慢性腎臟病患規律運動可強化心臟健康


  【24drs.com】慢性腎臟病(CKD)患者的體適能一般會漸漸衰退,但線上刊載於10月5日考科藍實證醫學資料庫(Cochrane Database of Systematic Reviews)的一篇新統合分析提出證據指出,規律運動可顯著改善體適能、心血管測量數據、營養參數與健康相關的生活品質。這項結果適合各類病患,從早期慢性腎臟病到透析患者或接受腎臟移植者都適用。
  
  瑞典斯德哥爾摩Karolinska研究中心醫學與臨床科學系的Susanne Heiwe博士和Stefan H. Jacobson博士回顧文獻指出,給CKD病患的運動處方建議是:在監督之下進行4-6個月的規律運動(每週3次)、高強度混合心血管與耐力訓練持續30-90分鐘,為了維持最大效果,病患必須持續規律運動。
  
  體適能方面有許多改善,特別是有氧活動能力(24篇研究、847名研究對象;標準平均差(SMD),-0.56;95%信心區間[CI],-0.70至-0.42)與行走能力(7篇研究、191名研究對象;SMD,-0.36;95% CI,-0.65至-0.06)尤其顯著。
  
  各項心血管數據也有明顯效益:
  * 休息時的舒張壓:11篇研究、419名研究對象(平均差異[MD],2.32 mm Hg;95% CI,0.59 - 4.05 mm Hg);
  * 休息時的收縮壓:9篇研究、347名研究對象(MD,6.08 mm Hg;95% CI,2.15 - 10.12 mm Hg);
  * 心律:11篇研究、229名研究對象(MD,6 bpm;95% CI,10 - 2 bpm);
  * 營養參數包括:
   白蛋白:3篇研究、111名研究對象(MD,-2.28 g/L;95% CI,-4.25至0.32 g/L);
   前白蛋白:3篇研究、111名研究對象(MD,-44.02 mg Cl;95% CI,-71.52 至16.53 mg Cl);
   熱量攝取:4篇研究、97名研究對象(SMD,-0.47;95% CI,-0.88至-0.05);
  * 健康相關的生活品質。
  
  不論運動類型、強度、介入期間或監督,可顯著改善高密度脂蛋白膽固醇(4篇研究、166名研究對象;MD -0.14 mmol/L MD;95% CI,-23 - 0.04 mmol/L;P = .005),但是,三酸甘油脂、總膽固醇、空腹血糖則無顯著改變。
  
  作者們搜尋了Cochrane Renal Group的專屬資料庫,涵蓋各種語言的研究文獻。他們選擇了納入CKD或腎臟移植成人病患進行至少8週體能運動計畫的隨機控制試驗,排除介入持續不到8週、僅建議增加體能活動、未進行共同介入或兩組都有做的研究。
  
  這篇回顧納入了45篇隨機試驗,共有1,863名病患,其中,32 篇符合統合分析規範;這些研究的介入方式涵蓋各種運動處方,包括心血管訓練、混合心血管與耐力訓練、僅有耐力訓練與瑜珈。符合納入的條件包括,運動處方必須持續至少20分鐘,研究者納入分析的包括高強度與低強度運動,以及受監督與未受監督的處方。報告運動順從性的14篇研究中,11篇研究發現高順從性,1篇有中度順從性,低順從性則無,只有1篇研究提到運動相關的傷害。
  
  研究者發現許多方面的研究基礎不夠,包括肌肉耐力、肌肉型態與型態測量、生理功能(例如登梯)、其他心血管方面(例如心律不整)、肌肉量、全身發炎、日常生活的體能活動、憂鬱、脂質、葡萄糖代謝、退出率、順從性、副作用和死亡率。此外,作者們建議,比較運動和藥物治療(例如statin類藥物)的效果,研究優勢在於提出心血管運動,後續研究應注重耐力訓練的效果,不論是單獨或併用心血管運動訓練。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6626&x_classno=0&x_chkdelpoint=Y
  

Regular Exercise Can Boost Health in Patients With CKD

By Laura Newman
Medscape Medical News

October 7, 2011 — Declining physical fitness is common among people with chronic kidney disease (CKD), but a new meta-analysis published online October 5 in the Cochrane Database of Systematic Reviews provides evidence showing that regular exercise can significantly improve physical fitness, cardiovascular measures, some nutritional parameters, and health-related quality of life. The results apply to patients across the spectrum, from those with early chronic kidney disease lasting more than 3 months, to those on dialysis, to those who received kidney transplants.

