Twelve weeks of supervised exercise improves self-reported symptom burden and fatigue in chronic kidney disease: a secondary analysis of the ‘ExTra CKD’ trial

Abstract

BackgroundChronic kidney disease (CKD) patients experience a high symptom burden including fatigue, sleep difficulties, muscle weakness and pain. These symptoms reduce levels of physical function (PF) and activity, and contribute to poor health-related quality of life (HRQoL). Despite the gathering evidence of positive physiological changes following exercise in CKD, there is limited evidence on its effect on self-reported symptom burden, fatigue, HRQoL and physical activity.MethodsThirty-six patients [mean ± SD 61.6 ± 11.8 years, 22 (61%) females, estimated glomerular filtration rate: 25.5 ± 7.8 mL/min/1.73 m2] not requiring renal replacement therapy underwent 12 weeks (3 times/week) of supervised aerobic exercise (AE), or a combination (CE) of AE plus resistance training. Outcomes included self-reported symptom burden, fatigue, HRQoL and physical activity.ResultsExercise reduced the total number of symptoms reported by 17% and had favourable effects on fatigue in both groups. AE reduced the frequency of ‘itching’, ‘impotence’ and ‘shortness of breath’ symptoms, and the intrusiveness for symptoms of ‘sleep disturbance’, ‘loss of muscular strength/power’, ‘muscle spasm/stiffness’ and ‘restless legs’. The addition of resistance exercise in the CE group saw a reduction in ‘loss of muscular strength/power’. No changes were seen in subjective PF or physical activity levels. AE increased self-efficacy for physical activity.ConclusionsSupervised exercise had favourable effects on symptom frequency and intrusiveness, including substantial improvements in fatigue. Although the intervention did not improve self-reported physical activity levels, AE increased patients’ self-efficacy for physical activity. These favourable changes in self-reported outcomes support the important role of exercise in CKD.

Effects of combined aerobic and resistance exercise on renal function in adult patients with chronic kidney disease: a systematic review and meta-analysis

“…19 Among them, there were nine randomized controlled trials 18 –26 and three one-arm quasi-randomized controlled trials. 17,27,28 Except for two randomized controlled trials 18,20 that were three-armed experiments, the others 17,19,21 –26,28 were two-armed experiments. The average patient age ranged from 47.5 (5.6) to 80.27 (4.98) years.…”

Relationships between illness representations, physical activity and depression in chronic kidney disease

“…; Wilkinson et al . ). A Cochrane review reported evidence demonstrating beneficial effects of physical activity on CKD and mood (Heiwe & Jacobson ).…”

Sarcopenia in CKD: a roadmap from basic pathogenetic mechanisms to clinical trials

“…Sarcopenia may be associated with bone disease (osteosarcopenia). In recent issues of Clinical Kidney Journal ( ckj ), several manuscripts address the issue of sarcopenia in CKD from the point of view of pathogenesis [6], monitoring and its clinical significance [7, 8], implementation and impact of exercise programmes [7, 9] and specific potential benefits of exercise programmes in dialysis and non-dialysis CKD patients, as assessed by clinical trials [10, 11].…”

“…This study addresses a key point in need of clarification as identified by recent vascular access guidelines [25]. Wilkinson et al [11] report that 12 weeks (3 times/week) of supervised aerobic exercise alone or in combination with resistance training in non-dialysis CKD patients resulted in a reduction in the total number of health-related quality of life symptoms reported by 17%. Aerobic exercise reduced the frequency of ‘shortness of breath’, and the intrusiveness of ‘sleep disturbance’, ‘loss of muscular strength/power’, ‘muscle spasm/stiffness’ and ‘restless legs’.…”