Aerobic exercise in obese diabetic patients with chronic kidney disease: a randomized and controlled pilot study

Abstract

BackgroundPatients with obesity, diabetes, and chronic kidney disease (CKD) are generally physically inactive, have a high mortality rate, and may benefit from an exercise program.MethodsWe performed a 24-week randomized controlled feasibility study comparing aerobic exercise plus optimal medical management to medical management alone in patients with type 2 diabetes, obesity (body mass index [BMI] > 30 kg/m2), and stage 2-4 CKD (estimated glomerular filtration rate [eGFR] 15-90 mL/min/1.73 m2 with persistent proteinuria). Subjects randomized to exercise underwent thrice weekly aerobic training for 6 followed by 18 weeks of supervised home exercise. The primary outcome variable was change in proteinuria.ResultsSeven subjects randomized to exercise and 4 control subjects completed the study. Exercise training resulted in an increase in exercise duration during treadmill testing, which was accompanied by slight but insignificant decreases in resting systolic blood pressure and 24-hour proteinuria. Exercise did not alter GFR, hemoglobin, glycated hemoglobin, serum lipids, or C-reactive protein (CRP). Caloric intake and body weight and composition also did not change with exercise training.ConclusionExercise training in obese diabetic patients with CKD is feasible and may have clinical benefits. A large-scale randomized controlled trial to determine the effects of exercise on renal functions, cardiovascular fitness, inflammation, and oxidative stress in diabetic patients with CKD is planned.

Associations between Healthy Lifestyle Behaviors and Proteinuria and the Estimated Glomerular Filtration Rate (eGFR)

“…As for physical activity, the serum creatinine concentrations of athletes are generally higher than those of sedentary people 36) . In addition, exercise training in obese diabetic patients with chronic kidney disease might decrease proteinuria but not alter GFR 37) . The above mechanisms have the potential to explain the paradoxical relationships between proteinuria/a low eGFR and smoking/physical inactivity observed in this study.…”

Vascular Effects of Exercise Training in CKD

“…Indeed, in the exercise group, a trend toward a decrease of both IL-6 and high-sensitivity CRP was seen, but it did not reach statistical significance (Table 1). In a small RCT in obese patients with CKD stages 2-4, no changes in CRP were seen after 6 months of aerobic training with progressive intensity versus control (63). Again, sample size was very small (seven exercise patients versus four controls).…”

Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure

“…A randomized, controlled study involving participants with diabetes mellitus and chronic kidney disease compared aerobic exercise plus optimal medical management with medical management alone. 128 The exercise group underwent 6 weeks of supervised aerobic training 3 times weekly, followed by 18 weeks of unsupervised home-based exercise. After 24 weeks, exercise training resulted in increased exercise duration during treadmill testing and a decrease in resting systolic BP, although the decrease was not statistically significant, likely related to the small sample size (n=7).…”