Hypertension and cardiovascular diseases are highly prevalent in hemodialysis patients and are associated with the reduction of physical functioning and quality of life. We evaluated the effects of supervised aerobic exercise training on physical functioning, blood pressure, quality of life, and laboratory data in hemodialysis patients. Fourteen patients were evaluated at the beginning and after 12 weeks of stretching exercises (control phase) and at the end of 12 weeks of aerobic exercise training performed during hemodialysis sessions (intervention phase). Patients underwent a 6-min walking test (6MWT), 24-h ambulatory blood pressure monitoring, a Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) quality of life questionnaire, and blood sample collections. After the intervention phase, the 6MWT distance increased from 508.7 +/- 91.9 m to 554.9 +/- 105.8 m (P = 0.001), systolic and diastolic blood pressure decreased respectively from 150.6 +/- 18.4 mm Hg to 143.5 +/- 14.7 mm Hg and from 94.6 +/- 10.5 mm Hg to 91.4 +/- 9.7 mm Hg (P < 0.05), while hemoglobin levels increased from 10.8 +/- 1.2 g/dL to 11.6 +/- 0.8 g/dL (P < 0.05). Moreover, there was a significant increase in the physical functioning, social functioning, and mental health dimensions of the SF-36. Aerobic exercise training during hemodialysis increased physical functioning, reduced blood pressure levels, and improved the control of anemia and quality of life in patients with end-stage renal disease.

Palavras-chave: Doença renal crônica. Exercício físico. Hemodiálise. Sistema cardiovascular. Qualidade de vida. Keywords:Chronic kidney disease. Exercise training. Hemodialysis. Cardiovascular system. Quality of life. RESUMOPacientes portadores de doença renal crônica (DRC) submetidos a tratamento dialítico apresentam alterações físicas e psicoló-gicas que predispõem ao sedentarismo. Nesta população, a prescrição rotineira de exercícios físicos não é uma prática freqüente, especialmente no nosso país. No entanto, alguns autores têm demonstrado que um programa de exercícios para estes pacientes contribui para o melhor controle da hipertensão arterial, da capacidade funcional, da função cardíaca, da força muscular e, conseqüentemente, da qualidade de vida. Além dos benefícios relacionados ao sistema cardiovascular, a realização do exercício traz benefícios secundários, pois quebra a monotonia do procedimento, melhora aderência e pode aumentar a eficácia da diálise. Na presente revisão, os autores discutem aspectos da realização de exercícios físicos em pacientes portadores de DRC em diálise e apresentam dados iniciais de sua experiência com a aplicação de exercícios supervisionados durante as sessões de hemodiálise. ABSTRACT Physical exercise in dialyzed patientsPatients with chronic kidney disease (CKD) on dialysis present physical and psychological limitations that induce to a sedentary life stile. The prescription of exercise for this population has not been common, especially in our country. In the last few years though, some authors have shown that exercising for these patients improves hypertension control, cardiac function, muscular strength, functional capacity and, consequently, their quality of life. Besides the benefits related to the cardiovascular system, exercise training during hemodialysis reduces the monotony of the procedure, improves adherence and contributes to the increase of dialysis efficacy. In this review, the authors discuss some aspects of exercise training in patients with CKD on dialysis and present their preliminary data of supervised exercises during hemodialysis sessions. INTRODUÇÃOO número de pacientes com doença renal crônica (DRC) em todo o mundo tem aumentado em proporções alarmantes, ocasionando um importante problema de saúde pública. No Brasil, de 1994 a 2005, o número de pacientes em hemodiálise (HD) e diáli-se peritoneal elevou-se de 24.000 para 65.121(1-2) . Como conseqüência, do número crescente de doentes renais crônicos, os gastos do Ministério da Saúde com a terapia renal substitutiva são de aproximadamente 1,4 bilhão de reais por ano, quantia esta correspondente a cerca de 10% do orçamento global desse ministério (1) .Nessa população, as doenças cardiovasculares (DCV) representam a principal causa de morbidade e de mortalidade. Além disso, contribuem sobremaneira para a diminuição da capacidade funcional, para a baixa tolerância ao exercício e, conseqüentemente, para a dificuldade de realização das atividades da vida diária (3)(4)(5) . Além das DCV, também contribuem ...

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Background: In the general population, regular practice of physical exercises is associated with improved physical capacity and reduction of cardiovascular events. Concerning patients with chronic kidney disease, a population with significant impairment of physical capacity and high rates of cardiovascular mortality, few studies have evaluated the effects of physical activity.

End-stage renal disease (ESRD) is associated with several hemodynamic and peripheral muscle abnormalities which could slow Rationale: the kinetics of O uptake (VO ) at the on-exercise transient. Although previous studies have shown that aerobic training is able to 2 2 accelerate VO kinetics in several disease populations, little is known if these positive findings are also applicable to hemodialysis patients.2 We therefore investigated the effects of supervised aerobic training on the VO kinetics at the onset of dynamic exercise in hemodialysis 2 patients.Twelve patients and 12 age-and gender-matched non-trained patients underwent sub-and supra-anaerobic threshold (AT) Methods: exercise tests on a cycle ergometer. Exercise training was performed during the first 2 hours of hemodialysis sessions by using a stationary cycle, three times weekly, for 12 weeks.We found that training significantly accelerated VO kinetics (tau decreased from 62.45 ± 19.61s to 44.96 ± 12.6s and MRT Results: 2 decreased from 77.45 ± 23.78s to 63.13 ± 16.31s) and reduced O deficit at the sub-AT bout (p<0.05). In contrast, VO kinetics were 2 2 actually slower at the final evaluation in the non-trained patients (p<0.05). Similar beneficial findings of training were observed at the supra-AT exercise bout (tau decreased from 52.92 ± 17.39s to 40.4 ± 13.82s and MRT decreased from 69.3 ± 21.13s to 58.4 ± 14.8s, p<0.05), including a significant increase in time to exercise intolerance from 311.92 ± 223.43s to 589.17 ± 358.12s.In conclusion, a 12-weeks supervised aerobic training program was highly effective in accelerating on-exercise VO kinetics Conclusions: 2 at both moderate and severe exercise intensity domains in ESRD patients undergoing hemodialysis. These beneficial effects might be mechanistically linked to increased tolerance to dynamic exercise after training in these patients.