Diferença mínima clinicamente relevante dos efeitos do exercício físico sobre a capacidade funcional em sujeitos com doença renal crônica

Abstract

This doctoral thesis aimed to review the literature on the effects of physical exercise on functional capacity parameters in chronic kidney disease patients at any stage of the disease and to calculate the minimally clinically relevant difference to determine the minimum distance that must be covered to observe these changes. The database searches were conducted between December 2022 and April 2024 in PubMed, Scopus, Cochrane, and Clinical Trials databases. The inclusion criteria for the studies were as follows: Population: Individuals over 18 years of age, with no upper age limit, with chronic kidney disease at any stage. Intervention: Studies that included interventions exclusively with physical exercise, without any dietary or other methodological interventions, were included. Comparators: Only studies with a control group were accepted for comparison purposes. Outcome: All studies evaluating the effect of physical exercise concerning the 6-minute walk test were included; Study Type: Randomized controlled trials. This meta-analysis included 18 studies that met the eligibility criteria. Sample sizes ranged from 8 to 75 subjects. Patients who received the interventions (aerobic, strength, combined physical exercises, and virtual reality) totaled 1,151 subjects. We found that the average change in post intervention scores between the groups was 37.43 meters, with a 95% confidence interval (CI95%) ranging from 19.36 to 55.49, indicating a significant effect of the combined studies (z = 4.061, p = <0.001). Additionally, the results indicated that, on average, the exercised groups showed statistically significant increases compared to the control groups of the interventions. The heterogeneity among the studies was significant (Q = 48.34, p = <0.001), with an I² of 64.8%, suggesting high variability among the studies. A distance of 57.5 meters was considered clinically relevant and could be used as a cutoff point for future studies evaluating the effect of physical exercise on the functional capacity of chronic kidney disease patients through the 6-minute walk test. We concluded that aerobic, resistance, combined, and virtual reality exercise modalities were effective in increasing the functional capacity of subjects at any stage of CKD. It was also evidenced that the greater the intensity and duration of the intervention, the higher the levels of functional capacity, with a distance of 57.5 meters considered the minimally clinically relevant distance.