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      Beneficios del ejercicio físico en la sesión de hemodiálisis. Una revisión sistemática Translated title: Benefits of physical exercise during the haemodialysis session. A systematic review

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          Abstract

          Resumen Objetivo: El objetivo principal de esta revisión fue conocer los principales beneficios del ejercicio físico durante la sesión de diálisis, en los pacientes en programa de hemodiálisis periódicas. Metodología: Se llevó a cabo una revisión sistemática a través de las bases de datos Pubmed, Science Direct y Google Académico. Se incluyeron artículos científicos en inglés y español, y se analizaron los artículos que trataban sobre ejercicio físico en la sesión de hemodiálisis. Se excluyeron aquellos artículos que no presentaran resultados y en los que el ejercicio físico fuese domiciliario. Resultados: Se incluyeron 18 artículos publicados entre 2015 y 2019. Todos los artículos fueron de diseño experimental. Se encontró una mejoría significativa de la fuerza muscular, al igual que de la capacidad física y de de la sintomatología depresiva. En menor medida, se observó una disminución de la presión arterial, disminución del proceso inflamatorio, mejoría de los valores nutricionales y mejora de la calidad de vida de estos pacientes. Conclusiones: El ejercicio físico en la sesión de hemodiálisis tiene beneficios para la salud de los pacientes. El ejercicio físico de baja intensidad, así como la electroestimulación neuromuscular en las sesiones de diálisis, mejora objetivamente la fuerza muscular, aumenta la capacidad física, mejora la sintomatología depresiva con un mejor manejo del estrés y la ansiedad. Además, perece que puede mejorar el proceso inflamatorio, parámetros nutricionales y disminuir la presión arterial, así como mejorar la calidad de vida. La electroestimulación neuromuscular y el ejercicio físico de baja intensidad, son los ejercicios más utilizados.

          Translated abstract

          Abstract Objective: The main objective of this review was to know the main benefits of physical exercise during the dialysis session, in patients in periodic hemodialysis program. Methodology: A systematic review was conducted through the Pubmed, Science Direct and Google Scholar databases. Scientific articles in English and Spanish were included, and articles dealing with physical exercise in the hemodialysis session were analyzed. Articles that did not present results and in which physical exercise was at home were excluded. Results: 18 articles published between 2015 and 2019 were included. All articles were of experimental design. A significant improvement in muscle strength was found, as well as in physical ability and depressive symptomatology. To a lesser extent, a decrease in blood pressure, decrease in the inflammatory process, improvement in nutritional values and improvement in the quality of life of these patients were noticed. Conclusions: Physical exercise in the hemodialysis session has benefits for the patient’s health. Low intensity physical exercise, as well as neuromuscular electro-stimulation in dialysis sessions, objectively improves muscle strength, increases physical capacity, improves depressive symptoms with better management of stress and anxiety. In addition, it seems that it can improve the inflammatory process, nutritional parameters and decrease blood pressure, as well as improving the quality of life. Neuromuscular electro-stimulation and low intensity physical exercise are the most commonly performed exercises.

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          Most cited references49

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          Exercise and CKD: Skeletal Muscle Dysfunction and Practical Application of Exercise to Prevent and Treat Physical Impairments in CKD.

          Patients with chronic kidney disease experience substantial loss of muscle mass, weakness, and poor physical performance. As kidney disease progresses, skeletal muscle dysfunction forms a common pathway for mobility limitation, loss of functional independence, and vulnerability to disease complications. Screening for those at high risk for mobility disability by self-reported and objective measures of function is an essential first step in developing an interdisciplinary approach to treatment that includes rehabilitative therapies and counseling on physical activity. Exercise has beneficial effects on systemic inflammation, muscle, and physical performance in chronic kidney disease. Kidney health providers need to identify patient and care delivery barriers to exercise in order to effectively counsel patients on physical activity. A thorough medical evaluation and assessment of baseline function using self-reported and objective function assessment is essential to guide an effective individualized exercise prescription to prevent function decline in persons with kidney disease. This review focuses on the impact of kidney disease on skeletal muscle dysfunction in the context of the disablement process and reviews screening and treatment strategies that kidney health professionals can use in clinical practice to prevent functional decline and disability.
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            Efficacy and safety of intradialytic exercise in haemodialysis patients: a systematic review and meta-analysis

