Influence of intradialytic aerobic training in cerebral blood flow and reflection on cognitive function and quality of life in chronic renal patients

Author(s)

Fernanda Stringuetta Belik

• Document type: Doctoral Thesis
• Press: Botucatu. 2016-03-31.
• Institution: Universidade Estadual Paulista (Unesp). Faculdade de Medicina. Botucatu
• Defense date: 2016-02-19
• Advisor: Roberto Jorge da Silva Franco; Luis Cuadrado Martin

Abstract

Introduction: Chronic kidney disease (CKD) has a complex interrelationship with other diseases. The literature reports a direct association between decline in kidney function and cognitive impairment, which is associated with worse quality of life (QoL). Changes in cerebral hemodynamics may play a role in the pathogenesis of cognitive impairment among patients on hemodialysis (HD). Recently, there is evidence to support the physical activity role in preventing or delaying cognitive decline. Objective: To evaluate the effects of intradialytic aerobic training on cerebral blood flow, cognitive function and QoL in patients with CKD in HD. Methods: randomized controlled trial of physiotherapy intervention, with analysis intention to treat. Thirty patients underwent exercise testing, evaluation of cerebral blood flow, arterial stiffness, cognitive function test and QoL questionnaire. Fifteen patients in intervention group (IG) underwent intradialytic aerobic exercise three times a week for four months. Others fifteen patients in control group (CG) had no intervention. All patients were reassessed after the physical activity protocol or four months after the first evoluation, for the control group. Results: In IG, results showed statistically significant improvement of cognitive function (p <0.001), maximum blood flow velocity of the basilar artery (p = 0.029) and QoL in the fields dialysis staff encouragement (p = 0.025) and pain (p = 0.008). The variable arterial stiffness was no statistically significant difference after intervention. The proportion of arteries which increased the maximum speed and average cerebral blood flow showed a statistically significant difference between groups (p = 0.002 and p = 0.038 respectively). Conclusion: Intradialytic aerobic exercise proved beneficial for the improvement of cognitive function and QoL of patients with CKD in HD. Physical training protocol had a positive effect on cerebral blood flow with numerical increase of the maximum and average speeds of the large majority of the evaluated arteries, suggesting a possible mechanism of improved cognitive function. (AU)

• FAPESP's process: 11/20652-7 - Influence of intradialytic aerobic training in cerebral blood flow and reflection on cognitive function and quality of life in chronic renal patients
• Grantee: Fernanda Stringuetta Belik
• Support Opportunities: Scholarships in Brazil - Doctorate