Exercise in Individuals With CKD

Abstract

There are few studies evaluating exercise in the nondialysis chronic kidney disease (CKD) population. This review covers the rationale for exercise among patients with CKD not requiring dialysis and the effects of exercise training on physical functioning, progression of kidney disease, and cardiovascular risk factors. In addition, we address the issue of the risk of exercise and make recommendations for implementation of exercise in this population. Evidence from uncontrolled studies and from small randomized controlled trials shows that exercise training results in improved physical performance and functioning among patients with CKD. In addition, although there are no studies examining cardiovascular outcomes, several studies suggest that cardiovascular risk factors such as hypertension, inflammation, and oxidative stress, may be improved with exercise training in this population. Although the current literature does not allow for definitive conclusions about whether exercise training slows the progression of kidney disease, no study has reported worsening of kidney function as a result of exercise training. In the absence of guidelines specific to the CKD population, recent guidelines developed for older individuals and patients with chronic disease should be applied to the CKD population. In sum, exercise appears to be safe in this patient population if begun at moderate intensity and increased gradually. Indeed, the evidence suggests that the risk of remaining inactive is higher. Patients should be advised to increase their physical activity when possible and referred to physical therapy or cardiac rehabilitation programs when appropriate.

Wearable sensors: can they benefit patients with chronic kidney disease?

“…A very important factor related to outcome in CKD patients is PA, and it is well known that exercise on a regular basis is beneficial for CKD patients [74][75][76]. It has been shown that sedentary HD patients have a 62% higher mortality risk compared with non-sedentary HD patients.…”

“…It has been shown that sedentary HD patients have a 62% higher mortality risk compared with non-sedentary HD patients. Previous studies already advocated that PA programs should be routinely implemented in patient care for CKD/ESRD patients since results showed strong associations between regular exercise and better HRQOL scores, higher muscle mass, better physical functioning, and longer survival [75,[77][78][79] (see also Figure 8). …”

A Review of the Role of Exercise and Factors Affecting its Uptake for People with Chronic Kidney Disease (Ckd) not Requiring Renal Replacement Therapy/ Преглед На Улогата На Вежбањето И Факторите Што Влијаат На Неговата Примена Кај Лица Со Хронична Бубрежна Болест (Хбб) За Кои Не Е Потребна Бубрежна Заменска Терапија

“…However much of this research was conducted in the dialysing population. Johansen & Painter [22] reviewed the research regarding exercise specifically in predialysis CKD and found a limited evidence base but could identify positive trends towards improved physical functioning for patients when the level of physical activity increased. A subsequent meta-analysis [21] investigated the research regarding exercise in CKD, separated into pre-RRT patients, RRT patients and transplant patients and concluded there was a dearth of good quality research investigating pre-RRT patients.…”

Exercise to Improve Physical Function and Quality of Life in CKD

“…Patients with advanced CKD have a comparable burden of patientreported symptoms, including fatigue, poor sleep, depression, and poor overall health-related quality of life (HRQOL), as those with dialysis-dependent ESRD (1). Moreover, patients with CKD commonly have poor physical function and frailty, conditions that lead to poor outcomes, including falls and hospitalizations (2,3). Patient-reported and physical functioning outcomes are not only important indicators of morbidity and functional independence, but may also have prognostic significance in terms of mortality risk (4)(5)(6).…”

“…Reasons for the paucity of studies in CKD may include concerns about safety, specifically BP and glycemic control, as well as the only recent recognition of nondialysis CKD as a clinically important disease state (3). In this context, Rossi et al conducted one of the largest clinical trials to date evaluating the safety and efficacy of a supervised exercise program in people with CKD, which is published in this issue of CJASN (8).…”