Exercise as a therapeutic intervention in chronic kidney disease: are we nearly there yet?

Abstract

Purpose of review The opportunity to review the more recent evidence for prescribing exercise-based physical rehabilitation for people living with chronic kidney disease (CKD) is timely. There has been a recent global focus evaluating how physical activity interventions might improve health-related quality of life and outcomes for people living with chronic health conditions in a post-COVID era. There is finally a long overdue commitment from the kidney research and clinical community to deliver pragmatic interventions to help people living with CKD to be able to live well with their condition. Recent findings This article reviews recent research, and discusses the challenges and potential solutions, for providing exercise-based therapeutic options for people living with CKD; including predialysis self-management interventions, options for both prehabilitation and posttransplant rehabilitation, pragmatic considerations for delivery of exercise therapy for people receiving haemodialysis treatment and the role of virtual kidney-specific rehabilitation. Summary Whilst there remains a need for further research in this area of patient care, there is now a body of evidence and kidney-specific guidelines that firmly support a rollout of pragmatic and scalable exercise-based interventions for people living with CKD. We are indeed nearly there now.

Exercise training in solid organ transplant candidates and recipients

“…A position statement by the Canadian Society of Transplantation and the Canadian Network for Rehabilitation and Exercise for Solid Organ Transplant Optimal Recovery (CAN-RESTORE) suggested that programs should consist of aerobic training or combined aerobic plus resistance training [1]. Self-management interventions with exercise behaviors, cycling, and other exercise-based interventions was suggested for kidney transplant candidates in a recent narrative review [29]. A systematic review in heart transplant candidates found that high-intensity interval training is generally superior or similar to other exercise training [30].…”

“…Most recent trials have used an outpatient program [9 ▪ ], a home-based program [5 ▪ ], and inpatient intervention [18 ▪ ]. Virtual or telerehabilitation programs have become more frequent since the pandemic and offer ways to deliver interventions with lower cost, but more evidence is needed to determine their efficacy compared to the more traditional methods [1,29].…”

Using Digital Health Interventions to Promote Prehabilitation Prior to Kidney Transplantation

“…It revolves around implementing specific lifestyle changes and typically consists of physical exercise training programs, dietary management, and psychosocial interventions. 1 Prehabilitation is now gradually considered to be an essential part of the enhanced recovery pathway for those receiving kidney transplantation. 2 A recently published multi-center clinical trial from the UK by Greenwood and colleagues 3 concluded positive findings on evaluating the effects of a digital health intervention (Kidney BEAM) to enhance physical activity in people with CKD including transplant waitlist patients.…”

“…Outside of the myriad of medical management modalities that may improve survival and quality of life outcomes in CKD, self-management interventions with a focus on improving physical activity and exercise behaviors has gained tremendous acknowledgement in recent years as a strategy to improve patient outcomes. 1 Prehabilitation is a recent concept that aims to optimize the patient's overall fitness before a major surgical procedure to promote recovery and outcomes overall. It revolves around implementing specific lifestyle changes and typically consists of physical exercise training programs, dietary management, and psychosocial interventions.…”

“…It revolves around implementing specific lifestyle changes and typically consists of physical exercise training programs, dietary management, and psychosocial interventions. 1 Prehabilitation is now gradually considered to be an essential part of the enhanced recovery pathway for those receiving kidney transplantation. 2…”