腎病及運動

Renal Rehabilitation

New concept of kidney disease rehabilitation

In recent years, the concept of exercise renal rehabilitation has become more common among nephrologists, dialysis experts, kidney transplant experts, and rehabilitation experts.

Glomerulonephritis
Nephrotic Syndrome

With proper exercise during the dormant phase of the disease, improvement in the quality of life of both adults and children was observed in glomerulonephritis and nephrotic syndrome1,2.

1. Yoshida S. Ventilatory threshold in patients with chronic glomerulonephritis. Nihon Jinzo Gakkai shi. 1993;35(6):695–703.
2. Berg U, Bohlin AB, Freyschuss U, Johansson BL, Lefvert AK. Renal function and albumin excretion during exercise in children during remission of the minimal change nephrotic syndrome. Acta Paediatr Scand. 1988;77(2):287–93.

Exercise therapy for chronic renal failure not on dialysis

People with kidney diseases should start exercising

The American College of Sports Medicine (ACSM) guidelines recommend exercise in patients with kidney diseases should be increased from mild to moderate, and exercise intensity should be adjusted according to monitored physical fitness3.

3. ACSM, Guidelines for Exercise Testing and Prescription Ninth Edition

Exercise is beneficial to patients' cardiovascular function and psychosocial condition

In the past, restrictions have been suggested on exercise in patients with kidney disease; however, many recent guidelines have emphasized exercise as beneficial for health, namely improving activities of daily living, cardiovascular function, and psychosocial conditions. It is now recommended to have moderate intensity exercise to stabilize kidney disease 4,5.

4. Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63(5):713–35.
5. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59.

Sports training guidelines for hemodialysis patients

In hemodialysis, when compared with non-exercise group, exercise group have significantly better exercise tolerance6,7,8,9,10,11,12,13,14,15,16,17.

Greater improvement in exercise tolerance (in VO2) is observed in renal failure patients who exercise for more than 6 months18.

In addition, clinical research shows when combining aerobic exercise with resistance training, exercise tolerance improvement is greater than that of aerobic exercise alone18.

6. Deligiannis A, Kouidi E, Tourkantonis A. Effects of physical training on heart rate variability in patients on hemodialysis. Am J Cardiol. 1999;84(2):197–202.
7. Goldberg AP, Geltman EM, Gavin JR 3rd, Carney RM, Hagberg JM, Delmez JA, et al. Exercise training reduces coronary risk and effectively rehabilitates hemodialysis patients. Nephron. 1986;42(4):311–6.
8. Goldberg AP, Geltman EM, Hagberg JM, Gavin JR 3rd, Delmez JA, Carney RM, et al. Therapeutic benefits of exercise training for hemodialysis patients. Kidney Int Suppl. 1983;16:S303–9.
9. Koufaki P, Mercer TH, Naish PF. Effects of exercise training on aerobic and functional capacity of end-stage renal disease patients. Clin Physiol Funct Imaging. 2002;22(2):115–24.
10. Mouidi E, Iacovides A, Iordanidis P, Vassiliou S, Deligiannis A, Ierodiakonou C, et al. Exercise renal rehabilitation program: psychosocial effects. Nephron. 1997;77(2):152–8.
11. Kouidi E, Karagiannis V, Grekas D, Iakovides A, Kaprinis G, Tourkantonis A, et al. Depression, heart rate variability, and exercise training in dialysis patients. Eur J Cardiovasc Prev Rehabil: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology. 2010;17(2):160–7.
12. Kouidi EJ, Grekas DM, Deligiannis AP. Effects of exercise training on noninvasive cardiac measures in patients undergoing long-term hemodialysis: a randomized controlled trial. Am J Kidney Dis. 2009;54(3):511–21.
13. Petraki M, Kouidi E, Grekas D, Deligiannis A. Effects of exercise training during hemodialysis on cardiac baroreflex sensitivity. Clin Nephrol. 2008;70(3):210–9.
14. Painter P, Moore G, Carlson L, Paul S, Myll J, Phillips W, et al. Effects of exercise training plus normalization of hematocrit on exercise capacity and health-related quality of life. Am J Kidney Dis. 2002;39(2):257–65.
15. Ouzouni S, Kouidi E, Sioulis A, Grekas D, Deligiannis A. Effects of intradialytic exercise training on health-related quality of life indices in haemodialysis patients. Clin Rehabil. 2009;23(1):53–63.
16. Reboredo MM, Neder JA, Pinheiro BV, Henrique DM, Faria RS, Paula RB. Constant work-rate test to assess the effects of intradialytic aerobic training in mildly impaired patients with end-stage renal disease: a randomized controlled trial. Arch Phys Med Rehabil. 2011;92(12):2018–24.
17. van Vilsteren MC, de Greef MH, Huisman RM. The effects of a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counselling for sedentary haemodialysis patients in the Netherlands: results of a randomized clinical trial. Nephrol Dial Transplant. 2005;20(1):141–6.
18. Sheng K, Zhang P, Chen L, Cheng J, Wu C, Chen J. Intradialytic exercise in hemodialysis patients: a systematic review and meta-analysis. Am J Nephrol. 2014;40(5):478–90.

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