Exercise training in CKD: efficacy, adherence, and safety

Abstract

Background: Exercise training increasingly is recommended as an important part of the management of cardiovascular disease. However, few studies have evaluated the effectiveness of exercise training in patients with chronic kidney disease (CKD), and those that have included very selective populations.

Study design: Analysis of secondary outcomes of a randomized controlled trial, with participants randomly assigned to either lifestyle intervention or usual care (control).

Setting & participants: Patients with CKD stages 3 to 4 and one or more uncontrolled cardiovascular risk factor were recruited from an outpatient clinic at a large tertiary hospital.

Intervention: Lifestyle intervention included access to multidisciplinary care through a nurse practitioner-led CKD clinic, exercise training, and a lifestyle program. The exercise training was a 2-phased program in which participants received 8 weeks of supervised training before commencing 10 months of home-based training.

Outcomes & measurements: Efficacy, as assessed by metabolic equivalent tasks (METs), 6-minute walk distance, Timed Get-Up-and-Go test, grip strength, and anthropomorphic measures; adherence, as assessed by self-reported physical activity; and safety, as assessed by reported serious adverse events, were recorded.

Results: 83 patients were randomly assigned and 72 patients completed follow-up testing (intervention, n=36; control, n=36). The intervention resulted in a significant improvement in METs (pre, 7.2±3.3; post, 9.7±3.6), 6-minute walk distance (pre, 485±110m; post, 539±82m), and body mass index (pre, 32.5±6.7kg/m(2); post, 31.9±7.3kg/m(2)). Reported physical activity levels significantly increased in the intervention group at 6 months, but decreased at 12 months. There were no serious adverse events related to the exercise training.

Limitations: This study was not powered to evaluate the safety of exercise training on serious adverse events.

Conclusions: The findings from the present study suggest that an exercise program that includes a supervised and home-based training phase is effective, adhered to, and safe in patients with CKD.

Keywords: Physical activity; aerobic exercise; cardiovascular risk; chronic kidney disease (CKD); exercise capacity; exercise training; lifestyle; modifiable risk factor; muscle strength; physical functioning; resistance training.