Exercício físico em pacientes com doença renal crônica terminal submetidos à hemodiálise : revisão sistemática e metanálise de ensaios clínicos randomizados

• Autor(a) principal: Scapini, Kátia Bilhar
• Data de Publicação: 2011
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca de teses e dissertações da Universidade de Passo Fundo (BDTD UPF)
• Texto Completo: http://10.0.217.128:8080/jspui/handle/tede/1077
• topic: Insuficiência renal crônica; Hemodiálise; Exercícios terapêuticos; Qualidade de vida; Envelhecimento; Chronic renal failure; Hemodialysis; Exercise therapy; Quality of life; Aging; CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA

The incidence and prevalence of end-stage renal disease (ESRD) has grown increasingly in recent years. This disease leads to physical-functional and psychological changes that hypothetically could be minimized by the physical exercise. Therefore, the aim of this study is to systematically review the effects of physical exercise on the physical-functional and psychological aspects in ESRD patients on hemodialysis (HD). For this purpose search was held in the databases MEDLINE, EMBASE, Cochrane Library and LILACS, covering the period from January 1980 until February 2011. Randomized clinical trials (RCTs) comparing aerobic exercise, resistance exercise or combined training with a control group in patients on HD were included. The outcomes of interest were: aerobic power, submaximal functional capacity (SFC), muscle strength, blood pressure at rest, left ventricular ejection fraction, depression and Kt/V. The evaluation for eligibility of the studies was performed by two reviewers independently. For data extraction of the included studies, a reviewer collected data and another reviewer examined it. A meta-analysis was performed using the random effects model. The search strategy identified 992 articles. Of these, 29 RCTs (1207 participants) were included, and six present more than one intervention group with exercises, resulting in a total of 37 groups (18 aerobic exercise, eight resistance exercise and 11 of combined training). Both the combined training (seven RCTs: 5.42 ml/kg/min; IC 95%: 4.00, 6.85; I2: 22%) and the aerobic exercise (seven RCTs: 3.97 ml/kg/min; IC 95%: 2.52, 5.43; I2: 0%) increased the aerobic power in patients on HD when compared to the control group. The resistance exercise (two RCTs), compared to the control group, increased the SFC, assessed by the walked distance in six-minutes walk test, in 21.24 meters (IC 95%: 4.14, 38.35; I2: 0%). Six studies evaluated the muscle strength, however, due to the great methodological variability between them, the data were described qualitatively, since, only in one RCT there wasn t significant increase in muscle strength. The combined training (six RCTs) significantly reduced the systolic blood pressure (SBP) in 5.84mmHg (IC 95%: -9.8, -1.88; I2: 0%) and the diastolic blood pressure (DBP) in 3.90 mmHg (IC 95%: -6.20, -1.60; I2: 10%) when compared to the control group. However, the same was not observed with the aerobic exercise (six RCTs, SBP: -0.84 mmHg; IC 95%: -7.18, 5.51; I2: 0% and DBP: 0.68 mmHg; IC 95%: -3.38, 4.74; I2: 35%). The ejection fraction did not significantly increased when compared combined training (two RCTs: 4.56 %; IC 95%: -0.17, 9.29; I2: 0%) or aerobic exercise (two RCTs: 1.88 %; IC 95%: -3.89, 7.65; I2: 0%) with control group. Both the combined training (two RCTs: -7.61; IC 95%: -9.65, -5.57; I2: 0%) and the aerobic exercise (two RCTs: -6.34; IC 95%: -7.80, -4.89; I2: 0%) reduced the Beck Depression Inventory scores when compared to control group. Any type of exercise significantly changed the Kt/V when compared to control group (combined training, two RCTs: -0.01; IC 95%: -0.18, 0.16; I2: 24%, aerobic exercise, five RCTs: 0.05; IC 95%: -0.10, 0.21; I2: 0% and resistance exercise, two RCTs: -0.26; IC 95%: - 0.55, 0.03; I2: 49%). Conclusions: Thus, it was concluded that the combined training increases the aerobic power and decreases the blood pressure levels and depression in end-stage renal patients on HD, while the aerobic exercise alone increases the aerobic power and reduces the depression scores and the resistance exercise increases the submaximal functional capacity of renal patients on HD