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Efeitos Fisiológicos do Exercício Físico em Doentes Pré-Diálise – Revisão Scoping
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A Doença Renal Crónica (DRC) em estádios G3b a G5, correspondente à fase pré-diálise, caracteriza-se por deterioração progressiva da função renal e por elevada carga de morbilidade cardiovascular, metabólica e funcional. Nesta fase, os doentes apresentam frequentemente descondicionamento físico, sarcopenia, inflamação crónica de baixo grau e maior risco de progressão da doença. O exercício físico tem sido reconhecido como uma intervenção não farmacológica potencialmente benéfica, mas a evidência específica para a fase pré-diálise permanece limitada.
Objetivo: Mapear os efeitos fisiológicos do exercício físico estruturado em doentes adultos com DRC nos estádios G3b a G5 (pré-diálise).
Métodos: Realizou-se uma Scoping Review (ScR) de acordo com as recomendações PRISMA-ScR. A pesquisa foi efetuada nas bases de dados MEDLINE via PubMed, ScienceDirect e B-on, utilizando uma estratégia estruturada segundo o modelo PCC (População, Conceito e Contexto). Foram incluídos estudos publicados nos últimos 10 anos, envolvendo intervenções de exercício físico estruturado em contexto clínico ou supervisionado. Após triagem por títulos e resumos, leitura integral e aplicação dos critérios de elegibilidade, foram incluídos oito estudos primários, maioritariamente ensaios clínicos.
Resultados: A evidência analisada demonstra de forma consistente melhorias na capacidade cardiorrespiratória, expressas pelo aumento do VO₂pico, bem como ganhos significativos na força muscular e no desempenho funcional. A função renal manteve-se globalmente estável ao longo das intervenções, não sendo identificados efeitos adversos associados ao exercício. Os efeitos sobre parâmetros hemodinâmicos, autonómicos e inflamatórios revelaram-se menos consistentes, possivelmente dependentes da intensidade e duração dos programas implementados.
Conclusão: O exercício físico estruturado é uma intervenção segura e clinicamente relevante na DRC em fase pré-diálise, associando-se a melhorias consistentes na aptidão cardiorrespiratória, na força muscular e na capacidade funcional, sem evidência de deterioração significativa da função renal durante os períodos de intervenção. Persistem, contudo, lacunas quanto ao seu impacto a longo prazo na progressão da doença e na modulação sustentada de marcadores inflamatórios e metabólicos, justificando a necessidade de ensaios clínicos de maior dimensão e duração.
Chronic Kidney Disease (CKD) in stages G3b to G5, corresponding to the pre-dialysis phase, is characterized by progressive decline in renal function and a high burden of cardiovascular, metabolic, and functional morbidity. During this stage, patients frequently present with physical deconditioning, sarcopenia, low-grade chronic inflammation, and an increased risk of disease progression. Exercise has been recognized as a potentially beneficial non-pharmacological intervention; however, evidence specifically addressing the pre-dialysis phase remains limited. Objective: To map and describe the physiological effects of structured physical exercise in adult patients with CKD stages G3b to G5 (pre-dialysis). Methods: A scoping review (ScR) was conducted in accordance with PRISMA-ScR guidelines. The literature search was performed in MEDLINE via PubMed, ScienceDirect, and B-on, using a structured strategy based on the PCC framework (Population, Concept, and Context). Studies published within the last 10 years involving structured exercise interventions in clinical or supervised settings were included. Following title and abstract screening, full-text review, and application of eligibility criteria, eight primary studies were included, the majority of which were clinical trials. Results: The available evidence consistently demonstrates improvements in cardiorespiratory fitness, reflected by increased peak oxygen uptake (VO₂peak), as well as significant gains in muscle strength and functional performance. Renal function remained globally stable throughout the interventions, with no exercise-related adverse effects identified. Effects on hemodynamic, autonomic, and inflammatory parameters were less consistent, possibly depending on the intensity and duration of the exercise programs. Conclusion: Structured physical exercise is a safe and clinically relevant intervention in pre-dialysis CKD, associated with consistent improvements in cardiorespiratory fitness, muscle strength, and functional capacity, without evidence of significant deterioration in renal function during the intervention period. However, gaps remain regarding its long-term impact on disease progression and sustained modulation of inflammatory and metabolic markers, highlighting the need for larger and longer-term clinical trials.
Chronic Kidney Disease (CKD) in stages G3b to G5, corresponding to the pre-dialysis phase, is characterized by progressive decline in renal function and a high burden of cardiovascular, metabolic, and functional morbidity. During this stage, patients frequently present with physical deconditioning, sarcopenia, low-grade chronic inflammation, and an increased risk of disease progression. Exercise has been recognized as a potentially beneficial non-pharmacological intervention; however, evidence specifically addressing the pre-dialysis phase remains limited. Objective: To map and describe the physiological effects of structured physical exercise in adult patients with CKD stages G3b to G5 (pre-dialysis). Methods: A scoping review (ScR) was conducted in accordance with PRISMA-ScR guidelines. The literature search was performed in MEDLINE via PubMed, ScienceDirect, and B-on, using a structured strategy based on the PCC framework (Population, Concept, and Context). Studies published within the last 10 years involving structured exercise interventions in clinical or supervised settings were included. Following title and abstract screening, full-text review, and application of eligibility criteria, eight primary studies were included, the majority of which were clinical trials. Results: The available evidence consistently demonstrates improvements in cardiorespiratory fitness, reflected by increased peak oxygen uptake (VO₂peak), as well as significant gains in muscle strength and functional performance. Renal function remained globally stable throughout the interventions, with no exercise-related adverse effects identified. Effects on hemodynamic, autonomic, and inflammatory parameters were less consistent, possibly depending on the intensity and duration of the exercise programs. Conclusion: Structured physical exercise is a safe and clinically relevant intervention in pre-dialysis CKD, associated with consistent improvements in cardiorespiratory fitness, muscle strength, and functional capacity, without evidence of significant deterioration in renal function during the intervention period. However, gaps remain regarding its long-term impact on disease progression and sustained modulation of inflammatory and metabolic markers, highlighting the need for larger and longer-term clinical trials.
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Palavras-chave
Doença renal crónica Pré-diálise Exercício físico Capacidade cardiorrespiratória Reabilitação