Efeito do treinamento intradialítico resistido e aeróbio sobre a função cognitiva e capacidade funcional de pacientes em hemodiálise: estudo controlado
Carregando...
Arquivos
Data
2016-02-29
Autores
Souza, Giovana Damasceno e [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Pacientes com doença renal crônica (DRC) em hemodiálise têm baixo nível de atividade física, e podem apresentar declínio cognitivo. Evidencias mostram benefícios de exercícios físicos nesses pacientes, no entanto poucos estudos buscaram avaliar tais benefícios sobre a função cognitiva. Objetivo. Avaliar o efeito do treinamento físico resistido e aeróbio intradialítico em indivíduos com DRC em hemodiálise sobre a função cognitiva e a capacidade funcional. Materiais e Método. Foram realizados dois estudos em paralelo. Estudo 1: experimental, aberto, controlado, randomizado que comparou dois grupos: grupo resistido (GR) e grupo controle (GC). Os pacientes do GR foram submetidos a exercícios resistidos e os pacientes do GC foram submetidos a exercícios placebo, da primeira à 12a semana. As avaliações foram realizadas antes da primeira semana da sessão de exercício e na semana imediatamente após a última sessão. Nesse estudo o comportamento das variáveis avaliadas foram compradas entre os grupos. Estudo 2: experimental, aberto, controlado, sequencial. Nove dos pacientes do GC, após a reavaliação do período controle, foram subsequentemente submetidos a exercícios aeróbios, sendo analisados após 12 semanas adicionais como grupo aeróbio (GA). Nesse estudo o comportamento das variáveis avaliadas desses nove pacientes após o período controle foi comparado após o período de intervenção. Os exercícios foram realizados nas primeiras duas horas de hemodiálise, três vezes por semana por aproximadamente 50 min. O GA utilizou ciclo ergômetro e o GR realizou onze exercícios (2 séries de 15-20 repetições), dos quais para membros superiores foram realizados antes do início da hemodiálise. A intensidade do esforço para ambos os grupos foi de 12 a 16 na escala BORG. O GC realizou exercícios metabólicos à guisa de placebo. Variáveis avaliadas: nível de atividade física (questionário IPAQ versão curta), função cognitiva (mini-exame do estado mental - MEEM) e capacidade funcional (teste de caminhada de 6 minutos - TC6M). Resultados. A amostra final do Estudo 1 foi composta por 28 pacientes, 13 no GC e 15 no GR, os grupos eram homogênios quanto aos dados demográficos e clínicos. A função cognitiva avaliada pelo MEEM apresentou um aumento da pontuação estatisticamente significante após a intervenção no GR (23,5±4,0 para 25±3,3 pontos) e no GC (21,5±3,5 para 23±3,0 pontos) (p = 0,03). A capacidade funcional, avaliada pelo TC6 apresentou aumento significante da distância percorrida no GR (529±137,8 para 554,5±137,5 metros) e no GC (507±155,5 para 545±121,2 metros) (p = 0,02). No comportamento do IPAQ houve deslocamento numérico dos pacientes para categorias de maior nível de atividade física nos dois grupos, ainda que sem atingir significância estatística. No Estudo 2, quanto ao MEEM, houve tendência a aumento da pontuação paralelo no momento 2 e no momento 3, porém sem significância estatística (p = 0,05). No TC6, não houve aumento significante da distância percorrida pelos pacientes após a intervenção em nenhum dos momentos. No comportamento do IPAQ houve deslocamento numérico dos pacientes para categorias de maior nível de atividade física comparando os três momentos, sem atingir significância estatística. Conclusão. Os pacientes com DRC em hemodiálise submetidos a protocolo de exercício resistido apresentaram melhora funcional e cognitiva. Porém, o protocolo de exercício metabólico (exercício placebo), realizado no GC, também trouxe repercussão. Já os pacientes submetidos a protocolo de exercício aeróbio não apresentaram a mesma melhora. O efeito de exercícios placebo observado no corrente trabalho abre a possibilidade de intervenções subliminares no sentido de melhorar o perfil de atividade física dos pacientes em hemodiálise. Sugerindo que um profissional no centro de terapia renal substitutiva, orientando e incentivando os pacientes com DRC a realizarem exercício físico, poderia mudar seus hábitos do dia a dia que possam levá-los a melhor disposição e função motora, além de melhora na função cognitiva com possível consequente melhora na qualidade de vida. Apoio CNPq, processo 13288/2015-2.
