as particularly beneficial and that exercise did not substantially increase harms. Background People living with CKD are at higher risk of cognitive impairment. Exercise may improve cognitive function. This systematic review and meta-analysis of randomized controlled trials was completed to determine the efficacy and harms of exercise in improving cognitive function in people living with CKD. Methods A systematic literature review identified randomized controlled trials of people with any stage of CKD, with an intervention that exercised large-muscle groups, and with a validated outcome measure of cognitive function. First, harms were analyzed. Then a random-effects meta-analysis was completed with subsequent planned subgroup analyses to investigate heterogeneity between CKD stages and treatments; between different exercise types, durations, and intensities; and between different outcome methodologies. Finally, quality of evidence was rated. Results Nineteen trials randomized 1160 participants. Harms were reported on 94 occasions in intervention groups versus 83 in control. The primary analysis found that exercise had a small but statistically significant effect on cognition in CKD (effect size=0.22; 95% confidence intervals, 0.00 to 0.44; P = 0.05). However, the quality of evidence was rated as low. Subgroup analyses found that type of exercise moderated the effect on cognition (chi square=7.62; P = 0.02), with positive effects only observed following aerobic exercise (effect size=0.57; 95% confidence interval, 0.21 to 0.93; P = 0.002). Conclusions Across the spectrum of CKD, exercise had a small but positive and clinically meaningful effect on cognitive function and did not seem to be harmful. Aerobic exercise was particularly beneficial. However, the results must be interpreted cautiously because of the low quality of evidence. Nevertheless, care teams may choose to recommend aerobic exercise interventions to prevent cognitive decline. Researchers should design unbiased studies to clarify what intensity and duration of exercise is required to maximize efficiency of such exercise interventions....

中文翻译：

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慢性肾病的运动和认知功能：疗效和危害的系统评价和荟萃分析


特别有益，并且该运动不会显着增加危害。背景 CKD 患者患认知障碍的风险更高。运动可以改善认知功能。完成这项随机对照试验的系统评价和荟萃分析，以确定运动在改善 CKD 患者认知功能方面的疗效和危害。方法 一项系统文献综述确定了对任何阶段的 CKD 患者进行的随机对照试验，其中一项干预锻炼了大肌肉群，并进行了经过验证的认知功能结果测量。首先，分析了危害。然后完成随机效应荟萃分析，随后进行计划的亚组分析，以研究 CKD 分期和治疗之间的异质性;在不同的运动类型、持续时间和强度之间;以及不同的结果方法之间。最后，对证据质量进行评级。结果 19 项试验随机分配了 1160 名参与者。干预组报告了 94 次伤害，而对照组报告了 83 次。主要分析发现，运动对 CKD 患者的认知影响很小但具有统计学意义（效应量 = 0.22;95% 置信区间，0.00 至 0.44;P = 0.05）。然而，证据质量被评为低。亚组分析发现，运动类型调节了对认知的影响（卡方=7.62;P = 0.02），仅在有氧运动后观察到积极影响 （效应量 = 0.57;95% 置信区间，0.21 至 0.93;P = 0.002）。结论 在 CKD 的整个范围内，运动对认知功能的影响很小但积极且具有临床意义，并且似乎无害。有氧运动特别有益。 然而，由于证据质量低，必须谨慎解释结果。尽管如此，医疗团队可能会选择推荐有氧运动干预，以防止认知能力下降。研究人员应设计公正的研究，以阐明需要什么强度和持续时间的运动才能最大限度地提高此类运动干预的效率。