Effects Of Walking Exercise On Blood Pressure Variability In Maintenance Hemodialysis Patients

Objective :1.To explore the intervention effect of walking exercise on blood pressure and blood pressure variability(BPV)in patients with maintenance hemodialysis(MHD)and to investigate its possible mechanism;2.Determine the optimal exercise intensity,time and frequency of maintenance hemodialysis patients according to the application of walking exercise prescription and the improvement effect of BPV;3.To understand the effects of walking on serum albumin,lipid,blood phosphorus and other biochemical indicators in patients.Methods:Convenience sampling method was used to select 98 MHD patients with sedentary habits in the blood purification center of our hospital as the research object.3 months before the intervention,all subjects received routine nursing + routine health education,and 6 months after the intervention,all subjects received walking exercise intervention on the original basis.Intervention measures: assessment before walking exercise + formulation of exercise prescription + health education of walking exercise+ walking exercise follow-up.BPV,blood pressure before and during dialysis,maximum,minimum and range of blood pressure during dialysis were compared at 3months before the intervention,3 months and 6 months after the intervention.The blood pressure data of the patients at the time of the first dialysis treatment per week were analyzed,and the coefficient of variation(CV)was used as an indicator of blood pressure variability.The secondary observation results were biochemical indexes before and after intervention.Results:1.A total of 82 patients completed the 6-month walking intervention.After 6 months of exercise intervention,SBP and DBPmax(P<0.05)of the patients with exercise frequency of 3-4 days/week before dialysis decreased compared with that before the intervention.SBPV,pre-dialysis SBP,pre-dialysis DBP,SBP range,DBPmax and DBPmin(all P<0.05)decreased in patients with exercise frequency greater than 4days/week compared with those before intervention.2.After 6 months of exercise intervention,DBP,SBP range and DBP range(all P<0.05)of patients with moderate intensity exercise before dialysis decreased compared with those before the intervention.SBP,DBP,SBP range,DBPma and DBPmin(all P<0.05)decreased in patients with high intensity exercise compared with those before the intervention.3.After 6 months of exercise intervention,SBP,SBPV,DBP,SBP range,DBPmax and DBP range before dialysis(P<0.05)were decreased compared with those before the intervention.SBPV,pre-dialysis SBP,pre-dialysis DBP,SBP range,DBPmax and pre-dialysis SBP(all P<0.05)decreased in patients with exercise time greater than 60 minutes compared with those before intervention.4.After 6 months of exercise intervention,triglyceride and blood calcium in the patients were lower than those in the control group,and albumin was higher than those in the control group(all P<0.05).5.Univariate analysis results showed that age,gender,body mass index(BMI),high-density lipoprotein,serum albumin,blood phosphorus,walking speed,time,frequency and average daily steps were correlated with BPV during dialysis.Triglyceride,HDL,serum albumin,ultrafiltration rate,average daily steps were correlated with DBPV.Conclusion: The intervention of walking exercise can significantly reduce blood pressure and BPV.In MHD patients,walking exercise with a daily average of more than 8000 steps and an average walking speed greater than 1.0 m/s improved BPV more significantly.walking exercise intervention can significantly improve patienttriacylglycerol,blood calcium,serum albumin levels;walking exercise may improve patient bpv outcomes by avoiding hypoproteinemia,reducing blood calcium,phosphorus levels,and promoting lipid beneficial changes.