Efeitos de um programa de exercícios funcionais transdialítico sobre desfechos cognitivos e qualidade de vida: um ensaio clínico randomizado

Abstract

Objective: The present study aimed to determine the chronic effects of an intervention with functional exercises immediately before hemodialysis sessions on cognitive outcome and quality of life in patients with chronic kidney disease. Materials and methods: A randomized clinical trial was carried out in a hospital in southern Brazil. Fifty-seven patients of both sexes were randomly assigned to an usual care group (GTU; n=28); and intervention group (GI; n=29). The intervention lasted 12 weeks with three week sessions. The IG received balance and functional strength exercises for the lower limbs before starting the hemodialysis session, lasting 20 minutes. Afterwards, the patients were referred to a hemodialysis session and, in the first two hours of dialysis therapy, both groups received aerobic training on a cycle ergometer lasting 20 minutes per session at the following intensities: weeks 1 to 6 – heart rate between 57 to 63% of maximum heart rate; weeks 7 to 12 – heart rate between 64 to 76% of maximum heart rate. The application of cognitive measurement and quality of life instruments was performed before and after the intervention. The 5% two-tailed significance level was used throughout the analysis. The Two-Way Analysis of Variance Anova test with repeated measures was used to verify the effects of the intervention when the variables presented a parametric behavior, using the Bonferroni Post-hoc in cases where there was a difference between the groups. Friedman's test was used for variables with non-parametric behavior. Results: Results: 42 patients completed the intervention with a minimum frequency of 50% of the sessions, 23 in the GTU and 19 in the GI. In general, participants had reduced cognitive function and quality of life, which reaffirmed the cognitive impairment and quality of life of renal patients on hemodialysis. The results showed that after the training period both groups showed improvements in cognitive function. However, the exercise protocol used in the present study did not produce changes in the total quality of life score of this population. Conclusion: Interventions with balance and functional strength exercises performed before individuals start the hemodialysis session are not superior to low intensity intradialytic aerobic training on the cognitive function and quality of life of individuals with chronic kidney disease undergoing hemodialysis.