Effects of a Renal Rehabilitation Exercise Program in Patients with CKD

Abstract

Background and objectives Patients with CKD have a high prevalence of cardiovascular disease associated with or exacerbated by inactivity. This randomized, controlled study investigated whether a renal rehabilitation exercise program for patients with stages 3 or 4 CKD would improve their physical function and quality of life.Design, setting, participants, & measurements In total, 119 adults with CKD stages 3 and 4 were randomized, and 107 of these patients proceeded to usual care or the renal rehabilitation exercise intervention consisting of usual care plus guided exercise two times per week for 12 weeks (24 sessions). Physical function was determined by three well established performance-based tests: 6-minute walk test, sit-to-stand test, and gait-speed test. Health-related quality of life was assessed by the RAND 36-Item Short Form Health Survey.Results At baseline, no differences in self-reported level of activity, 6-minute walk test, and sit-to-stand test scores were observed between the usual care (n=48) and renal rehabilitation exercise (n=59) groups, although baseline gait-speed test score was higher in the renal rehabilitation exercise group (P,0.001). At follow-up, the renal rehabilitation exercise group but not the usual care group showed significant improvements in the 6-minute walk test (+210.46266.0 ft [19% improvement] versus 2106219.9 ft; P,0.001), the sit-to-stand test (+26.9627% of age prediction [29% improvement] versus +0.7612.1% of age prediction; P,0.001), and the RAND-36 physical measures of role functioning (P,0.01), physical functioning (P,0.01), energy/fatigue levels (P=0.01), and general health (P=0.03) and mental measure of pain scale (P=0.04). The renal rehabilitation exercise regimen was generally well tolerated.Conclusions A 12-week/24-session renal rehabilitation exercise program improved physical capacity and quality of life in patients with CKD stages 3 and 4. Longer follow-up is needed to determine if these findings will translate into decreased mortality rates.

The effectiveness and safety of modest exercise in Japanese patients with chronic kidney disease: a single-armed interventional study

“…Moreover, Castaneda et al [16] reported that supervised resistance training three times per week for 3 months lead to increased muscle strength in patients with stage 4 and 5 CKD. Rossi et al [17] reported that supervised resistance training with aerobic exercises three times per week for 3 months restored physical functions in moderate to severe CKD patients, as assessed by methods similar to those used in our study. Although we cannot compare the efficacy of these studies to our study, we believe that broad use of easy home exercises without any special equipment contributes to physical strength and better fitness.…”

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

“…In a larger study of 83 patients with CKD (42% diabetic), of whom 72 completed follow-up testing, lifestyle intervention including exercise training (8 weeks of supervised training followed by 10 months of homebased training) resulted in a significant improvement in METs, 6-minute walk distance, and BMI [42] . Rossi et al [43] performed a trial of 107 patients (41% diabetic), in which patients were randomized to renal rehabilitation (guided exercise twice weekly for 12 weeks) vs. usual care. The exercise group showed significant improvements in the 6-minute walk test, the sit-to-stand test, physical functioning, energy/fatigue levels, and general health.…”

Health-Related Quality of Life Impacts Mortality but Not Progression to End-Stage Renal Disease in Pre-Dialysis Chronic Kidney Disease: A Prospective Observational Study

“…It is therefore important to consider what strategies could be used to improve HRQL; improving HRQL will not only improve patient well-being but may convey a survival advantage. Previous studies have demonstrated that optimisation of haemoglobin, psychological interventions and physical exercise may be of benefit [33–35]. However, the majority of these studies have focused on patients who have reached ESRD rather than pre-dialysis CKD.…”