臨牀透析 Vol.28 No.9(2-4)


特集名 透析患者における生活習慣改善策
題名 [各論―各生活習慣が及ぼす影響と具体的な対策]運動不足
発刊年月 2012年 08月
著者 三浦 美佐 東北大学大学院医学系研究科機能医科学講座内部障害学分野
著者 伊藤 修 東北大学大学院医学系研究科機能医科学講座内部障害学分野
【 要旨 】 近年の血液透析技術の進歩は慢性腎不全患者に著しい延命効果をもたらしたが,その一方で,透析患者は多くの問題点を抱えながら長期間の透析生活を送らなければならない.透析患者では,腎性貧血,尿毒症性低栄養,筋力低下,運動耐容能の低下,骨格筋の減少と機能異常,活動量減少などがみられる.そして,長期間にわたる透析により,低血圧や心不全に伴う心臓機能低下などの合併症が発生し,QOLの低下へとつながる.したがって,この透析患者の廃用症候群への対策として運動療法は非常に重要であり,患者の個々の身体能力に合わせたプログラムの実施が望まれる.
Theme Improving Plans for Lifestyle in Patients on Chronic Dialysis
Title Exercise therapy for dialysis patients
Author Misa Miura Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine
Author Osamu Ito Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine
[ Summary ] Hemodialysis (HD) patients exhibit reduced levels of fitness. They also display various structural, metabolic and functional abnormalities, due to uremic changes in skeletal muscles. The exercise capacity of HD patients declines in a manner independent of the extent of renal dysfunction. Aerobic and resistance exercise are beneficial in terms of improving physical functions, including maximal oxygen uptake and muscle strength. A host of other functions and conditions may improve as well. These include improved anthropometrics, nutritional status, hematological indexes, inflammatory cytokine levels, depression and health related quality of life issues. As a result, it is widely accepted that exercise is a cornerstone of treatment for HD patients as it is for the health of the general population. However it is often difficult to incorporate exercise regimens into treatment programs. Recently interventions during hemodialysis sessions have become more popular and have been shown to be safe. The risks of exercise related injuries in the general population have been studied and found to be low. Exercise programs should be incorporated into treatment programs for HD patients. As a result, their development and implementation should be carried out in an expeditious manner.
戻る