Efeitos do exercício físico durante a hemodiálise em indivíduos com insuficiência renal crônica: uma revisão

Abstract

FISIOTERAPIA E PESQUISA 2008; 15(1): 86-91 RESUMO: As principais alterações observadas em indivíduos com insuficiência renal crônica são anemia, hipertensão arterial sistêmica e atrofia muscular, que levam à baixa capacidade aeróbica e perda de força muscular. Assim, parte do tratamento desses indivíduos consiste em programas de exercício físico. O objetivo desta revisão da literatura foi documentar os efeitos agudos e as adaptações crônicas, cardiovasculares e musculares em indivíduos no estágio final da doença renal, submetidos a programas de exercício físico durante a hemodiálise. Foram selecionados artigos científicos nas bases eletrônicas Medline, Lilacs e PEDro, assim como no acervo de periódicos da biblioteca da Faculdade de Medicina da UFMG. Foram analisados 13 artigos envolvendo exercício físico aeróbico associado ou não a fortalecimento muscular durante a hemodiálise, variando quanto à intensidade, freqüência e duração da intervenção. A maioria demonstrou que exercícios físicos realizados durante a hemodiálise promovem efeitos benéficos na melhora da capacidade aeróbica, força muscular e no controle dos fatores de risco cardiovasculares, auxiliando a remoção dos solutos durante a hemodiálise. Embora o tema seja ainda pouco explorado, a literatura disponível evidencia benefícios do exercício durante a hemodiálise sobre a capacidade aeróbica e força muscular dos pacientes.DESCRITORES: Diálise renal; Insuficiência renal crônica; Terapia por exercício ABSTRACT: Main alterations seen in patients with chronic renal insufficiency are anemia, systemic arterial hypertension, and muscular atrophy, which lead to low aerobic capacity and loss of muscle strength. Hence part of these patients treatment consists in programs of physical exercise. The purpose of this literature review was to assess muscle and cardiovascular acute effects and chronic adaptations in end-stage renal disease patients submitted to physical exercise during hemodialysis. After browsing through Medline, Lilacs and PEDro databases, as well as searching for periodic articles at the UFMG Medicine School library, 13 articles were selected, related to aerobic exercise associated or not to muscle strengthening during hemodialysis. Studies varied as to exercise intensity, frequency and duration. Most articles found that physical exercise performed during hemodialysis favoured better aerobic capacity, muscle strength, and control of cardiovascular risk factors, helping solute removal during hemodialysis. Though the subject is scarcely studied, available literature shows that exercises during hemodialysis are beneficial to patients' aerobic capacity and muscle strength.

Repercussão de um protocolo fisioterapêutico intradialítico na funcionalidade pulmonar, força de preensão manual e qualidade de vida de pacientes renais crônicos

“…6 Some studies have reported that physical exercise training programs have modified morbidity and survival of azotemic patients, causing metabolic, physiological, and psychological benefits. 1,8,9,11 When properly supervised, exercises performed during HD are indicated and safe for those patients, 1,8,9 although they have not become routine in dialysis centers. 11 Thus, the present study aimed at assessing the results of a physical therapy intervention on the respiratory muscle function, grip strength, and QOL of patients undergoing HD.…”

“…Repercussion of an intradialytic physical therapy protocol et al (2008) 8 has evidenced an improvement in the "physical functioning" and "mental health" domains of SF-36 in the experimental group, which underwent a physical exercise program comprising aerobic and muscle strength training for 16 weeks, as compared with the control group. Soares et al (2007) 4 have recommended an active exercise training for lower and upper limbs, consisting of 24 sessions, three times per week, similar to the protocol of the present study.…”

“…Some studies, through systematic literature review, 8,10,11 have reported the effects of physical exercises on dialysis patients. Moura et al (2008) 8 have analyzed 13 articles involving aerobic physical exercise associated or not with muscle strengthening during HD.…”

“…Moura et al (2008) 8 have analyzed 13 articles involving aerobic physical exercise associated or not with muscle strengthening during HD. They have concluded that most protocols reported beneficial effects on aerobic capacity, muscle strength, and control of cardiovascular risk factors, but the way of applying those programs differed regarding intensity, frequency, and duration.…”

“…[4][5] Renal dysfunction is characterized by a glomerular filtration rate (GFR) lower than 60 mL/ min/1.73m 2 , for more than three months, and, when GFR reaches levels lower than 15 mL/min/1.73m 2 , the renal dysfunction is called end-stage CKD. 6 Currently, CKD can be considered a severe public health problem, because of its high morbidity and mortality rates, and negative impact on physical and psychosocial aspects of patients advanced CKD [7][8][9][10][11] . According to data from the study by Coelho et al (2008), 12 96% of the dialyses in our country are performed at units of the Brazilian Public Unified Health Care System (SUS).…”