School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China,
School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China,
Am J Nephrol. 2023;54(9-10):379-390. doi: 10.1159/000532109. Epub 2023 Aug 3.
Clinical guidelines recommend exercise training for patients undergoing maintenance hemodialysis (MHD). However, the effectiveness of different types of exercise remains uncertain.
The aims of the study were to compare and rank the effect of different types of exercise on walking capacity, cardiorespiratory fitness, dialysis adequacy, and health-related quality of life (HRQOL) in patients undergoing MHD.
Eight databases (four English and four Chinese) were searched from inception to January 1, 2022. Randomized controlled trials evaluating the efficacy of different exercises for patients undergoing MHD were included. Two independent reviewers screened the literature, extracted data, assessed the risk of bias, and evaluated the certainty of evidence. A frequentist random-effect network meta-analysis was conducted.
Ninety trials with 4,084 participants comparing 15 types of exercise were included, reporting on the six-minute walking test (45 trials), peak oxygen uptake (22 trials), dialysis adequacy (30 trials), and HRQOL (23 trials). Network meta-analysis showed that the most effective intervention for walking capacity was intradialytic aerobic exercise combined with blood flow restriction with a mean difference and 95% confidence interval of 97.35 (11.89-182.81), for peak oxygen uptake it was non-intradialytic combined aerobic and resistance exercise with a value of 4.35 (2.25-6.44), for dialysis adequacy it was intradialytic combined aerobic and resistance exercise with a value of 0.17 (0.06-0.28), for the physical component summary of HRQOL it was intradialytic aerobic exercise with a value of 4.93 (2.31-7.54), and for the mental component summary of HRQOL it was non-intradialytic combined aerobic and resistance exercise with a value of 6.36 (0.45-12.27). Ultimately, intradialytic combined aerobic and resistance exercise could improve all the above outcomes compared to usual care.
This study concluded that intradialytic combined aerobic and resistance exercise is optimal for MHD patients due to its significant positive effects on multiple outcomes. Walking capacity can be further enhanced by combining blood flow restriction with exercise. For improving dialysis adequacy, intradialytic exercise proves to be more effective than non-intradialytic exercise. Further well-designed clinical trials are needed to investigate the effects of exercise with varying durations, intensities, and frequencies.
临床指南建议对维持性血液透析（MHD）患者进行运动训练。然而，不同类型运动的效果仍不确定。
本研究旨在比较和排序不同类型运动对 MHD 患者的步行能力、心肺功能、透析充分性和健康相关生活质量（HRQOL）的影响。
从建库至 2022 年 1 月 1 日，检索了 8 个数据库（4 个英文数据库和 4 个中文数据库）。纳入了评估 MHD 患者不同运动效果的随机对照试验。两位独立的审查员筛选文献、提取数据、评估偏倚风险并评估证据的确定性。采用频率论随机效应网络荟萃分析。
共纳入 90 项试验，涉及 4084 名参与者，比较了 15 种运动类型，报告了 6 分钟步行测试（45 项试验）、峰值摄氧量（22 项试验）、透析充分性（30 项试验）和 HRQOL（23 项试验）。网络荟萃分析显示，步行能力最有效的干预措施是血液透析内有氧运动结合血流限制，平均差异和 95%置信区间为 97.35（11.89-182.81）；峰值摄氧量最高的是血液透析外联合有氧和抗阻运动，为 4.35（2.25-6.44）；透析充分性最好的是血液透析内联合有氧和抗阻运动，为 0.17（0.06-0.28）；HRQOL 的生理成分综合评分最高的是血液透析内有氧运动，为 4.93（2.31-7.54）；HRQOL 的心理成分综合评分最高的是血液透析外联合有氧和抗阻运动，为 6.36（0.45-12.27）。最终，与常规护理相比，血液透析内联合有氧和抗阻运动可以改善所有上述结果。
本研究得出结论，血液透析内联合有氧和抗阻运动对 MHD 患者最为有效，因为它对多种结果都有显著的积极影响。通过结合血流限制和运动可以进一步提高步行能力。为了提高透析充分性，血液透析内运动比非血液透析内运动更有效。需要进一步设计良好的临床试验来研究不同持续时间、强度和频率的运动的效果。