Susanne Heiwe, PhD, and Stefan H. Jacobson, MD, PhD, from the Department of Medicine and Clinical Sciences, Karolinska Institutet, Stockholm, Sweden, reviewed the evidence. They write: "[I]n adults with CKD the following exercise regimen is recommended: four to six months supervised, regular (three sessions/week), high intensity mixed cardiovascular and resistance training lasting 30 to 90 minutes. To maintain this peak effect the patient has to continue with the regular exercise training intervention."

Improvement in several areas of physical fitness, particularly aerobic capacity (24 studies, 847 participants; standardized mean difference (SMD), ?0.56; 95% confidence interval [CI], ?0.70 to ?0.42) and walking capacity (7 studies, 191 participants; SMD, ?0.36; 95% CI, ?0.65 to ?0.06) was striking.

Cardiovascular benefits were also demonstrated for the following dimensions:

  • resting diastolic blood pressure: 11 studies, 419 participants (mean difference method [MD], 2.32 mm Hg; 95% CI, 0.59 - 4.05 mm Hg);
  • resting systolic blood pressure: 9 studies, 347 participants (MD, 6.08 mm Hg; 95% CI, 2.15 - 10.12 mm Hg);
  • heart rate, 11 studies, 229 participants (MD, 6 bpm; 95% CI, 10 - 2 bpm);
  • some nutritional parameters:
    • albumin: 3 studies, 111 participants (MD, ?2.28 g/L; 95% CI, ?4.25 to 0.32 g/L);
    • prealbumin: 3 studies, 111 participants (MD, ?44.02 mg Cl; 95% CI, ?71.52 to 16.53 mg Cl;
    • energy intake: 4 studies, 97 participants (SMD, ?0.47; 95% CI, ?0.88 to ?0.05);
  • and health-related quality of life.

Statistically significant improvement in high-density lipoprotein cholesterol was shown with regular exercise, regardless of type, intensity, length of intervention, or supervision (4 studies, 166 participants; MD ?0.14 mmol/L MD; 95% CI, ?23 - 0.04 mmol/L; P = .005), but there were no significant changes in triglycerides, total cholesterol, or fasting blood glucose.

The authors searched the Cochrane Renal Group's specialized register, which encompasses studies in all languages. They selected reviews of any randomized controlled trial that enrolled adults with CKD or kidney transplant in physical exercise programs for a minimum of 8 weeks. They excluded studies involving interventions that lasted less than 8 weeks, those only advising an increase in physical activity, and studies in which co-interventions were not applied or given to both groups.

Forty-five studies that randomly assigned 1863 patients to groups were included in this review. Of these, 32 satisfied criteria for meta-analysis. Interventions in those studies covered a range of exercise regimens, including cardiovascular training, mixed cardiovascular and resistance training, resistance-only training, and yoga. To be included in the review, the exercise regimen had to be at least 20 minutes long, but the investigators included studies on both high- and low-intensity exercise and studies on both supervised and unsupervised regimens

Of 14 studies reporting compliance with exercise, 11 studies found high compliance, 1 had moderate compliance, and none reported low compliance. Only 1 study reported exercise-induced injuries.

The investigators flagged several areas as having an insufficient research base. These include attention to muscular endurance, muscle morphology and morphometrics, physical function (such as stair climbing), other cardiovascular dimensions (eg, arrhythmias), muscle mass, systemic inflammation, level of physical activity in daily living, depression, lipids, glucose metabolism, drop-out rates, compliance, adverse events, and mortality. In addition, the authors recommend study of the effects of exercise vs drug treatment (eg, statins), or as a compliment to statins. The preponderance of research has addressed cardiovascular exercise, and the authors state that future research should give a high priority to assessing the effects of resistance training interventions, either alone or in combination with cardiovascular exercise training.

The authors have disclosed no relevant financial relationships.

Cochr Datab System Rev. Published online October 5, 2011.

    
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