Effects of aerobic exercise on patients with pre-dialysis chronic kidney disease: a systematic review of randomized controlled trials

Reviewing systematically the randomized controlled trials (RCTs) that evaluated aerobic exercisealone vs. usual care in exercise tolerance, functional capacity, and quality of life (QoL) in patients withpre-dialysis. Searches in the MEDLINE, Cochrane CENTRAL, EMBASE, PEDro, and LILACS databases untilFebruary 2021 included RCTs that evaluated the effects of aerobic exercise on peak VO₂, functional capacity,lower limb muscle strength, and QoL. The random effect meta-analysis model was used andreported as mean difference (MD) and 95% confidence interval (CI), risk of bias through RoB2.0 and thequality of evidence by GRADE. 10 RCTs, with 365 patients. Aerobic exercise increased 2.07 ml/kg/min (95% CI = 1.16 to 2.98; I2= 24%, QoE moderate) at peak VO₂; 77.78m (95% CI= 33.27 to 122.30; I2= 44.5%, QoE moderate) in the 6MWT and 7.65 repetitions (95% CI= 5.73 to 9.58; I2= 0 %; QoE moderate) in STS-30 versus usual care. In QoL, studies reported improvements in the questionnaire scores. <i>Eu.</i>² = 24%, QoE moderado) no pico de VO₂; 77,78 m (IC95% = 33,27-122,30; <i>Eu.</i>² = 44,5%, QoE moderado) nas repetições 6MWT e 7,65 (IC95% = 5,73-9,58; <i>Eu.</i>² = 0%; QoE moderado) em STS-30" Aerobic exercise increases VO₂ peak, functional capacity and lower limb muscle strength in patients with pre-dialysis. Effects on QoL appear to be beneficial. Aerobic exercise should be encouraged in the rehabilitation of patients at any stage of chronic kidney disease. Aerobic exercise promotes improved exercise tolerance, functional capacity, and muscle strength of the lower limbs. There is some evidence to show it is beneficial to improve the quality of life.

本研究系统评价了针对预透析患者，对比单纯有氧运动与常规护理在运动耐量、功能能力及生活质量（Quality of Life, QoL）方面效果的随机对照试验（Randomized Controlled Trials, RCTs）。检索截至2021年2月的MEDLINE、Cochrane CENTRAL、EMBASE、PEDro及LILACS数据库，纳入评估有氧运动对峰值摄氧量（peak VO₂）、功能能力、下肢肌肉力量与生活质量影响的RCTs。采用随机效应模型进行Meta分析，结果以均数差（mean difference, MD）及95%置信区间（confidence interval, CI）报告；通过RoB2.0工具评估偏倚风险，采用GRADE系统评价证据质量。共纳入10项RCTs，涉及365例患者。与常规护理相比，有氧运动可使峰值摄氧量提升2.07 ml/kg/min（95%CI：1.16~2.98；I²=24%，证据质量中等），6分钟步行试验（6MWT）距离增加77.78 m（95%CI：33.27~122.30；I²=44.5%，证据质量中等），30秒坐站试验（STS-30）的重复次数增加7.65次（95%CI：5.73~9.58；I²=0%，证据质量中等）。在生活质量方面，多项研究报告了问卷评分的改善情况。有氧运动可提升预透析患者的峰值摄氧量、功能能力与下肢肌肉力量，对生活质量的改善亦具有获益趋势。建议在慢性肾脏病各阶段患者的康复管理中推广有氧运动。有氧运动可改善运动耐量、功能能力与下肢肌肉力量，现有证据表明其对提升生活质量具有积极作用。