血液透析病人的運動訓練

Exercise Training for Hemodialysis Patients

台灣末期腎病變的發生率及盛行率都是世界第一。透析治療是末期腎病患者最主要的治療方式，末期腎病患者在接受長期血液透析治療後，常常由於貧血以及尿毒症相關的肌肉病變與神經病變，導致肌肉耗損及過度疲憊，進而發生活動耐力不足、肌肉張力與強度下降的情況。目前學界尚未發展出完整的透析病人運動訓練指引，參考相關實證研究建議運動訓練前須要進行危險評估，評估病人是否有任何可能因運動誘發之潛在疾病。透析病患運動訓練時間建議需持續至少6個月以上，可採取合併有氧及肌力訓練與單一有氧訓練，在非透析時進行，定期足量的身體活動可以帶給病人最多的助益。若體力不足，可從輕度活動開始，之後漸進增加運動的強度及時間，以達到每日至少30分鐘中度強度運動的目標，方可達到心肺復健的效果。透析病患運動訓練的成敗在於，專業人員的介入，在非透析時進行，設計個別化訓練內容與設備，合理且可負擔的費用，與家人、醫護人員的支持。透析病患進行運動訓練可以改善病人的最大氧氣攝取量，對於有氧代謝能力、心臟血管功能、生活品質均有所助益。對於仔細評估後判定無其他醫療問題的透析病人而言，運動訓練是安全的。運動訓練能否延緩慢性腎病的惡化則有待更多的研究證實。

Both end-stage renal disease and chronic kidney disease are major diseases in Taiwan. Patients with chronic kidney disease often have reduced physical functioning and performance. Aerobic exercise interventions combined with resistance exercise training have been shown to increase maximal oxygen consumption and improve physical performance and functioning. Risk factors of cardiovascular diseases, such as hypertension, lipid profiles, inflammation, and oxidative stress may also be improved. Exercise programmes should be initiated at relatively low intensity in inactive patients and progressed as slowly as tolerated in order to avoid injury and discontinuation of exercise. Patients with chronic kidney disease should be suggested to increase their physical activity and exercise assessment, counselling and training should be offered to them.