Bradshaw Ellen, Alejmi Abdulfattah, Rossetti Gabriella, D'Avossa Giovanni, Macdonald Jamie Hugo
Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom.
Department of Renal Medicine, Betsi Cadwaladr University Health Board, Bangor, United Kingdom.
Clin J Am Soc Nephrol. 2024 Nov 1;19(11):1461-1472. doi: 10.2215/CJN.0000000000000533. Epub 2024 Jul 31.
Cognitive impairment is common in CKD. Exercise targets multiple risk factors of cognitive decline. Meta-analysis found that exercise had a small but positive effect on cognitive function in CKD, albeit the quality of evidence was low. Further analyses revealed that aerobic exercise was particularly beneficial and that exercise did not substantially increase harms.
People living with CKD are at higher risk of cognitive impairment. Exercise may improve cognitive function. This systematic review and meta-analysis of randomized controlled trials was completed to determine the efficacy and harms of exercise in improving cognitive function in people living with CKD.
A systematic literature review identified randomized controlled trials of people with any stage of CKD, with an intervention that exercised large-muscle groups, and with a validated outcome measure of cognitive function. First, harms were analyzed. Then a random-effects meta-analysis was completed with subsequent planned subgroup analyses to investigate heterogeneity between CKD stages and treatments; between different exercise types, durations, and intensities; and between different outcome methodologies. Finally, quality of evidence was rated.
Nineteen trials randomized 1160 participants. Harms were reported on 94 occasions in intervention groups versus 83 in control. The primary analysis found that exercise had a small but statistically significant effect on cognition in CKD (effect size=0.22; 95% confidence intervals, 0.00 to 0.44; = 0.05). However, the quality of evidence was rated as low. Subgroup analyses found that type of exercise moderated the effect on cognition (chi square=7.62; = 0.02), with positive effects only observed following aerobic exercise (effect size=0.57; 95% confidence interval, 0.21 to 0.93; = 0.002).
Across the spectrum of CKD, exercise had a small but positive and clinically meaningful effect on cognitive function and did not seem to be harmful. Aerobic exercise was particularly beneficial. However, the results must be interpreted cautiously because of the low quality of evidence. Nevertheless, care teams may choose to recommend aerobic exercise interventions to prevent cognitive decline. Researchers should design unbiased studies to clarify what intensity and duration of exercise is required to maximize efficiency of such exercise interventions.
认知障碍在慢性肾脏病（CKD）中很常见。运动针对认知衰退的多种风险因素。荟萃分析发现，运动对CKD患者的认知功能有微小但积极的影响，尽管证据质量较低。进一步分析表明，有氧运动特别有益，且运动不会大幅增加危害。
CKD患者发生认知障碍的风险更高。运动可能改善认知功能。本系统评价和随机对照试验的荟萃分析旨在确定运动对CKD患者认知功能的疗效和危害。
系统文献回顾确定了针对任何CKD阶段患者的随机对照试验，干预措施为锻炼大肌肉群，并采用经过验证的认知功能结局指标。首先分析危害。然后进行随机效应荟萃分析，并随后进行计划中的亚组分析，以研究CKD阶段和治疗之间、不同运动类型、持续时间和强度之间以及不同结局方法之间的异质性。最后对证据质量进行评级。
19项试验将1160名参与者随机分组。干预组报告了94次危害事件，对照组为83次。初步分析发现，运动对CKD患者的认知有微小但具有统计学意义的影响（效应量=0.22；95%置信区间，0.00至0.44；P = 0.05）。然而，证据质量被评为低。亚组分析发现，运动类型对认知的影响存在差异（卡方=7.62；P = 0.02），仅在有氧运动后观察到积极影响（效应量=0.57；95%置信区间，0.21至0.93；P = 0.002）。
在整个CKD范围内，运动对认知功能有微小但积极且具有临床意义的影响，且似乎无害。有氧运动尤其有益。然而，由于证据质量低，结果必须谨慎解释。尽管如此，护理团队可能会选择推荐有氧运动干预措施以预防认知衰退。研究人员应设计无偏倚的研究，以明确需要何种强度和持续时间的运动才能使此类运动干预措施的效率最大化。
