Exercise Training and Reduction of Cardiovascular Disease Risk Factors in Patients With Chronic Kidney Disease

Bronas, Ulf G.

doi:10.1053/j.ackd.2009.07.005

Cited by 42 publications

(36 citation statements)

References 66 publications

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“…At the initiation of dialysis, mortality rates increase when _ VO 2 peak is below a critical level of 17.5 ml/kg per min (16). However, exercise rehabilitation can trigger cardioprotective mechanisms (17)(18)(19)(20), increase EC, and improve health-related quality of life (8).…”

Section: Introductionmentioning

confidence: 99%

The Duke Activity Status Index in Patients with Chronic Kidney Disease

Ravani¹,

Kilb²,

Bedi

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Exercise capacity is impaired at a younger age in CKD patients than in the general population. This study examined the reliability of the Duke Activity Status Index (DASI) questionnaire as a measure of exercise capacity in medically stable adults with stage 3-4 CKD (estimated GFR [eGFR], 15-59 ml/min per 1.73 m 2 ).Design, setting, participants, & measurements Peak oxygen uptake ( _ VO 2 peak), estimated from DASI responses and cardiopulmonary exercise test measurements, was obtained at baseline and 6 months in a derivation sample (n=23) and once in a validation sample (n=20). Bland-Altman analysis and linear mixed models were used to estimate bias, concordance correlation coefficients, and intraclass correlation coefficients as the proportion of the variance due to participant (intertest reliability) and method (test-retest reliability).Results The two samples were homogeneous with respect to age (mean 60614 years), eGFR (35.5615 ml/min per 1.73 m 2 ), male sex (53%), and diabetes (56%). Mean measured _ VO 2 peak was 16.564 ml/kg per min. The DASI questionnaire overestimated _ VO 2 peak by 4.3 ml/kg per min. Intertest reliability was 53% when eGFR was $35 ml/min per 1.73 m 2 (median) and 60% when eGFR was ,35 ml/min per 1.73 m 2 (P,0.01). Test-retest reliability was 81% when eGFR was ,35 ml/min per 1.73 m 2 and 71% when eGFR was $35 ml/min per 1.73 m 2 (P,0.01).Conclusions The DASI questionnaire may be a reliable measure of exercise capacity in CKD patients, especially when eGFR is ,35 ml/min per 1.73 m 2 . Larger prospective studies are needed to determine its prognostic value.

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Section: Introductionmentioning

confidence: 99%

The Duke Activity Status Index in Patients with Chronic Kidney Disease

Ravani¹,

Kilb²,

Bedi

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…12,13 Although the potential anti-inflammatory effects of regular exercise in CKD patients have been recognized, research in this area is lacking, particularly in predialysis patients. 14,15 Apart from the potential benefits, given that exercise is currently advocated in the routine clinical care of CKD patients, 16,17 it is also paramount to determine if exercise is safe to their underlying compromised immunity and inflammatory status. Although an acute bout of moderate exercise usually exerts little influence on immune and inflammatory responses in healthy people, 18,19 it is not clear what effect it may have in CKD patients.…”

mentioning

confidence: 99%

Evidence for Anti-Inflammatory Effects of Exercise in CKD

Viana

Kosmadakis

Watson

et al. 2014

Journal of the American Society of Nephrology

150

123

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CKD is associated with a complex state of immune dysfunction characterized by immune depression, predisposing patients to infections, and immune activation, resulting in inflammation that associates with higher risk of cardiovascular disease. Physical exercise may enhance immune function and exert antiinflammatory effects, but such effects are unclear in CKD. We investigated the separate effects of acute and regular moderate-intensity aerobic exercise on neutrophil degranulation (elastase release), activation of T lymphocytes (CD69 expression) and monocytes (CD86 and HLA-DR expression), and plasma inflammatory markers (IL-6, IL-10, soluble TNF-receptors, and C-reactive protein) in patients with predialysis CKD. A single 30-minute (acute) bout of walking induced a normal pattern of leukocyte mobilization and had no effect on T-lymphocyte and monocyte activation but improved neutrophil responsiveness to a bacterial challenge in the postexercise period. Furthermore, acute exercise induced a systemic anti-inflammatory environment, evidenced by a marked increase in plasma IL-10 levels (peaked at 1 hour postexercise), that was most likely mediated by increased plasma IL-6 levels (peaked immediately postexercise). Six months of regular walking exercise (30 min/d for 5 times/wk) exerted anti-inflammatory effects (reduction in the ratio of plasma IL-6 to IL-10 levels) and a downregulation of T-lymphocyte and monocyte activation, but it had no effect on circulating immune cell numbers or neutrophil degranulation responses. Renal function, proteinuria, and BP were also unaffected. These findings provide compelling evidence that walking exercise is safe with regard to immune and inflammatory responses and has the potential to be an effective anti-inflammatory therapy in predialysis CKD.

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“…However, the current results further demonstrate that exercise training whether performed before or after the occurrence of RVH, protected the renal tissue against oxidative injury. Mainly for its cardioprotective effect, use of exercise training was considered as an essential component in the treatment of patients with chronic renal disease (33).It appears that the protective impact of exercise training is also evident directly on the injured kidney tissue.…”

Section: Discussionmentioning

confidence: 99%

Regular swimming exercise performed either before or after the induction of renovascular hypertension alleviates oxidative renal injury in rats

Kumral¹,

Şener²,

Yeğen³

2014

Marmara Pharm J

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Epidemiological studies have shown that regular exercise and increased aerobic fitness are associated with a decrease in allcause mortality and morbidity, including diseases related with high blood pressure. However, whether exercise has an antiinflammatory impact on the pathogenesis of hypertension was not elucidated yet. In the present study, to investigate the potential protective and therapeutic effects of exercise training (swimming for 30 min/day, 5 days/week for 9 weeks) on renovascular hypertension (RVH) 10-week-old male Wistar albino rats were divided into 4 groups as sham-operated sedentary control group, sedentary group with RVH (2-Kidney, 1-Clip Goldblatt) and two exercised RVH groups, which had 9-week training either before the surgery or after the surgery. Systolic blood pressures (SBP) were measured by the tail-cuff method on a weekly basis and at the end of 12 weeks, rats were decapitated to obtain kidneys. SBP were significantly higher in the sedentary RVH group than the control group, whereas in the trained RVH group measurements were not different than those of the control animals. In the renal tissues of the sedentary RVH group, malondialdehyde and myeloperoxidase levels were increased with a concomitant decrease in glutathione levels, while in the trained RVH group the levels were not different than those of the control group. Moreover, in the trained RVH group, superoxide dismutase and catalase levels measured as antioxidant parameters, were also significantly increased as compared with those of the sedentary RVH group. Current results demonstrate that regular moderate training controls high blood pressure in RVH, while RVH-induced oxidative damage in renal tissue is ameliorated through the modulation of oxidant-antioxidant balance. Exercise training does not only improve the circulatory functions, but it also initiates an anti-inflammatory process to defend against the angiotensin-II-induced renal injury.

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Exercise Training and Reduction of Cardiovascular Disease Risk Factors in Patients With Chronic Kidney Disease

Cited by 42 publications

References 66 publications

The Duke Activity Status Index in Patients with Chronic Kidney Disease

The Duke Activity Status Index in Patients with Chronic Kidney Disease

Evidence for Anti-Inflammatory Effects of Exercise in CKD

Regular swimming exercise performed either before or after the induction of renovascular hypertension alleviates oxidative renal injury in rats

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