Efeitos do exercício físico resistido na modulação autonômica cardíaca e na capacidade funcional de pacientes renais crônicos em hemodiálise

Abstract

Patients with chronic kidney disease (CKD) are often affected by functional limitations resulting from a sedentary lifestyle. Although poorly studied and with various protocols, intradialytic muscle strengthening programs can promote physiological, functional, and psychological improvements in these patients. Thus, this study aimed to evaluate the effects of an intradialytic resistance exercise program on cardiac autonomic modulation and functional capacity in patients with CKD. Forty-one chronic renal patients undergoing hemodialysis at the University Hospital of the Federal University of Maranhão (HUUFMA) and the Nephrology Center of Maranhão (CENEFROM) were analyzed, divided into Intervention Group (IG) (intervention by physical exercise) and Control Group (CG) (side dish). Participants underwent anamnesis, laboratory tests recording, sleep quality and anxiety levels, and depression score testing. Additionally, we performed a resting electrocardiogram to analyze heart rate variability, handgrip strength measurement, and the 6-minute walk test (6MWT) performance. Afterwards, the IG performed the protocol of 12 weeks of intradialytic physical training, with a frequency of three times a week. At the end of the 12 weeks, participants in both groups (CG and IG) underwent reassessment. The constitution in relation to sex in the IG was thirteen men and nine women and in the CG twelve men and seven women, the mean age in the IG was 52.41 ± 14.77 years and in the CG was 53.63 ± 14, 15 years. There was an increase in hand grip strength (kgf) 23.05 ± 6.04 vs 30.05 ± 7.56 (p=0.001) and an increase in the distance covered in the 6MWT(m) 374.60 ± 45.26 vs 444.10 ± 49.79 (p<0.0001), in the group submitted to physical training. In the analysis of heart rate variability, there was an increase in cardiac autonomic modulation in the intervention group (physical training), with increased parasympathetic predominance (SDNN p=0,0004, RMSSD p<0,0001, SD1 p=0,03, SD1/SD2 p=0,0003). In the control group 15% of the participants had sleep disorders and in the intervention group 13%. There was no change in sleep quality in both groups before and after 12 weeks, however there was a reduction in anxiety levels in both groups (p<0.05), being more pronounced in the intervention group. There was no statistical difference in the depression score, before and after the study period. There were no changes in biochemical variables before and after 12 weeks of intradialytic exercise (p>0.01). Based on these results, it is possible to conclude that resistance exercise performed in the intradialytic phase is an effective therapeutic strategy for patients with CKD, mainly because it increases functional capacity and improves cardiac autonomic modulation