Efeitos do treinamento resistido no nível de atividade física diária, na força muscular e na capacidade funcional em pacientes com doença renal crônica em hemodiálise

Abstract

Background: Physical inactivity is highly prevalent and increases all causes of mortality in end-stage renal disease (ESRD) patients on hemodialysis (HD). In contrast, a more active lifestyle is associated with better outcomes in these patients. We therefore investigated the effects of supervised intradialytic resistance training on physical activities in daily life, physical capacity, quality of life and muscle strength in ESRD patients. Methods: Twenty four ESRD patients (54.2 ± 13.5 years) under HD (6.0 ± 5.7 years) were randomly assigned to either 3-month moderate-intensity resistance training or a control period. Resistance training was performed during the first two hours of HD sessions, three times a week, for three months. Physical activities in daily life was evaluated using an accelerometer regarding the time spent in different activities and positions of daily life (walking, standing, sitting and lying down), and the number of steps taken. The accelerometer was used for seven consecutive days (three dialysis days and four nondialysis days). Physical capacity, quality of life and muscle strength were evaluated by six-minute walking test (6MWT), SF-36 questionnaire and maximum voluntary isometric contraction test, respectively. The values were expressed as delta (post-pre treatment). Results: After three months of training, we didn’t find significant difference in walking time (-1.2 ± 18.3 vs. -9.2 ± 13.1 min/day), standing time (-10.2 ± 28.6 vs. 3.2 ± 20.1 min/day), sitting time (20.8 ± 58.9 vs. -30.0 ± 53.0 min/day), lying down time (-9.3 ± 57.9 vs. 34.6 ± 54.0 min/day) and number of steps taken [-147 (1834) vs. -454 (2066)] in training and control groups, respectively. The 6MWT distance increased significantly in training group when compared with control group (48.8 ± 35.9 vs. 6.9 ± 45.9 m, p=0.04). No significant difference was found in muscle strength (3.4 ± 7.2 vs. 0.5 ± 7.3 Kgf) in training and control groups, respectively. Three domains of the SF-36 showed significant increase in training group when compared with control group, respectively (physical functioning = 13.7 ± 9.9 vs. -12.5 ± 16.7, p=0.003; role physical = 0.0 (0.0) vs. -50.0 (93.7), p=0.03; general health = 6.6 ± 14.1 vs. -10.4 ± 21.4, p=0.01). Intradialytic resistance training was safely performed by all participants. Conclusions: The present study showed that daily life activities were not modified after three months of intradialytic resistance training in HD patients. However, the exercise program was able to increase the physical capacity and some domains quality of life in these patients.