| ObjectiveThis study through analysis method of evidence-based medicine,which contain a systematic review and meta-analysis.Summarize specific effects and instructional method of exercise therapy in patients which receiving peritoneal dialysis.Refer to the evidence of evidence-based medicine,we selected baduanjin—a motortherapy—which had a therapeutic effects and health care function,used on the patients in our Clinic Center in order to study the Clinical Efficacy of Baduanjin in the Patient of Peritoneal Dialysis.And then we can realized the therapeutic effect and regulation of Baduanjin,which can play an important part in the guideline for Clinical Practice.MethodsStudy one:Designed search strategy and used domestic and international literature database base on the selected clinical question——Exercise Intervention and peritoneal dialysis patients.Analyzing data by Review Manager 5.3,which contain a systematic review and meta-analysis.Depending on the situation,choose a different effect model to calculate the effect of indicators;subgroupanalysis and sensitivity analysis if necessary.Finally,we showed the results by forest map and funnel charts.Study two:Selected peritoneal dialysis patients form Chronic Disease Management center of Guangdong province TCM hospital.After signing the informed consent,the subjects met the inclusion criteria were non-randomized assignment to each group according to their wishes.The exercise group on the basis of daily activities,adding Baduanjin practice.The control group keep up formerly treatment and daily activities.After a three-month observation period,changes of various indexes were compared between the two groups.Study three:On the basis of study two,our project draw out patients venous blood.In order to verify the effect of Baduanjin on the antioxidant capacities?microinflammation state?immunologic function in the Patient of Peritoneal Dialysis.The blood were examined for other items,such as T-AOC?SOD?MDA?IL-2?IL-6?INF-??TNF-a.Similarity,these indexes were compared between two groups after a three-month observation period.ResultsStudy one:7trials(254patients)included in this systemic review.Individual studies observation time and outcomes has great difference.The longest observation time is 10 months,whereas the least follow-up time is 8 weeks.Type of intervention measures are various,including Walking,running,skiing,biking,swimming,tai chi,etc.Generally,the duration of exercise,more proposal is to be 20 to 30 minutes.Every trials are comparability.Yet,the method of random allocation had large risks and we could not get the proposal of random allocation in details.According to the meta-analysis,the total effect of systolic blood pressure as follows:MD=8.16,95%CI among 4.17 to 12.15,Z=4.01,P=0.0001;the result of diastolic blood pressure as illustrated in the following content:MD=4.24,95%CI among 0.85 to 7.62,Z=2.45,P=0.01.Total Ultrafiltration Volume' result is showed that MD=21.87,95%CI among 6.05 to 37.70,Z=2.71,P=0.007.Degree of fatigue ' result is showed that MD=0.97,95%CI among 0.77 to 1.16,Z=9.82,P<0.01.All the data above had Statistical Significance.Study two:The baseline situation between the two groups,including age,gender,body mass index,primary kidney disease,duration of dialysis,total Ultrafiltration Volumedialysis and residual urine volume,had no significant difference(P>0.05).In terms of Vital Signs.The systolic pressure,diastolic pressure and heart rate' s changes before and after intervention in the exercise group were significantly different(P<0.05);whereas the control group' s had no statistical significance(P>0.05).In terms of heart rate,the difference before and after intervention showed significantly different(P<0.05).The respiratory rate' s changes before and after intervention in the control group had significantly different(P<0.05).The comparison of respiratory rate's changes before and after intervention between two groups was statistically significant(P<0.05).In terms of energy metabolism.Each group had a significantly difference in the index of REE and REE/Pred(P<0.05).Other indicators had been shown that there was not significantly different in the changes before and after intervention(P>0.05).In terms of body composition.The differences about indexes of LTM,BCM?ATM?Fat between before and after observation period were not statistically significant(P>0.05).Indicator of OH shown that there was a significantly different in the changes before and after intervention(P<0.05).the control group' s ICW had a statistical significance as well(P<0.05).In terms of nutrition.The skinfold thickness,body mass index,total protein,albumin,Ca,Na,K,glucose and total cholesterol' s changes before and after intervention in the exercise group were significantly different(P<0.05),whereas the control group' s had no statistical significance(P>0.05).Study three:The baseline situation