Significance Of Exercise On Iproving Quality Of Life In Patients With Chronic Kidney Disease

Chronic kidney disease (CKD), with increasing incidence and prevalence, has become one of the top ten causes of death worldwide. How to improve the prognosis of CKD patients, improve the survival rate and quality of life, is the obligatory mission of nephrology workers. Exercise is an eternal topic of all living things, and the role of exercise in patients with kidney disease has been controversial in the past, and now there is increasing evidence that appropriate exercise is beneficial for patients with CKD. The significance of exercise for CKD patients Exercise has become a key therapy for the treatment and prevention of various diseases, but it has not been fully valued in CKD patients, and some even think that exercise is not good for CKD patients. There are very few doctors who actually formulate exercise prescriptions for patients in clinical practice, and even fewer patients insist on long-term and high-efficiency exercise. As the disease progresses, the patient's physical activity ability will decline, and the main activities are limited to monotonous, local mechanical daily housework, which is easy to cause local joint and muscle fatigue and injury, and may increase the risk of cardiovascular disease for a long time. A physical activity that is planned, purposeful, and coordinated throughout the body is more beneficial to health. Several studies in recent years have shown that regular exercise is beneficial for patients with CKD, regardless of exercise type, duration, or intensity. Of course, continuous high-intensity sports, such as football, basketball, and long-distance running, can easily induce adverse events and are not suitable for CKD patients. It is currently recognized that patients with CKD should focus on moderate-intensity aerobic exercise, 30 to 60 min/time, 3 to 5 times/week, which can be combined with resistance exercise and flexibility exercise. At the same time, we should also pay attention to formulate personalized exercise prescriptions for different ages, physiological and pathological states, and adjust them in time according to the physiological state of patients.

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Improve Kidney Function Cistanche

The impact of exercise on outcomes in patients with CKD The 2012 Organizational Guidelines for Improving Global Outcomes in Kidney Disease recommends that CKD patients be encouraged to engage in physical activity compatible with cardiovascular health and tolerance to improve patient outcomes. The guidelines lay the foundation stone for the movement in CKD management. Subsequently, whether it is the "Expert Consensus on Exercise Rehabilitation for Patients with CKD in the United Kingdom" in 2015, the "Recommendation of Exercise Rehabilitation for Patients with CKD and End-stage Renal Disease in the United States" in 2017, and the "Expert Consensus on Exercise Rehabilitation for Adult CKD Patients" in 2019 It is recommended that CKD patients need moderate-intensity aerobic exercise and resistance exercise, and that exercise guidance should be as important as nutritional guidance, but it is still unclear which exercise method is better. The so-called moderate-intensity exercise refers to reaching 60% to 75% of the maximum heart rate during exercise, and its estimation formula is: maximum heart rate = 208-(0.7 × age). The American Kidney Foundation guidelines also point out that patients with CKD should undergo a motor function assessment and redesign of their exercise plan at least every 6 months. A number of domestic and foreign studies, represented by the Dialysis Prognosis and Practice Model Study (DOPPS), have proved that regardless of CKD stage and treatment plan, low exercise level is closely related to poor clinical prognosis, and exercise training is effective for CKD patients at any stage. The benefits are mainly reflected in the improvement of cardiovascular function, renal function and quality of life. Exercise can increase left ventricular ejection fraction, lower blood pressure and blood lipid levels, improve microvascular function, and reduce the risk of cardiovascular disease. It can also significantly improve arteriosclerosis, increase renal blood flow, accelerate the clearance of toxins such as urea nitrogen and creatinine, and reduce renal damage induced by oxidative stress and inflammation, thereby delaying the progression of CKD. Exercise training can effectively improve the patient's psychological state, aerobic metabolism, increase the body's disease resistance, adjust the mental state, and significantly improve the patient's quality of life.

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The current situation of the implementation of exercise in CKD patients At present, the form, intensity, duration and specific implementation of exercise in CKD patients can be described as a hundred flowers blooming and a hundred schools of thought contend. It mainly includes aerobic exercise, resistance exercise and flexibility exercise. Aerobic exercise can be performed in a flat outdoor venue with no obstacles, a quiet environment and fresh air, such as walking, brisk walking, aerobics, dancing, swimming, etc., or indoors using medical treadmills, power bicycles, treadmills, etc. to exercise. Resistance exercise is mainly carried out with the help of sports equipment, such as elastic bands, sandbags, dumbbells, tensioners, etc. Flexibility exercises include stretching, yoga, etc. Some traditional sports in my country, such as Baduanjin, Taijiquan and meditation, have also become popular among CKD patients in recent years. Walking is the easiest aerobic exercise. The First Affiliated Hospital of Chengdu Medical College conducted a 3-month controlled study on the number of daily walks and found that walking more than 10,000 steps a day had the best effect on CKD patients. Ice and snow exercise is a kind of mild hypothermic aerobic exercise. 

The First Affiliated Hospital of Hebei Northern University performs ice and snow exercise once a week for patients with CKD stage 3, which can significantly improve the renal function of patients and reduce the incidence of poor renal prognosis. A randomized controlled study in the United Kingdom in 2021 showed that cycling exercise during dialysis for 6 months for hemodialysis patients, 3 times/week, 30min/time, can effectively reduce the weight of the left ventricle, which is safe and well tolerated. Thera-band resistance training with elastic band is a simple, economical and effective resistance exercise, 3 times per week, training of shoulder joint adduction, abduction and knee flexion and extension, which can enhance the muscle strength of patients. , improve physical function. Yoga is a flexible exercise, 5 times/week, 40-60min/time, can lower blood pressure, improve renal function, and improve quality of life. The West China Hospital of Sichuan University adopts the "Three-in-One" form of "Harmony Tai Chi", which is characterized by traditional Chinese exercises, for CKD patients, including the Eight Forms of Harmony Tai Chi, Health Baduanjin and Meditation. The three are not only a whole, but also can be split, step by step, adjusted at any time, not restricted by equipment and venues, good exercise compliance and high safety. In conclusion, exercise is an important measure to improve the quality of life of patients with CKD, and it should be incorporated into daily clinical management practice, so that patients can fully realize the benefits of appropriate exercise therapy and help to integrate it into their daily life naturally. Traditional sports such as tai chi and yoga, which are popular among the masses, are worthy of promotion in CKD patients due to their low intensity, simple and flexible operation, and lower incidence of adverse events.

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