红蛋白。HRQOL的心理成分总结、C反应蛋白、肌酐、钾、钠、钙和磷酸盐未见显著变化。亚组分析显示，透析期间的CARE比非透析期间的CARE改善了更多结局，除握力和血红蛋白外。CARE是改善MHD患者身体功能、有氧运动能力、透析充分性和HRQOL的有效方法。临床医生和政策制定者应实施策略，激励患者进行更多运动。有必要开展设计良好的临床试验，以探索非透析期间CARE的有效性。
