Effect of Aerobic Exercise on Dialysis-Related Symptoms in Individuals Undergoing Maintenance Hemodialysis A Systematic Review and Meta-Analysis of Clinical Trials
Effect of Aerobic Exercise on Dialysis-Related Symptoms in Individuals Undergoing Maintenance Hemodialysis A Systematic Review and Meta-Analysis of Clinical Trials
复制标题
DOI：
10.2215/cjn.15080920
复制
发表时间：
2021-04-07
影响因子：
9.8
通讯作者：
Bohm, Clara
中科院分区：
文献类型：
--
作者：
Hargrove, Nicholas;El Tobgy, Nada;Bohm, Clara
血液透析与高症状负担相关，损害健康相关的生活质量和功能状态。有效的症状管理是接受血液透析的个体的优先事项。有氧运动可能是一种有效的非药物治疗特定血液透析相关症状。本系统综述研究了有氧运动对维持性血液透析成人肾功能衰竭患者血液透析相关症状的影响。设计、环境、参与者和测量方法：研究medline、PubMed、CochraneCENTRAL、CINAHL、PsycINFO、SPORTDiscus、EMBASE、PEDro和Scopus数据库，从1960年或成立之初至2020年4月15日，研究有氧运动对血液透析相关症状的影响的随机对照试验，确定为预先指定的主要或次要结局，并与维持血液透析的成人对照组进行比较。我们确定不宁腿综合征为主要结局。结果在3048项研究中，15项随机对照试验符合入选标准。这些研究调查了有氧运动对不宁腿综合征（2项研究）、睡眠障碍（4项研究）、焦虑（4项研究）、抑郁（9项研究）、肌肉痉挛（1项研究）和疲劳（1项研究）的影响。在10项研究中，运动干预是透析内的，在5项研究中，运动干预是血液透析外的。异质性干预措施和结果以及中至高偏倚风险排除了对大多数症状的荟萃分析。与不运动的对照组相比，有氧运动显示出不宁腿综合征、肌肉痉挛和疲劳症状的改善。在使用贝克抑郁量表的研究中，对抑郁症状的荟萃分析显示，与对照组相比，运动组的贝克抑郁量表得分降低幅度更大（平均差值27.57；95%可信区间28.25至26.89）。结论：我们的综述表明，在维持性血液透析的成年人中，有氧运动可以改善几种与血液透析相关的症状，包括不宁腿综合征、抑郁症状、肌肉痉挛和疲劳。然而，需要在更多样化的血液透析人群中使用经过验证的结果测量，证明其可靠性和反应性，以充分表征该干预措施的效果。
Background Hemodialysis is associated with a high symptom burden that impairs health-related quality of life and functional status. Effective symptom management is a priority for individuals receiving hemodialysis. Aerobic exercise may be an effective, nonpharmacologic treatment for specific hemodialysis-related symptoms. This systematic reviewinvestigatedthe effect of aerobic exercise on hemodialysis-related symptomsinadultswith kidney failure undergoing maintenance hemodialysis. Design, setting, participants,& measurementsWesearchedMEDLINE, PubMed, CochraneCENTRAL, CINAHL, PsycINFO, SPORTDiscus, EMBASE, PEDro, and Scopus databases from1960 or inception until April 15, 2020 for randomized controlled trials investigating the effect of aerobic exercise on hemodialysis-related symptoms, identified as prespecified primary or secondary outcomes, as compared with controls in adults on maintenance hemodialysis. We identified restless legs syndrome as the primary outcome. Results Of 3048 studies identified, 15 randomized controlled trials met the eligibility criteria. These studies investigated the effect of aerobic exercise on restless legs syndrome (twostudies), sleep disturbance (four studies), anxiety (four studies), depression (nine studies), muscle cramping (one study), and fatigue (one study). Exercise interventions were intradialytic in ten studies and outside of hemodialysis in five studies. Heterogenous interventions and outcomes and moderate to high risk of bias precluded meta-analysis for most symptoms. Aerobic exercise demonstrated improvement in symptoms of restless legs syndrome, muscle cramping, and fatigue, as compared with nonexercise controls. Meta-analysis of depressive symptoms in studies using the Beck Depression Inventory demonstrated a greater reduction in Beck Depression Inventory score with exercise as compared with control (mean difference 27.57; 95% confidence interval, 28.25 to 26.89). Conclusions Our review suggests that in adults onmaintenance hemodialysis, aerobic exercise improves several hemodialysis-related symptoms, including restless legs syndrome, symptoms of depression, muscle cramping, andfatigue. However, theuse ofvalidatedoutcomemeasureswithdemonstrated reliability andresponsiveness in more diverse hemodialysis populations is required to fully characterize the effect of this intervention.