between the two groups,including T-AOC?SOD?IL-2?IL-6?INF-? and TNF-a had no significant difference(P>0.05).whereas in terms of MDA had a statistical significance(P<0.05).In terms of antioxidant ability.Each group had a significantly difference in the index of T-AOC and SOD(P<0.05).Similarly,the comparison of changes before and after intervention between two groups was statistically significant(P<0.05).In terms of microinflammation state.Each group had a significantly difference in the index of IL-2 and IL-6(P<0.05).The comparison of changes before and after intervention between two groups had not statistically significant(P>0.05).In terms of immune system function.Each group had a significantly difference in the index of INF-? and TNF-a(P<0.05).The comparison of TNF-a ' changes before and after intervention between two groups had a statistically significant(P<0.05).whereas in terms of NF-? had no statistical significance(P>0.05).Conclusion1?The results of Meta-Analysis suggest that Exercise Therapy have the ability to improve patients' systolic and diastolic blood pressure,while their are receiving peritoneal dialysis.Exercise Therapy also can play an improve role in patients' ultrafiltration volume.It could be one of the reasons for exercise improve patients' blood pressure condition,In terms of the quality of life,exercise relieve the fatigue degree.2?The result of clinical intervention trials indicate that Baduanjin is beneficial for patients with peritoneal dialysis in their systolic and diastolic blood pressure.By reducing the excitability of sympathetic nervous system,it could be the one of the main reasons why exercise had the effect of maintain the role of Vascular diastolic function.In terms of the heart rate.Baduanjin can decrease the heart rate in peritoneal dialysis patients.As we known,Baduanjin can be useful for the syndrome of flaring up of heart fire.it has specific effects on palpitations and irregular heartbeat which caused by the syndrome of marrow depletion due to kidney deficiency.In terms of the respiratory rate,Baduanjin can lower patient's respiratory rate by enhancing their breathing.3?In terms of energy metabolism.Baduanjin can improve patients' level of REE and REE/Pred.The needs of energy can be improved by exercise,as well as the basal metabolic rate.Baduanjin can consolidate and protect human' s kidney qi,thereby promote an energetic kidney qi,which can improve the body's metabolism.4?In terms of volume status.Baduanjin can lower patients' volume load,while their were receiving peritoneal dialysis.Baduanjin attain the effect of promoting metabolism of the body fluid and reducing volume load of body,not only through regulating vital energy,promoting the function of spleen governing transportation and transformation,but also by warming kidney and activating yang.5?In terms of nutrition.Baduanjin can improve the nutritional status of patients with peritoneal.dialysis.One of the reason it is baduanjin can regulate viscera function.Baduanjin promoting Spleen' s transport and transform function,which can increase patient' appetite,stimulate digestion and absorption,and then improve body' s nutritional status.6?In terms of experimental index.Baduanjin can improve patient' s oxidation resistance.Traditional chinese exercise has a protective effect for pelvic kidney.By controlled breading,Baduanjin has antioxidant activity not only through warming kidney and activating yang,but also regulating triple energy.7?In terms of microinflammation state.Baduanjin can lower patient' s IL-6 level,which can reduce damage to kidney by reducing the number and activity of proinflammatory factors.Moreover,for further study,we should combine patient' s serum calcium,which exists a certain correlation between them.8?In terms of immunologic state.Baduanjin can improve patient' s immunologic function.Baduanjin has supporting healthy energy to eliminate evils effect,which suitable for Qi-Deficiency type patients with kidney disease.We recommend that people with chronic kidney disease shall strengthen their daily exercise,which can delay the development of nephropathy,especially for the CKD3 patient.9?Base on the clinical question——Exercise Intervention and peritoneal dialysis patients,we apply analysis method of evidence-based medicine for study.The result of Meta-analysis indicate that there were some important points can be applied to the peritoneal dialysis patient.The result of clinical intervention trials provide medical evidence and instructional method of exercise therapy for patients which receiving peritoneal dialysis.In brief,this study indicate that traditional Chinese exercise is beneficial for peritoneal dialysis patients' quality of life and disease state.we should developing the superiority of TCM to prevention and treatment of Chronic Kidney Disease. |
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