Американский колледж спортивной медицины (ACSM) опубликовал перечень противопоказаний для занятия физическими упражнениями (полный список абсолютных и относительных противопоказаний находится здесь[see Table 1]). Упражнения противопоказаны пациентам с ХПН с систолическим артериальным давлением > 200 mm Hg или диастолическим давлением > 110 mm Hg, электролитными расстройствами, недавними инфарктами миокарда, или недавними изменениями на ЭКГ.
Recently in the 2005 K/DOQI Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients, a brief paragraph generally recommending exercise was added (available here). This short, all-encompassing recommendation is only the beginning, since current data support the concept that both cardiovascular and resistance training improve the physiologic, psychological, functional, and clinical domains in CKD patients. However, larger, more detailed studies with patients across the spectrum of CKD are needed. Safety guidelines and detailed exercise prescriptions need to be developed. Eventually, cardiovascular and resistance training guidelines will exist for CKD patients just like they exist for patients with heart and lung disease (articles in exercise physiology class).
Recommendations to Clinicians
In the meantime, clinicians should encourage both cardiovascular and resistance training in patients with CKD; however, data indicate that they are not. In many cases, because of safety concerns, the training (especially for someone unaccustomed to exercise) may need to be supervised. Clinicians in the United States should consider consulting personnel registered by ACSM, such as the Registered Clinical Exercise Physiologist. These people are trained to deal with clinical populations and can correctly prescribe and monitor exercise training of all types in this population.
Finding the time of day when appropriate personnel can be present may be a challenge; however, the results of previously reported exercise training studies for patients on dialysis is encouraging. Patients who exercise during nondialysis time at dialysis visits sometimes have higher compliance than the healthy population, and appropriate personnel can be present to monitor exercise sessions.