Eficácia comparativa de diferentes modalidades de exercício sobre função renal e controle glicêmico em pacientes com doença renal diabética não-diálise: revisão sistemática e meta-análise em rede

Resumo original em inglês

O que aconteceu

To evaluate the comparative efficacy and safety of structured exercise modalities on renal function and glycemic control in non-dialysis diabetic kidney disease (DKD).

Systematic review and network meta-analysis.

Six databases (PubMed, Embase, Cochrane CENTRAL, Web of Science, CNKI, Wanfang) were searched from inception to July 15, 2026.

Randomized controlled trials (RCTs) evaluating structured exercise (aerobic, resistance, combined, or mind-body) versus usual care or an active comparator in adults with non-dialysis DKD (duration ≥4 weeks).

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261489091.

O que encontraram

Renal endpoints were estimated glomerular filtration rate (eGFR) and urinary albumin excretion (UAE); glycemic endpoints were glycated hemoglobin (HbA1c) and fasting blood glucose (FBG).

Twenty RCTs (1,746 patients) were included. Compared with usual care, resistance training (RT) was the sole modality significantly increasing eGFR (mean difference [MD] 11.36 mL/min/1.73 m², 95% CI 4.47 to 18.25; low certainty) and outperforming aerobic training (MD 8.61, 2.22 to 15.00). Mind-body exercise (MBE) was the only intervention significantly reducing UAE (standardized mean difference -1.41, -2.67 to -0.16; low certainty). For glycemic regulation, RT (MD -1.65%), aerobic training (MD -1.07%), and combined training (CT; MD -0.70%) significantly lowered HbA1c (all low certainty). Significant FBG reductions occurred only with RT (MD -1.78 mmol/L; low certainty) and CT (MD -1.71 mmol/L; moderate certainty). In sensitivity analyses, RT's eGFR benefit lost significance after excluding high-risk trials (MD 8.24, -1.17 to 17.64), and CT's HbA1c reduction was attenuated in pure-exercise models (MD -0.60%, -1.39 to 0.19). Subgroup analyses showed CT uniquely sustained FBG reductions across short-term (≤12 weeks: MD -1.50) and longer-term (>12 weeks: MD -2.39) regimens. Structured safety was monitored in only five trials (25.0%): three reported mild, transient events without serious harm, while two explicitly declared zero adverse events. Thus, current evidence is insufficient to draw definitive conclusions regarding comparative safety.

Por que isso importa

Structured exercise confers distinct adaptations in non-dialysis DKD. Combined training provides a reliable foundation for sustained glycemic management, while mind-body exercise represents a viable strategy for albuminuria. Resistance training's apparent renal benefit warrants caution due to fragility against bias. Prescriptions should be individualized rather than seeking a single optimal modality. Given the sparse monitoring of adverse events, comparative clinical safety cannot be definitively established and mandates routine surveillance.

Resumo publicado sob licença CC BY. A tradução para o português ainda não chegou a este estudo.