臨牀透析 Vol.34 No.8(6)


特集名 透析患者の余暇とレクリエーション
題名 透析患者がスポーツをするうえでの工夫と注意点
発刊年月 2018年 07月
著者 上月 正博 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 】 CKD患者は,高齢化や運動不足に加えて,尿毒症物質の蓄積,アシドーシス,炎症性サイトカインなどのためフレイル・PEW(protein energy wasting)をきたしやすい.運動耐容能の低下やフレイル・PEWはQOLや生命予後に大きな影響を与える.透析患者への運動療法は,最大酸素摂取量の増加,心機能改善,骨格筋線維の増加,血圧低下,血清脂質改善,PEWの改善,透析効率改善,ADLやQOLが改善するなどの効果を有する.運動様式としては,血管シャントや腹膜カテーテルの感染や圧迫に十分注意を払う必要があり,相手と接触するスポーツは避け,ウォーキングを中心とした有酸素運動,レジスタンストレーニング,柔軟体操が基本である.今後の腎臓リハビリテーションの普及・発展が期待される.
Theme Leisure and dialysis patients
Title How should exercise and sports be introduced to patients undergoing dialysis?
Author Masahiro Kohzuki Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine
[ Summary ] Chronic kidney disease (CKD) is associated with high mortality and morbidity, and such patients have poor exercise tolerance. A variety of factors including anemia, poor muscle mass, cardiovascular changes, and limited physical activity contribute to exercise intolerance. This review focuses on the importance and efficacy of exercise and sports for hemodialysis (HD) patients. Systematic review and meta-analysis of randomized controlled trials have revealed that exercise-based renal rehabilitation (aerobic and resistance training) improves aerobic capacity, muscular functioning, cardiovascular function, walking capacity, and health-related quality of life in CKD patients undergoing HD. A proper risk assessment, thorough medical examination, exercise testing, and counselling are recommended before initiating an exercise regimen in individuals with CKD. Although renal transplant patients have successfully enrolled and excelled in many national and international sporting events including track and field, swimming, table tennis, tennis, badminton, bowling, volleyball, golf, cycling, and road races, the current recommendation is for individuals undergoing HD to avoid collision sports. Special care must be taken to avoid infection or damage to the peritoneal dialysis catheter and HD vascular access sites.
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