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J Physiother. 2019 Jan;65(1):4-15. doi: 10.1016/j.jphys.2018.11.008. Epub 2018 Dec 21.

Combined training is the most effective training modality to improve aerobic capacity and blood pressure control in people requiring haemodialysis for end-stage renal disease: systematic review and network meta-analysis.

Author information

1
Heart Institute, Faculty of Medicine, University of São Paulo, Brazil; São Judas Tadeu University, São Paulo, Brazil. Electronic address: katiascapini@gmail.com.
2
Catholic University of Pelotas, Brazil.
3
Heart Institute, Faculty of Medicine, University of São Paulo, Brazil.
4
Institute of Cardiology of Rio Grande do Sul, Porto Alegre, Brazil.
5
Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
6
University of Passo Fundo, Brazil.
7
São Judas Tadeu University, São Paulo, Brazil.
8
Ribeirão Preto School of Physical Education and Sports, University of São Paulo, Brazil.

Abstract

QUESTIONS:

Do aerobic, resistance and combined exercise training improve aerobic capacity, arterial blood pressure and haemodialysis efficiency in people requiring haemodialysis for end-stage renal disease? Is one exercise training modality better than the others for improving these outcomes?

DESIGN:

Systematic review with network meta-analysis of randomised trials.

PARTICIPANTS:

Adults requiring haemodialysis for end-stage renal disease.

INTERVENTION:

Aerobic training, resistance training, combined training and control (no exercise or placebo).

OUTCOME MEASURES:

Aerobic capacity, arterial blood pressure at rest, and haemodialysis efficiency.

RESULTS:

Thirty-three trials involving 1254 participants were included. Direct meta-analyses were conducted first. Aerobic capacity improved significantly more with aerobic training (3.35 ml/kg/min, 95% CI 1.79 to 4.91) and combined training (5.00 ml/kg/min, 95% CI 3.50 to 6.50) than with control. Only combined training significantly reduced systolic (-9 mmHg, 95% CI -13 to -4) and diastolic (-5 mmHg, 95% CI -6 to -3) blood pressure compared to control. Only aerobic training was superior to control for haemodialysis efficiency (Kt/V 0.11, 95% CI 0.02 to 0.20). However, when network meta-analysis was conducted, there were some important different findings. Both aerobic training and combined training again elicited greater improvements in aerobic capacity than control. For systolic blood pressure, combined training was superior to control. For diastolic blood pressure, combined training was superior to aerobic training and control. No modality was superior to control for haemodialysis efficiency. Combined training was ranked as the most effective treatment for aerobic capacity and arterial blood pressure.

CONCLUSION:

Combined training was the most effective modality to increase aerobic capacity and blood pressure control in people who require haemodialysis. This finding helps to fill the gap created by the lack of head-to-head comparisons of different modalities of exercise in people with end-stage renal disease.

REGISTRATION:

PROSPERO CRD42015020531.

KEYWORDS:

Chronic kidney failure; Exercise; Network meta-analysis; Physical therapy; Renal dialysis

PMID:
30581137
DOI:
10.1016/j.jphys.2018.11.008
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