Exercício aeróbico baseado no primeiro limiar ventilatório em pacientes com excesso de peso e doença renal crônica: impacto sobre a capacidade cardiorrespiratória e funcional

INTRODUCTION: Chronic kidney disease (CKD) and obesity are both associated with reduced physical capacity. The potential benefit of aerobic training on physical capacity has been recognized. The exercise intensity can be established using different methods mostly subjective or indirect. Ventilatory threshold (VT) is a direct and objective method that allows prescribing exercise intensity according to individual capacity. OBJECTIVES: To evaluate the impact of aerobic training at VT intensity on cardiopulmonary and functional capacities in CKD patients with excess of body weight. METHODS: Ten CKD patients (eight men, 49.7 ± 10.1 years; BMI 30.4 ± 3.5 kg/m², creatinine clearance 39.4 ± 9.8 mL/min/1.73 m²) underwent training on a treadmill three times per week during 12 weeks. Cardiopulmonary capacity (ergoespirometry), functional capacity and clinical parameters were evaluated. RESULTS: At the end of 12 weeks, VO2PEAK increased by 20%, and the speed at VO2PEAK increased by 16%. The training resulted in improvement in functional capacity tests, such as six-minute walk test (9.2%), two-minute step test (20.3%), arm curl test (16.3%), sit and stand test (35.7%), and time up and go test (15.3%). In addition, a decrease in systolic and diastolic blood pressures was observed despite no change in body weight, sodium intake and antihypertensive medication. CONCLUSION: Aerobic exercise performed at VT intensity improved cardipulmonary and functional capacities of overweight CKD patients. Additional benefit on blood pressure was observed. These results suggest that VT can be effectively applied for prescribing exercise intensity in this particular group of patients.INTRODUÇÃO: O excesso de peso e a doença renal crônica (DRC) estão associados à baixa capacidade cardiorrespiratória (CR) e funcional (CF). Já foi observado que o treinamento aeróbico (TA) melhora a CR e CF. Métodos indiretos e subjetivos são comumente empregados para a prescrição da intensidade do TA. O limiar ventilatório (LV) é um método direto e objetivo que permite prescrever a intensidade do TA de acordo com a capacidade física do paciente. OBJETIVOS: Avaliar o impacto do TA com base na intensidade do LV sobre a CR e CF de pacientes com excesso de peso e portadores de DRC na fase não dialítica. MÉTODOS: Dez pacientes (oito homens; 49 ± 10,1 anos, IMC 30,4 ± 3,5 kg/m² , depuração de creatinina 39,4 ± 9,8 mL/min/1,73m²) foram submetidos à TA 3 vezes por semana durante 12 semanas. CR (ergoespirometria), CF e parâmetros clínicos foram avaliados. RESULTADOS: O TA promoveu aumento de 20% no consumo pico de O2 (VO2PICO), 16% na velocidade alcançada no VO2PICO e melhora em 9,2% na caminhada de seis minutos, 20,3% na marcha estacionária, 35,7% no sentar e levantar, 16,3% na resistência muscular de membro superior e 15,3% no tempo de ir e voltar. A pressão arterial diminuiu sem modificação nos anti-hipertensivos, no peso ou no consumo de sódio. CONCLUSÃO: Os resultados indicam que o TA baseado na intensidade do LV melhora a CR, CF e pressão arterial de pacientes portadores de DRC com excesso de peso. Isso sugere que o TA baseado na intensidade LV é eficaz e pode ser empregado com segurança nesses pacientes.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP)UNIFESP Fundação Oswaldo RamosUNIFESP, Fundação Oswaldo RamosSciEL

IMPACT OF AEROBIC EXERCISE ON VISCERAL FAT OF NONDIALYSIS DEPENDENT OVERWEIGHT CKD PATIENTS: A PILOT STUDY

This is a randomized controlled study that aimed to assess the impact of aerobic exercise on visceral fat of overweight CKD patients. Twenty-six sedentary patients in stages 3–4 of CKD (73% men; 52.3±8.6 years, BMI 30.6±4.3 kg/m2) were included. Patients were assigned to aerobic exercise group (EG; n=13) or control group (CG; n=13). The aerobic training was conducted on a treadmill at the ventilatory threshold three times per week during 12 weeks. The CG patients remained without practicing exercise during follow up. Visceral and subcutaneous fat were assessed by computed tomography, and lean body mass (LBM) by DEXA. At the end of 12 weeks, visceral fat decreased 5% in EG and increased 3% in CG (p=0.02). Waist circumference decreased 1.5% in EG and increased 0.8% in CG (p=0.02). No changes were observed in body weight and subcutaneous fat. LBM tended to increase in EG and decrease in CG (p=0.09). In addition, blood pressure decreased (p<0.01) despite no change in body weight, 24 h urinary sodium and antihypertensive medication. Our results suggest aerobic exercise as an effective approach to reduce visceral fat while maintaining lean body mass in CKD patients

DESCRIPTION OF THE SUBJECTIVE GLOBAL ASSESSMENT COMPONENTS IN NONDIALYSIS-DEPENDENT CHRONIC KIDNEY DISEASE PATIENTS

Subjective Global Assessment (SGA) is a well-recognized and valid tool for diagnosing malnutrition in chronic kidney disease (CKD). SGA is based on components as weight change, dietary intake change, gastrointestinal symptoms, functional capacity, comorbidities related to nutritional condition and physical examination. Herein, we aimed at investigating which SGA alteration was the most prevalent in patients in the nondialysis stages of CKD. Seven-hundred and three patients were studied (91% CKD stages III and IV, eGFR 34.1±13.7 mL/min, 64±13.3 years, 58% men, 45% diabetics, BMI 27.9±7.4 kg/m2). Each of the SGA components was scored from 1 to 7 according to the severity, and values ≤ 5 were considered as abnormal. Malnutrition was observed in 11.5% of the patients, of which 10.5% mild to moderately malnourished (score of 3–5) and 0.7% severely malnourished (score of 1 or 2). The frequency of alterations in the SGA components is demonstrated below: As can be seen dietary intake change was the most frequent alteration among the SGA components in nondialysis CKD patients.fx