Effects of different exercises on patients with chronic kidney disease:a network Meta-analysis
蒲诗 1彭红梅 1李杨 1黄霞 1张友影 1石钰1
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作者信息
1. 陆军军医大学第二附属医院肾内科,重庆 400037
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摘要
目的 采用网状Meta分析方法评价不同运动方式对慢性肾脏病患者的干预效果,为医护人员制订运动方案提供依据.方法 计算机检索Web of Science、PubMed、Embase、Cochrane Library、中国生物医学文献数据库、万方数据库、中国知网等数据库中不同运动方式对慢性肾脏病患者影响的随机对照试验,检索时限为2000年1月1日—2023年3月1日.由2名研究人员独立进行文献筛选、数据提取和文献质量评价,采用R软件联合gemtc程序包分析数据,采用Stata软件绘图.结果 共纳入52篇文献,累计样本量为3 127例,共涉及3种运动方式(有氧运动、抗阻运动和联合运动).网状Meta分析结果显示,在延缓肾功能进展和提高心肺耐力方面,3种运动方式的干预疗效与常规护理比较,差异均具有统计学意义(P＜0.05);在控制血压和提高步行能力方面,3种运动方式均优于常规护理,差异均具有统计学意义(P＜0.05).累积排序概率曲线图下面积排序结果显示,在延缓肾功能进展效果方面,有氧运动＞抗阻运动＞联合运动;在控制血压方面,抗阻运动＞有氧运动＞联合运动;在改善心肺耐力方面,有氧运动＞抗阻运动＞联合运动;在提高步行能力方面,抗阻运动＞联合运动＞有氧运动.亚组分析结果显示,≥24周是有氧运动的最佳干预周期;抗阻运动干预≥ 12周可达到降压效果,干预≤12周可改善步行能力,但是干预时间≥24周,联合运动效果最佳.结论 有氧运动为延缓肾功能进展和提高心肺耐力的最佳方式,在控制血压和提高步行能力方面,抗阻运动为最佳运动方式,医护人员应根据患者病情需求选择合适的运动类型.
Abstract
Objective To evaluate the effects of different exercises on patients with chronic kidney disease based on network Meta-analysis so to provide a basis for medical and nursing staff to develop exercise programs.Methods Randomized controlled trials on the effects of different exercises on patients with chronic kidney disease were electronically searched in databases such as Web of Science,PubMed,Embase,Cochrane Library,China Biology Medicine disc,WanFang Data,and China National Knowledge Infrastructure.The search period was from January 1,2000,to March 1,2023.Two researchers conducted literature screening,data extraction,and literature quality evaluation independently.The data was analyzed by using R software in conjunction with the gemtc package and plotted by using Stata software.Results A total of 52 articles were included,with a cumulative sample size of 3 127 cases,involving three types of exercise(aerobic,resistance,and combined).The network Meta-analysis showed statistically significant differences between the three exercise methods and routine nursing in delaying renal function progression and improving cardiovascular endurance(P＜0.05).In controlling blood pressure and improving walking ability,the effects of three exercise methods were all superior to routine nursing,and the differences were statistically significant(P＜0.05).The area under the cumulative ranking probability curve showed that aerobic exercise＞resistance exercise＞combined exercise in terms of delaying renal function progression.In controlling blood pressure,resistance exercise＞aerobic exercise＞combined exercise.In terms of improving cardiovascular endurance,aerobic exercise＞resistance exercise＞combined exercise;In terms of improving walking ability,resistance exercise＞combined exercise＞aerobic exercise.Subgroup analysis showed that ≥ 24 weeks was the optimal intervention period for aerobic exercise.Resistance exercise intervention for ≥ 12 weeks could lower blood pressure,and intervention for ≤ 12 weeks could improve walking ability.However,when the intervention time was longer than 24 weeks,combined exercise had an excellent effect.Conclusions Aerobic exercise is an excellent way to delay renal function progression and improve cardiovascular endurance.Resistance exercise is the optimal exercise method for controlling blood pressure and improving walking ability.Medical and nursing staff should choose appropriate types of exercise based on the patient's medical needs.
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万方数据