ckd and exercise 中國醫藥大學北港附設醫院 復健科主任 陳信水. ckd associated...
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CKD and Exercise
中國醫藥大學北港附設醫院復健科主任陳信水
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CKD associated physical dysfunction
• Muscle wasting
• Weight loss
• Excessive fatigue
• Sexual dysfunction
• Uremic myopathy
• Uremic neuropathy
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Factors leading to poor physical function in CKD
• Inactivity
• Functional and structural muscle abnormalities
• Inflammation
• Blood flow and anemia
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History of HD exercise
• 30 years ago: first introduced.– Exercise training improves abnormal lipid and car
bohydrate metabolism in hemodialysis patients. – Trans Am Soc Artif Intern Organs. 1979;25:431-7
• Previous study:– The effectiveness of intradialytic leg ergometry ex
ercise for improving sedentary life style and fatigue among patients with chronic kidney disease: A randomized clinical trial
– Int J Nurs Stud. 2010 May 25.
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Exercise is a good advice to HD patients
• 1979-2005: many studies to HD with exercise benefits.
• Critical review to commend exercise is a good health to HD.
• 2005 to now :exercises are not provacated to suggest to HD patients. Why?
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Uncontrolled triads
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Nonrandomized controlled trials
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Randomized controlled trials
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Randomized controlled trials
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The effects of exercise
• Muscle structure and function
• Cardiac function
• Blood pressure and other cardiovascular risk factors.
• Glycemic control and insulin resistance
• HD efficiency
• Psychological adaptation, quality of life and nutrition
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The assessment of exercise capacity
• Exercise tolerance tests
• Functional capacity tests
• Neuromuscular function tests
• Muscle composition and structure.
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Aerobic exercise training during hemodialysis increased physical functioning, reduced blood pressure levels, and improved the control of anemia and quality of life in patie
nts with end-stage renal disease.
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Practical methods for applying exercise therapy
• Recommendations– Age over 65y/o or 45-64y/o with chronic diseases can
be apply to ACKD patients.• Circulation 2007;116:1094-1105
• Exercise type: aerobic, resistance and flexibility activities.– Aerobic:30 min, mod intensity, 5 days/week– Resistance: major muscle group, 2 times/week– Flexibility activities: all days that A and R performed.
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Exercise protocols
• Intra-dialysis exercise
• Home exercise
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Adaptation to exercise training in hemodialysis
• Physical adaptations to exercise training
• Functional adaptations to exercise training
• Psychologic adaptations to exercise training
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Physical adaptations to exercise training
• The cardiorespiratory system and aerobic capacity.
• Cardiac functioning.
• Muscle architecture and neuromuscular control.
• Components of metabolic syndrome.
• Dialysis adequacy.
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Functional adaptations to exercise training
• Muscular strength
• Functional performance
• Disability
• Depression• Quality of life
Psychological adaptations to exercise training
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Limitation on exercise therapy
• Exercise protocols currently available have often been developed for research.
• The dropout rate is high.
• Clear contraindication for exercise are excluded most of HD patients.
• Age-relative limitation
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Exercise is contraindicated in CKD Patients with
• a systolic blood pressure > 200 mm Hg or a diastolic blood pressure > 110 mm Hg.
• electrolyte abnormalities.
• recent myocardial infarction.
• recent changes in the electrocardiogram.
The American College of Sports Medicine (ACSM)
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Conclusion
• No large randomized controlled trials evaluating the survival benefits of exercise.
• Frail and incapacitated patients are mostly need physical rehabilitation as a part of there clinical care
• Exercise are likely to be significant gains for healthcare system by reducing the collateral costs of CKD patient who was deconditioning.