Physical exercise in individuals in hemodialysis: benefits and best indications - systematic review

Abstract

INTRODUCTION: The number of patients with chronic chronic disease (CKD) on hemodialysis (HD) has increased. In Brazil, in 2012, the number of patients in HD was 97,586, with a mortality rate of 19%. Physical exercise (PE) is an adjuvant therapy capable of promoting glycemic control, blood pressure and other gains relevant to CKD control. OBJECTIVE: To describe the benefits of quality of life, care and the most effective protocols of physical exercise for the individual on hemodialysis. METHODS: Systematic review study. Consultations of the SciELO and PubMed databases between 2005 and 2016 on the physiological effects of exercise and the quality of life of the individual on hemodialysis. The cross-over descriptors used were: "hemodialysis" and "exercises", "hemodialysis" and "exercises" and "intradialitic" and "exercises". RESULTS: 23 articles were selected with different EF programs, 8 exercises, 6 resisted, 5 composed by the association of both, and 1 of a comparison between aerobic and resisted. A sample ranged from 6 to 103 patients. Intervention time of 2 to 4 months. All programs should be improved in relation to functional capacity, reduction of inflammation, improvement of arterial compliance and others. In resisted PE, one of the studies reported deleterious effects for the patients, while those with resisted and aerobic PE showed benefits. CONCLUSION: EF was able to prevent oxidative stress, reduce blood pressure and increase blood glucose, increase muscle volume and strength, and gain quality in life, but there was no agreement on the best protocol.

Association of physical activity level and physical fitness with the cognitive function of patients in hemodialysis

“…Considering the effects of hemodialysis treatment and the high rates of cognitive impairment, supervised physical exercise is an essential tool in maintaining the patients' health on hd, influencing several variables (Lacerda et al, 2018). It can improve Kt/V (a method that assesses hemodialysis adequacy/quality), exercise capacity, depression, and life quality, as well as reducing blood pressure without increasing the incidence of adverse events (Pu et al, 2019).…”

Exercício físico e a doença renal crônica

“…Other studies demonstrate the importance of physical exercise for advanced stage CKD (grade 5) during hemodialysis [3,4]. It is known that at this stage the presence of pain, sarcopenia, reduced cardiorespiratory reserve and reduced quality of life are changes [8].…”

“…Several studies point to the importance of physical exercise in the quality of life, in the clinical and functional conditions of this population [3,4]. According to the Brazilian Guideline for Cardiovascular Rehabilitation [5], when correctly prescribed, physical exercise is an important ally for the control of hypertension, systemic arterial disease, diabetes mellitus and cardiovascular diseases, considered as the main risk factors for the onset of CKD [5,6].…”

“…However, there is still no consensus in the scientific literature on the frequency, intensity, type and duration of exercise for CKD to be performed safely, taking into account the stages of the disease. It is known that in the initial stages, individuals do not present the signs and symptoms of the disease, thus, clinical follow-up and routine examinations are essential [1,2,4]. In this case, physical exercises can be prescribed aiming at the control of risk factors, with intensity above 85% of HRmax, similarly to those described in the guidelines [5].…”

“…Thus, physical exercise can delay the onset of these diseases and optimize the individual's overall health condition [9]. It is suggested that physical exercise be performed in the first two hours of hemodialysis due to the high risk of hypotension and hypoglycemia after this period [4]. We also emphasize the care with access for hemodialysis, as there is no technical-scientific basis in the literature for its mobilization during treatment [7].…”