Efeito do exercício aeróbico à distância em relação ao presencial sobre os parâmetros cardiorrespiratórios e capacidade funcional de pacientes com doença renal crônica e excesso de peso

• Autor(a) principal: Aoike, Danilo Takashi [UNIFESP]
• Data de Publicação: 2016
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=3607321; http://repositorio.unifesp.br/handle/11600/46174
• topic: Aerobic exercise; Cardiopulmonary and functional capacity; CKD; Doença renal crônica; Exercício aeróbico; Capacidade física; Qualidade de vida

Introduction: In patients with chronic kidney disease (CKD) the presence of overweight or obesity is associated with several metabolic complications, including worsening renal function. In addition, the association between CKD and excess body fat can lead to aggravation of cardiorespiratory capacity, physical function and quality of life of the patients. Studies show that aerobic training improves several aspects of physical capacity of these patients. Although the incorporation of physical exercise on a CKD standard treatment is a challenge and this is recommended by current guidelines for all stages of disease. Besides, the lack of studies showing real benefits of practical and affordable programs further complicates the implementation of training programs for these patients. Objective: The aim of this study was compare the performance of aerobic exercise performed remotely (home-based) with the conducted in person (center-base) on cardiorespiratory and functional capacity of overweight patients with non- dialysis dependent CKD (stage 3 or 4). Methods: This was a prospective, randomized, interventional, controlled trial of a 24 weeks. Forty sedentary patients were studied (27 men), aged 55.5±8.3 years (mean±SD); BMI of 31.2±4.4 kg/m2 and estimated glomerular filtration rate of 26.9±11.7 mL/min/1.73m2. The patients were randomly assigned to the control group or the exercise group. Those who were assigned to the exercise group could choose to perform the home-based exercise or center-based exercise. The control group was instructed not to perform exercise during the follow-up. The patients from the center-based exercise group performed the aerobic training on a treadmill three times per week during 12 weeks on 9 alternate days at the Psychobiology and Exercise Study Centre under supervision of an exercise physiologist. The patients from the home-based exercise group performed aerobic training at locations nearby their home, backyard, park or street three times per week on alternate days during 12 weeks according to the instructions given by exercise physiologist. The exercised groups were subjected to the same continuous aerobic exercise protocol consisted of three weekly sessions on alternate days, at the intensity of anaerobic threshold lasting 30 minutes. The duration was increased by 10 minutes every four weeks until it reached 50 minutes. Patients underwent assessment of cardiorespiratory fitness, functional capacity tests, the questionnaire of quality of life (SF-36), questionnaire of quality of sleep (Pittsburgh sleep quality index) and routine laboratory tests before, after 12 weeks and after 24 weeks of follow-up. Results: A significant increase (p<0.05) of VO2 peak, speed at anaerobic threshold, VO2 at respiratory compensation point and maximum ventilation was observed after 12 weeks of training in the home-based group, reaching values similar to those obtained in the center-based group . As for the functional testing was observed improvement in 6-minute walk test, time up and go test, step test, sit and stand test and arm curl test was found after 12 weeks of training in the home-based group, achieving values not different from those in the center-based group. In both exercised groups the values achieved in the tests were maintained until the end of 24 weeks. No changes in those parameters were observed in the control group. The benefits observed in cardiorespiratory parameters and functional capacity resulting from the exercise reflected in improved quality of life and sleep. In addition, only in the exercised groups there 10 was a decrease in blood pressure, with no change in antihypertensive medication, sodium intake and body weight. No adverse effects were observed. Conclusion: Home-based aerobic training promoted similar benefits to those found in the center-based group in cardiorespiratory fitness, functional capacity, quality of life and sleep besides reducing blood pressure of overweight patients with CKD. The results of this study indicate that home-based exercise is effective and can be used safely.