            Objective To assess the efficacy and safety of intradialytic exercise for haemodialysis patients. Design Systematic review and meta-analysis. Data sources Databases, including PubMed, Embase, the Cochrane Library, China Biology Medicine and China National Knowledge Infrastructure, were screened from inception to March 2017. Eligibility criteria Randomised controlled trials (RCTs) aimed at comparing the efficacy and safety of intradialytic exercise versus no exercise in adult patients on haemodialysis for at least 3 months. A minimum exercise programme period of 8 weeks. Data extraction Study characteristics and study quality domains were reviewed. Studies were selected, and data extracted by two reviewers. Data analysis The pooled risk ratios and mean differences (MDs) with 95% CIs for dichotomous data and continuous data were calculated, respectively. Results A total of 27 RCTs involving 1215 subjects were analysed. Compared with no exercise, intradialytic exercise increased dialysis adequacy (Kt/V) (MD 0.07, 95% CI 0.01 to 0.12, p=0.02) and maximum volume of oxygen that the body can use during physical exertion peak oxygen consumption (MD 4.11, 95% CI 2.94 to 5.27, p<0.0001), alleviated depression standardised mean difference (−1.16, 95% CI −1.86 to –0.45, p=0.001) and improved physical component summary-short form-36 (SF-36) level (MD 7.72, 95% CI 1.93 to 13.51, p=0.009). Also, intradialytic exercise could significantly reduce systolic blood pressure (MD −4.87, 95% CI −9.20 to –0.55, p=0.03) as well as diastolic blood pressure (MD −4.11, 95% CI −6.50 to –1.72, p=0.0007). However, intradialytic exercise could not improve mental component summary-SF-36 level (MD 3.05, 95% CI −1.47 to 7.57, p=0.19). There was no difference in the incidence of adverse events between the intradialytic exercise and control groups. Conclusions Intradialytic exercise resulted in benefits in terms of improving haemodialysis adequacy, exercise capacity, depression and quality of life for haemodialysis.
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              A structured exercise programme during haemodialysis for patients with chronic kidney disease: clinical benefit and long-term adherence

              Objective Long-term studies regarding the effect of a structured physical exercise programme (SPEP) during haemodialysis (HD) assessing compliance and clinical benefit are scarce. Study design A single-centre clinical trial, non-randomised, investigating 46 patients with HD (63.2±16.3 years, male/female 24/22, dialysis vintage 4.4 years) performing an SPEP over 5 years. The SPEP (twice/week for 60 min during haemodialysis) consisted of a combined resistance (8 muscle groups) and endurance (supine bicycle ergometry) training. Exercise intensity was continuously adjusted to improvements of performance testing. Changes in endurance and resistance capacity, physical functioning and quality of life (QoL) were analysed over 1 year in addition to long-term adherence and economics of the programme over 5 years. Average power per training session, maximal strength tests (maximal exercise repetitions/min), three performance-based tests for physical function, SF36 for QoL were assessed in the beginning and every 6 months thereafter. Results 78% of the patients completed the programme after 1 year and 43% after 5 years. Participants were divided—according to adherence to the programme—into three groups: (1) high adherence group (HA, >80% of 104 training sessions within 12 months), (2) moderate adherence (MA, 60–80%), and 3. Low adherence group (LA, 120%, MA: 40–50%), QoL in three scores of SF36 subscales and physical function in the three tests taken between 11% and 31%. Moreover, a quantitative correlation analysis revealed a close association (r=0.8) between large improvement of endurance capacity and weak physical condition (HA). Conclusions The exercise programme described improves physical function significantly and can be integrated into a HD routine with a high long-term adherence.
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                Author and article information

                Journal
                enefro
                Enfermería Nefrológica
                Enferm Nefrol
                Sociedad Española de Enfermería Nefrológica (Madrid, Madrid, Spain )
                2254-2884
                2255-3517
                September 2020
                : 23
                : 3
                : 233-243
                Affiliations
                [1] Córdoba Andalucía orgnameUniversidad de Córdoba orgdiv1Departamento de Enfermería orgdiv2Facultad de Medicina y Enfermería Spain
                [3] Córdoba orgnameInstituto Maimónides de Investigación Biomédica de Córdoba Spain
                [2] Córdoba orgnameHospital Universitario Reina Sofía de Córdoba orgdiv1Servicio de Nefrología Spain
                Article
                S2254-28842020000300002 S2254-2884(20)02300300002
                10.37551/s2254-28842020024
                dd69ae67-5d0d-44bd-88b9-a7a8cab94e34

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 05 August 2020
                : 15 July 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 50, Pages: 11
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                SciELO Spain

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                hemodiálisis,ejercicio físico,exercise,hemodialysis,physical exercise,electroestimulación neuromuscular,neuromuscular electro-stimulation

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