Structured Exercise in Obese Diabetic Patients with Chronic Kidney Disease: A Randomized Controlled Trial

Abstract

Background: Patients with type 2 diabetes mellitus (DM), obesity, and chronic kidney disease (CKD) are generally physically inactive and may benefit from exercise. Our objective was to determine the effects of structured exercise on physical fitness, kidney function, endothelial function, inflammation, and body composition in such patients. Methods: In this randomized, controlled trial, 36 male patients (age 49-81) were randomly assigned to exercise + diet management (n = 18) or diet alone (n = 18). Participants were eligible if they had type 2 DM, body mass index >30 kg/m², CKD stages 2-4, and persistent proteinuria (>200 mg/g creatinine for >3 months). The exercise intervention was a 12-week (3 days per week) program of aerobic and resistance training followed by 40 weeks of home exercise. The primary outcome measure was change from baseline in urine protein to creatinine ratio (UPCR) at 12 and 52 weeks. Results: Thirty-two participants completed the study (14 exercise + diet, 18 diet-alone group). The change from baseline in UPCR was slightly greater in the diet-alone group at 12 weeks but not at 52 weeks. Changes in both symptom-limited and constant-workrate treadmill times were significantly higher in the exercise + diet group at 12 weeks but not at 52 weeks. There were no significant differences in urine albumin to creatinine ratio, estimated glomerular filtration rate, endothelial function, inflammation, or body composition between the groups. Conclusions: In obese diabetic subjects with CKD, structured exercise improved exercise capacity but not body composition or renal function. This is a work of the US Government and is not subject to copyright protection in the USA. Foreign copyrights may apply. Published by S. Karger AG, Basel

Clinical practice guideline for renal rehabilitation: systematic reviews and recommendations of exercise therapies in patients with kidney diseases

“…Regarding the renal outcome, nine RCTs were analyzed [20][21][22][23][24][25][26][27][28]; one paper evaluated the time to renal replacement therapy or death as a primary endpoint [20], one estimated the incidence rate of very-high-risk CKD based on the heat map of the KDIGO 2013 classification [21], and the others compared changes in eGFR [22][23][24][25][26][27][28]. In the report that evaluated the hard outcome (a composite of renal replacement therapy and death) [20], no significant difference was observed; however, the results may not have simply reflected the effect of exercise therapy, because the outcome was investigated 20 or more years after the therapeutic intervention.…”

“…In a meta-analysis of seven studies that compared changes in eGFR [22][23][24][25][26][27][28], a significant improvement of + 2.22 ([0.68-3.76] mL/min/1.73 m 2 : I 2 = 18%) was observed by the exercise intervention for 12-24 weeks (Fig. 1).…”

“…The VO 2 peak was examined as an outcome in nine RCTs [23,24,27,28,[30][31][32][33][34], and improvements were observed in most studies despite differences in the intervention method. For the meta-analysis, we performed the pairwise evaluation using the reported figures before and after intervention in three studies [30,32,34].…”

“…For the meta-analysis, we performed the pairwise evaluation using the reported figures before and after intervention in three studies [30,32,34]. In the remaining six studies [23,24,27,28,31,33], the values after intervention were compared. By meta-analysis, heterogeneity was observed, but a significant overall improvement of + 3.23 [1.45-5.02] mL/kg/min (I 2 = 67%) was observed as a whole (Fig.…”

“…There have also been five RCTs that evaluated the 6-min walking distance as an outcome [16,19,23,27,28], one pair analysis according to the change between before and after intervention [19], and four papers that compared the value after intervention [16,23,27,28]. As a result of meta-analysis, a significant improvement in the walking distance of + 51.3 [22.2-80.4] m (I 2 = 27%) was obtained in the exercise group.…”