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. Eu.2 = 24%, QoE moderado) no pico de VO2; 77,78 m (IC95% = 33,27-122,30; Eu.2 = 44,5%, QoE moderado) nas repetições 6MWT e 7,65 (IC95% = 5,73-9,58; Eu.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.系统评价评估仅有氧运动对比常规护理对透析前患者运动耐量、功能能力及生活质量（quality of life, QoL）影响的随机对照试验（randomized controlled trials, RCTs）。截至2021年2月，在MEDLINE、Cochrane CENTRAL、EMBASE、PEDro及LILACS数据库中开展的检索，共纳入评估有氧运动对峰值摄氧量（peak VO2）、功能能力、下肢肌肉力量及QoL影响的RCTs。本研究采用随机效应Meta分析模型进行统计分析，结果以均数差（mean difference, MD）及95%置信区间（confidence interval, CI）、偏倚风险（通过偏倚风险评估工具2.0版RoB2.0评估）、证据质量（通过推荐分级的评估、制订与评价系统GRADE分级）进行报告。本研究共纳入10项RCTs，涉及365例患者。相较于常规护理，有氧运动可使患者峰值摄氧量提升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）步行距离增加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）重复次数增加7.65次（95% CI=5.73~9.58；I²=0%，证据质量中等）。在QoL方面，纳入研究均报告患者的生活质量问卷评分得到改善。有氧运动可提升透析前患者的峰值摄氧量、功能能力及下肢肌肉力量，对生活质量的改善亦存在积极获益。建议在慢性肾脏病（chronic kidney disease）各阶段患者的康复治疗中推广有氧运动。有氧运动可改善运动耐量、功能能力及下肢肌肉力量，现有证据表明其对生活质量的提升具有正向作用。