Exercício físico em pacientes dialisados

Abstract

Palavras-chave: Doença renal crônica. Exercício físico. Hemodiálise. Sistema cardiovascular. Qualidade de vida. Keywords:Chronic kidney disease. Exercise training. Hemodialysis. Cardiovascular system. Quality of life. RESUMOPacientes portadores de doença renal crônica (DRC) submetidos a tratamento dialítico apresentam alterações físicas e psicoló-gicas que predispõem ao sedentarismo. Nesta população, a prescrição rotineira de exercícios físicos não é uma prática freqüente, especialmente no nosso país. No entanto, alguns autores têm demonstrado que um programa de exercícios para estes pacientes contribui para o melhor controle da hipertensão arterial, da capacidade funcional, da função cardíaca, da força muscular e, conseqüentemente, da qualidade de vida. Além dos benefícios relacionados ao sistema cardiovascular, a realização do exercício traz benefícios secundários, pois quebra a monotonia do procedimento, melhora aderência e pode aumentar a eficácia da diálise. Na presente revisão, os autores discutem aspectos da realização de exercícios físicos em pacientes portadores de DRC em diálise e apresentam dados iniciais de sua experiência com a aplicação de exercícios supervisionados durante as sessões de hemodiálise. ABSTRACT Physical exercise in dialyzed patientsPatients with chronic kidney disease (CKD) on dialysis present physical and psychological limitations that induce to a sedentary life stile. The prescription of exercise for this population has not been common, especially in our country. In the last few years though, some authors have shown that exercising for these patients improves hypertension control, cardiac function, muscular strength, functional capacity and, consequently, their quality of life. Besides the benefits related to the cardiovascular system, exercise training during hemodialysis reduces the monotony of the procedure, improves adherence and contributes to the increase of dialysis efficacy. In this review, the authors discuss some aspects of exercise training in patients with CKD on dialysis and present their preliminary data of supervised exercises during hemodialysis sessions. INTRODUÇÃOO número de pacientes com doença renal crônica (DRC) em todo o mundo tem aumentado em proporções alarmantes, ocasionando um importante problema de saúde pública. No Brasil, de 1994 a 2005, o número de pacientes em hemodiálise (HD) e diáli-se peritoneal elevou-se de 24.000 para 65.121(1-2) . Como conseqüência, do número crescente de doentes renais crônicos, os gastos do Ministério da Saúde com a terapia renal substitutiva são de aproximadamente 1,4 bilhão de reais por ano, quantia esta correspondente a cerca de 10% do orçamento global desse ministério (1) .Nessa população, as doenças cardiovasculares (DCV) representam a principal causa de morbidade e de mortalidade. Além disso, contribuem sobremaneira para a diminuição da capacidade funcional, para a baixa tolerância ao exercício e, conseqüentemente, para a dificuldade de realização das atividades da vida diária (3)(4)(5) . Além das DCV, também contribuem ...

Repercussão de um protocolo fisioterapêutico intradialítico na funcionalidade pulmonar, força de preensão manual e qualidade de vida de pacientes renais crônicos

“…Those authors have justified their findings due to the small size of the sample and lack of routine physical exercise programs in dialysis centers, which can also explain some results of the research. On the other hand, Reboredo et al (2007) 10 have found a significant improvement in the "physical functioning", "general health perception", "vitality", and "social functioning" domains after three months of intradialytic aerobic training.…”

“…In addition to the influence on the QOL, both dialysis and the disease itself interfere with almost all body systems (cardiovascular, immune, endocrine/ metabolic, 12,10,14,18 and muscle skeletal) 19 , the respiratory system being specifically the most impaired according to some authors. 3,6,12,14 The most commonly found pulmonary alterations are as follows: limitation to air flow; obstructive disorders; a reduction in pulmonary diffusion capacity; and a decrease in respiratory muscle endurance and strength.…”

“…3,6,14 However, measuring respiratory muscle strength and function allows the early diagnosis of those changes, helping in establishing supervised training protocols. 13 Some authors have emphasized that, along with impairment of the respiratory system, the muscle structure alterations 19 caused by the build up of uremic toxins result in symptoms, such as fatigue, atrophy, cramps, asthenia 9,10,15,20 , and general muscle weakness. 6 Some studies have reported that physical exercise training programs have modified morbidity and survival of azotemic patients, causing metabolic, physiological, and psychological benefits.…”

“…Several studies have confirmed that. 4,5,10,14,15,17 The standardized and most commonly used instrument to assess QOL in the bibliography researched is the 36-Item Short-Form Health Survey (SF-36). By using that questionnaire, Faria et al (2008) 18 have assessed patients with CKD undergoing dialysis and have found an impairment in the "general health perception" and "vitality" domains of all individuals studied.…”

“…[4][5] Renal dysfunction is characterized by a glomerular filtration rate (GFR) lower than 60 mL/ min/1.73m 2 , for more than three months, and, when GFR reaches levels lower than 15 mL/min/1.73m 2 , the renal dysfunction is called end-stage CKD. 6 Currently, CKD can be considered a severe public health problem, because of its high morbidity and mortality rates, and negative impact on physical and psychosocial aspects of patients advanced CKD [7][8][9][10][11] . According to data from the study by Coelho et al (2008), 12 96% of the dialyses in our country are performed at units of the Brazilian Public Unified Health Care System (SUS).…”