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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.
J Physiother. 2019 01; 65(1):4-15.JP

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.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

30581137

Citation

Scapini, Kátia B., et al. "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." Journal of Physiotherapy, vol. 65, no. 1, 2019, pp. 4-15.
Scapini KB, Bohlke M, Moraes OA, et al. 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. J Physiother. 2019;65(1):4-15.
Scapini, K. B., Bohlke, M., Moraes, O. A., Rodrigues, C. G., Inácio, J. F., Sbruzzi, G., Leguisamo, C. P., Sanches, I. C., Tourinho Filho, H., & Irigoyen, M. C. (2019). 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. Journal of Physiotherapy, 65(1), 4-15. https://doi.org/10.1016/j.jphys.2018.11.008
Scapini KB, et al. 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. J Physiother. 2019;65(1):4-15. PubMed PMID: 30581137.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Scapini,Kátia B, AU - Bohlke,Maristela, AU - Moraes,Oscar A, AU - Rodrigues,Clarissa G, AU - Inácio,José Fs, AU - Sbruzzi,Graciele, AU - Leguisamo,Camila P, AU - Sanches,Iris C, AU - Tourinho Filho,Hugo, AU - Irigoyen,Maria C, Y1 - 2018/12/21/ PY - 2017/10/12/received PY - 2018/06/27/revised PY - 2018/11/26/accepted PY - 2018/12/26/pubmed PY - 2019/12/27/medline PY - 2018/12/25/entrez KW - Chronic kidney failure KW - Exercise KW - Network meta-analysis KW - Physical therapy KW - Renal dialysis SP - 4 EP - 15 JF - Journal of physiotherapy JO - J Physiother VL - 65 IS - 1 N2 - 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. SN - 1836-9561 UR - https://www.unboundmedicine.com/medline/citation/30581137/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1836-9553(18)30151-6 DB - PRIME DP - Unbound Medicine ER -