Renal Rehabilitation

腎病及運動

腎病康復新概念

近年腎病康復運動概念在腎病專家、透析專家、腎移植專家、康復專家漸趨普遍。

腎小球腎炎(Glomerulonephritis)
腎病綜合症(腎病症候群 Nephrotic syndrome)

通過病情休眠期進行合適運動,腎小球腎炎(GLOMERULONEPHRITIS)腎病綜合症(腎病症候群 NEPHROTIC SYNDROME)成人和兒童患者生活質量得到改善1,2

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.

不需洗腎的腎病患者之運動治療

腎病患者應開始運動

美國運動醫學會(ACSM)指南建議,腎病患者運動應從輕度開始加至中度,根據監測體能調校運動強度3

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

運動有利於患者的心血管功能和心理社交狀況

過去建議限制腎病患者的運動;然而,最近眾多指引都強調運動對健康狀況有利,如改善日常生活活動(ADL),心血管功能和心理社交狀況,並建議中度運動來穩定腎病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.

血液透析洗腎患者的運動訓練指引

血洗腎患者運動人士與不運動相比,運動治療組的運動耐受性明顯較好6,7,8,9,10,11,12,13,14,15,16,17

運動療法多於6個月,運動耐量(VO2)有較大改善18

此外臨床研究分析顯示,帶氧運動和阻力訓練結合,運動耐量改善比單獨帶氧運動更大18

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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