Patients with chronic kidney disease (CKD) on hemodialysis, have low levels of physical activity, and cognitive decline. Evidence of the benefits of physical exercise in these patients have gained ground, however few studies have sought to evaluate such benefits on cognitive function. Objectives: Evaluate the effect of strengthening and aerobic intradialitic exercise training in individuals with CKD on hemodialysis on cognitive function and functional capacity. Methods: Two studies were performed at the same time. Study 1: experimental, open, controlled, randomized trial comparing two groups: Strengthening group (SG) and control group (CG). SG patients underwent resistance training and CG patients underwent placebo exercise, from the first to the 12th week of intervention. The evaluations were performed before the first week of the exercise session and the week immediately after the last exercise session. In this study the behavior of the variables evaluated in the CG patients was compared to the behavior of those variables in the SG. Study 2: experimental, open, controlled, sequential. Nine of the CG patients, after a reassessment of the control period, were subsequently subjected to aerobic exercise and they were assessed after 12 additional weeks as aerobic group (AG). In this study the behavior of these variables evaluated nine patients during the control period was compared to the behavior of those variables after the intervention period. The exercises were conducted in the first two hours of dialysis, three times a week, for about 50 min. The AG used cycle ergometer and the SG did eleven types of exercises (2 sets of 15-20 reps), The training for upper limbs were carried out before the start of the hemodialysis session. The intensity of the effort for both groups was 12 to 16 on the Borg scale. The CG kept doing metabolic exercises to placebo guise. Variables assessed: physical activity (IPAQ short version), cognitive function (Mini-Mental State Examination - MMSE) and functional capacity (6-minute walk test - 6MWT). Results: The Study 1 consisted of 28 patients, 13 in the CG and 15 in the SG. The groups were homogeneous regarding the demographic and clinical data. Cognitive function by the MMSE showed a statistically significant increase in scores after the intervention in the GR (23.5 ± 4.0 to 25 ± 3.3 points) and CG (21.5 ± 3.5 to 23 ± 3 0 points) (p = 0.03). Functional capacity by 6MWT showed a significant increase in the distance walked by patients after intervention in the SG (529 ± 137.8 to 554.5 ± 137.5 meters) and CG (507 ± 155.5 to 545 ± 121, 2 meters) (p = 0.02). The IPAQ behavior showed numerical shift to a higher level of physical activity in both groups, although without reaching statistical significance. In Study 2, nine patients made up the AG. The MMSE showed a tendency to increase in score at moment 2 and moment 3, but without statistical significance (p = 0.05). In the 6MWT, there wasn't significant increase in the distance walked by patients after the intervention in any of the moments. The IPAQ behavior showed numerical shift to a higher level of physical activity in both groups, although without reaching statistical significance. Conclusion: Patients with CKD on hemodialysis undergoing resistance exercise protocol showed functional and cognitive improvement. However, the metabolic exercise protocol (placebo exercise) performed in the CG also brought repercussions. Yet patients undergoing aerobic exercise protocol did not show the same improvement. The effect of placebo exercises obsereved in the present research brings the possibility of subliminal interventions to improve the profile of physical activity among hemodialysis patients. Suggesting that a professional in the center of renal replacement therapy, guiding and encouraging patients with CKD to carry out physical activity, could change their habits in everyday life. It can give them more liveliness and motor function, as well as improvement in cognitive function with possible consequent improvement in quality of life. CNPq support, process 13288 / 2015-2.
Patients with chronic kidney disease (CKD) on hemodialysis, have low levels of physical activity, and cognitive decline. Evidence of the benefits of physical exercise in these patients have gained ground, however few studies have sought to evaluate such benefits on cognitive function. Objectives: Evaluate the effect of strengthening and aerobic intradialitic exercise training in individuals with CKD on hemodialysis on cognitive function and functional capacity. Methods: Two studies were performed at the same time. Study 1: experimental, open, controlled, randomized trial comparing two groups: Strengthening group (SG) and control group (CG). SG patients underwent resistance training and CG patients underwent placebo exercise, from the first to the 12th week of intervention. The evaluations were performed before the first week of the exercise session and the week immediately after the last exercise session. In this study the behavior of the variables evaluated in the CG patients was compared to the behavior of those variables in the SG. Study 2: experimental, open, controlled, sequential. Nine of the CG patients, after a reassessment of the control period, were subsequently subjected to aerobic exercise and they were assessed after 12 additional weeks as aerobic group (AG). In this study the behavior of these variables evaluated nine patients during the control period was compared to the behavior of those variables after the intervention period. The exercises were conducted in the first two hours of dialysis, three times a week, for about 50 min. The AG used cycle ergometer and the SG did eleven types of exercises (2 sets of 15-20 reps), The training for upper limbs were carried out before the start of the hemodialysis session. The intensity of the effort for both groups was 12 to 16 on the Borg scale. The CG kept doing metabolic exercises to placebo guise. Variables assessed: physical activity (IPAQ short version), cognitive function (Mini-Mental State Examination - MMSE) and functional capacity (6-minute walk test - 6MWT). Results: The Study 1 consisted of 28 patients, 13 in the CG and 15 in the SG. The groups were homogeneous regarding the demographic and clinical data. Cognitive function by the MMSE showed a statistically significant increase in scores after the intervention in the GR (23.5 ± 4.0 to 25 ± 3.3 points) and CG (21.5 ± 3.5 to 23 ± 3 0 points) (p = 0.03). Functional capacity by 6MWT showed a significant increase in the distance walked by patients after intervention in the SG (529 ± 137.8 to 554.5 ± 137.5 meters) and CG (507 ± 155.5 to 545 ± 121, 2 meters) (p = 0.02). The IPAQ behavior showed numerical shift to a higher level of physical activity in both groups, although without reaching statistical significance. In Study 2, nine patients made up the AG. The MMSE showed a tendency to increase in score at moment 2 and moment 3, but without statistical significance (p = 0.05). In the 6MWT, there wasn't significant increase in the distance walked by patients after the intervention in any of the moments. The IPAQ behavior showed numerical shift to a higher level of physical activity in both groups, although without reaching statistical significance. Conclusion: Patients with CKD on hemodialysis undergoing resistance exercise protocol showed functional and cognitive improvement. However, the metabolic exercise protocol (placebo exercise) performed in the CG also brought repercussions. Yet patients undergoing aerobic exercise protocol did not show the same improvement. The effect of placebo exercises obsereved in the present research brings the possibility of subliminal interventions to improve the profile of physical activity among hemodialysis patients. Suggesting that a professional in the center of renal replacement therapy, guiding and encouraging patients with CKD to carry out physical activity, could change their habits in everyday life. It can give them more liveliness and motor function, as well as improvement in cognitive function with possible consequent improvement in quality of life. CNPq support, process 13288 / 2015-2.
Descrição
Palavras-chave
Treinamento físico, Função cognitiva, Capacidade funcional, Hemodiálise, Physical training, Cognitive function, Functional capacity, Hemodialysis