| 摘要: | 透析患者因為疾病本身及諸多慢性病的影響，如高血壓、心衰竭、冠心病、貧血、憂鬱、 糖尿病導致運動能力、運動表現及自覺生理機能較差。因為運動能力差，又使得患者運 動意願更差，成一惡性循環。先前資料顯示運動能力、運動表現及自覺生理機能不僅為 影響患者生活品質之重要因素，也影響患者存活。高血壓、心衰竭、憂鬱、糖尿病等患 者及先前有關透析患者(大多為血液透析)報導接受運動訓練可以得到許多好處。目前透 析患者運動訓練多為對血液透析患者在透析時作單一運動模式訓練，如騎腳踏車，作12 至24 週的短期介入。之後比較生活品質、憂鬱等指標。初步結果短期運動對患者運動 能力及生活品質都有顯著的進步。但是單一運動模式訓練做久難免無聊及難以持久，患 者順應性仍是很大的問題，且單一訓練未必適合每一個人，運動訓練應依個人情況及需 求不同調整。此外先前研究對運動所致之運動能力增加、耐力、心肺功能改善及重要的 健康指標如存活、共病、心肺危險性則資料闕如。本研究設計先對所有意識清楚，能自 由行走之透析患者作問卷調查，對有意願及需求之患者給予一年期個人化之到院及居家 運動訓練以研究長期運動訓練對透析患者運動能力、耐力、肺功能改善、心肺危險性、 睡眠、不寧腿症候群之影響。本研究設計除依個人情況調整運動，加長訓練追蹤時間， 更定期對運動能力、肌耐力、心肺功能、血管硬度做追蹤，以期更適切解答運動對患者 的影響。存活、共病的影響可能需要更長的訓練及追蹤才看得見，期使在訓練結束後5-10 年仍能對患者做追蹤調查。
Dialysis patients suffer an excessive burden of chronic conditions like hypertension, congestive heart failure, coronary heart disease, anemia, depression and diabetes mellitus. These conditions lead to poor exercise capacity, physical performance, and self-reported physical functioning. Poor physical capacity forward retards the attempts to exercise and become a vicious cycle. Exercise capacity, physical performance, and self-reported physical functioning not only affect patients’quality of life but also reduce their survival. Previous researches revealed patients with hypertension, heart failure, depression, diabetes mellitus and end-stage renal disease on hemodialysis benefits from exercise training. However, previous trainings usually use single exercise mode, like cycling, and a short term (12 to 24 weeks) intervention, compare the endpoint of quality of life, depression, sleep and restless leg syndrome. Most studies had favorable results. For these reasons, prolonged the benefit of long term results might be anticipated. However, the situation between every patient varied. Single exercise mode is not suitable to everyone and might lead to poor adherence. Previous studies overall lack of evidence regarding to the impact of exercise-induced changes in exercise capacity, endurance, and cardiovascular function on a number of relevant health outcomes (survival, morbidity, and cardiovascular risk), and, more importantly, there is no evidence on the long-term impact of exercise and/or physical activity interventions on these health outcomes. These changes need to be followed longer. We designed this one year individualized exercise training and two year follow up program to investigate the effect of long term exercise training on change of exercise capacity, endurance, cardiovascular risk (arterial stiffness), depression, Sleep, restless leg syndrome, and quality of life in clear consciousness, ambulatory dialysis patients. We not only prolong the training course, but the follow up after stop training. We also investigate their exercise capacity, endurance, arterial stiffness regularly till for two years to answer the effect of long term effect on patients. The effects to survival and comorbidity require to follow longer and maybe obtained 5 to 10 years after the end of the study. |
