Efeitos do exercício aeróbio intradialítico com restrição parcial do fluxo sanguíneo em pacientes em hemodiálise: um ensaio clínico randomizado.

Abstract

Introduction: Chronic kidney disease (CKD) is related to physical weakness and increases in levels of oxidative stress and inflammatory profile, especially in its final stage. Regular physical exercise, in turn, is associated with improvement in physical capacity, positive modification in the inflammatory profile and reduction of oxidative stress. Objective: The objective of the present study was to analyze the effects of an intervention with continuous-low-to-moderate intradialytic exercise with partial blood flow restriction (BFR) on health indicators and parameters of the immune system and oxidative stress of patients on hemodialysis (HD). Materials and methods: An experimental, randomized, phase III, open label clinical trial was conducted. The sample consisted of 66 patients in HD. Questionnaire was administered (sociodemographic, nutritional, behavioral and quality of life variables) and blood samples were collected before and after the intervention. Participants were randomly assigned to: 1. Exercise group using BFR (GBFR); 2. Exercise group not using BFR (GE); and 3. Control group (GE). The exercise intervention was applied thrice weekly, for twenty minutes, and lasted twelve weeks an adapted cycle ergometer as follows: mesocycle 1 (weeks 1-6) - heart rate from 60% to 63% of the maximal heart rate (HRmax); and mesocycle 2 (weeks 7 - 12) - heart rate from 64% to 76% of HRmax. The 5% significance level was used during the analysis. The test of variance (ANOVA) of two mixed factors, with a factor group and repeated measures in the time factor was used in the comparison of the training protocols when the variables presented parametric behavior. The contrast command of Stata was used as post-hoc. The Friedman test was used for variables violating the assumption of normal distribution of residuals and that could not be normalized by transformation. Results: Overall, the main findings indicated that: i) the participants had reduced levels of strength and functional capacity, which reaffirmed the weakened physical condition of patients with CKD in HD; ii) participants had elevated serum levels of inflammation markers, which reaffirmed the systemic inflammation condition of this population; iii) continuous exercise with BFR was effective in improving the functional capacity of patients in HD; iv) twelve weeks of continuous low-to-moderate intensity exercise with RFS reduced the systemic level of tumor necrosis factor (TNF-α) marker by 33%; v) the CG and GE groups did not present any changes in the outcomes studied; and vi) the exercise protocol used in the present study did not present produced changes in muscle strength levels, oxidative stress markers and interleukins 6 and 1beta. CONCLUSION: Continuous low-to-moderate intensity training was effective in improving functional capacity and reducing systemic inflammation in patients with CKD in HD.