Patients with chronic kidney disease show poorer functional and cardiorespiratory capacity than healthy individuals, and these impairments result in sedentarism. The aim of this study was to conduct a systematic review and meta-analysis of randomized clinical trials on the effects of different intradialytic exercise protocols on cardiopulmonary capacity in chronic kidney disease patients. The primary outcome was peak oxygen consumption (VO_2peak) and the secondary outcomes were exercise duration and ventilation in the cardiopulmonary test. The quality of the evidence was evaluated using the GRADE guidelines. Seven studies with a total of 124 participants met the inclusion criteria. Compared to the non-exercise group, the exercise group improved in mean VO_2peak (MD 4.06 [IC 0.81; 7.31]). In a separate analysis according to exercise modality, aerobic exercise plus strength training performed better than aerobic exercise alone (MD 5.28 [IC 3.90; 6.66]). In the exercise group, both exercise tolerance values (MD 3.10 [IC 1.70; 4.51]) and ventilation values in the cardiopulmonary test were better than those of the control group (MD 13.10 [IC 7.12; 19.09]). Thus, intradialytic exercise protocols can improve cardiopulmonary function, exercise tolerance and ventilatory efficiency in chronic kidney disease patients.

Individuals with chronic kidney disease (CKD) have a systemic inflammatory state. We assessed the effects of exercise on inflammatory markers in individuals with CKD. An electronic search was conducted, including MEDLINE. Experimental clinical trials that investigated the effects of exercise on inflammatory markers in individuals with CKD at all stages were included. Meta-analyses were conducted using the random-effects model and standard mean difference (SMD). Subgroup analyses were performed for resistance, aerobic, and combined exercise interventions. Twenty-nine studies were included in the meta-analyses. Exercise interventions showed significant reductions in C-reactive protein (CRP) (SMD: −0.23; 95% CI: −0.39 to −0.06), interleukin (IL)-6 (SMD: −0.35; 95% CI: −0.57, −0.14), and tumor necrosis factor-alpha (TNF-α) (SMD: −0.63, 95% CI: −1.01, −0.25) when compared with the controls. IL-10 levels significantly increased (SMD: 0.66, 95% CI: 0.09, 1.23) with exercise interventions. Resistance interventions significantly decreased CRP (SMD: −0.39, 95% CI: −0.69, −0.09) and TNF-α (SMD: −0.72, 95% CI: −1.20, −0.23) levels, while increasing IL-10 levels (SMD: 0.57, 95% CI: 0.04, 1.09). Aerobic interventions only significantly reduced IL-6 levels (SMD: −0.26, 95% CI: −0.51, −0.01). No significant changes in any inflammatory markers were observed with combined exercise interventions. Exercise interventions are effective as an anti-inflammatory therapy in individuals with CKD compared to usual care control groups. Resistance interventions seem to promote greater anti-inflammatory effects.

Em 2050, o número de brasileiros residindo em áreas urbanas passará dos 200 milhões e 29% da população será composta por idosos. Os idosos longevos possuem 80 anos ou mais, os idosos jovens são aqueles que apresentam idade entre 60 e 79 anos. O objetivo foi verificar a diferença da percepção de idosos jovens e longevos do Rio Grande do Sul quanto ao ambiente urbano em que vivem. Estudo de base populacional, observacional, descritivo, retrospectivo, com paradigma de análise quantitativa, analisou dados da pesquisa Perfil dos Idosos do RS, realizado pelo Instituto de Geriatria e Gerontologia da PUCRS em parceria com a Escola de Saúde Pública do RS. A amostra foi composta por 6913 questionários respondidos por idosos de 59 cidades. A análise dos dados foi realizada com cada um dos grupos etários e as variáveis independentes foram testadas pelo Qui-Quadrado, sendo o nível de significância menor que 0,05. Como resultado, a percepção de dificuldades, como poucos bancos, falta de faixas de segurança, tempo de sinal muito curto para pedestres, degraus muito altos e mau cheiro dos banheiros públicos, foi maior entre os idosos jovens. Os idosos longevos perceberam menos esses fatores, porém, referiram que frequentam menos os ambientes comunitários.

Hemodialysis contributes to increased oxidative stress and induces transitory hypoxemia. Compartmentalization decreases the supply of solutes to the dialyzer during treatment. The aim of this study was to investigate the acute effects of intradialytic aerobic exercise on solute removal, blood gases and oxidative stress in patients with chronic kidney disease during a single hemodialysis session. Thirty patients were randomized to perform aerobic exercise with cycle ergometer for lower limbs during 30 minutes with intensity between 60-70% of maximal heart rate, or control group (CG). Blood samples were collected prior to and immediately after exercise or the equivalent time in CG. Analysis of blood and dialysate biochemistry as well as blood gases were performed. Mass removal and solute clearance were calculated. Oxidative stress was determined by lipid peroxidation and by the total antioxidant capacity. Serum concentrations of solutes increased with exercise, but only phosphorus showed a significant elevation (p = 0.035). There were no significant changes in solute removal and in the acid-base balance. Both oxygen partial pressure and saturation increased with exercise (p = 0.035 and p = 0.024, respectivelly), which did not occur in the CG. The total antioxidant capacity decreased significantly (p = 0.027). The acute intradialytic aerobic exercise increased phosphorus serum concentration and decreased total antioxidant capacity, reversing hypoxemia resulting from hemodialysis. The intradialytic exercise did not change the blood acid-base balance and the removal of solutes.