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Exercise Training in Chronic Kidney Disease Patients

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Abstract

Chronic kidney disease (CKD) is a major public health problem that affects an estimated 1.7 million Australians. Patients with CKD commonly progress to end-stage kidney disease (ESKD) requiring dialysis and/or kidney transplantation. They are at high risk of cardiovascular disease and many die from this prior to reaching ESKD. Few therapies are available to slow CKD progression and reduce cardiovascular morbidity and mortality. The benefit of exercise training has been well demonstrated in a range of disease conditions including ESKD and was recently highlighted by a systematic review in haemodialysis patients and a recent Cochrane review of all stages of CKD. However, the effects of exercise training in patients with CKD have not been extensively investigated. Our systematic search of the literature found only ten clinical trials in this area. The aim of this review is to review these studies, and to discuss the findings, safety considerations and suggest future areas of research. Overall, the majority of the studies are small, non-randomized, non-controlled trials. They have found that exercise training can increase exercise capacity, improve muscle strength and function, decrease blood pressure, and improve inflammation and oxidative stress biomarkers. The effects of exercise training on kidney function, cardiovascular disease and quality of life are unknown. Studies are needed to answer these questions and develop evidence-based exercise training guidelines for individuals with CKD.

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References

  1. Beddhu S, Baird BC, Zitterkoph J, et al. Physical activity and mortality in chronic kidney disease (NHANES III). Clin J Am Soc Nephrol 2009 Dec; 4 (12): 1901–6

    Article  PubMed  Google Scholar 

  2. Segura-Orti E, Johansen KL. Exercise in end-stage renal disease. Semin Dial 2010 Jul-Aug; 23 (4): 422–30

    Article  PubMed  Google Scholar 

  3. Parsons TL, King-Vanvlack CE. Exercise and end-stage kidney disease: functional exercise capacity and cardiovascular outcomes. Adv Chronic Kidney Dis 2009 Nov; 16 (6): 459–81

    Article  PubMed  Google Scholar 

  4. Segura-Orti E. Exercise in haemodyalisis patients: a literature systematic review. Nefrologia 2010; 30 (2): 236–46

    PubMed  Google Scholar 

  5. Heiwe S, Jacobson SH. Exercise training for adults with chronic kidney disease. Cochrane Database Syst Rev 2011; (10): CD003236

    PubMed  Google Scholar 

  6. Gulati M, Black HR, Shaw LJ, et al. The prognostic value of a nomogram for exercise capacity in women. N Engl J Med 2005 Aug 4; 353 (5): 468–75

    Article  PubMed  CAS  Google Scholar 

  7. Gulati M, Pandey DK, Arnsdorf MF, et al. Exercise capacity and the risk of death in women: the St James Women Take Heart Project. Circulation 2003 Sep 30; 108 (13): 1554–9

    Article  PubMed  Google Scholar 

  8. Myers J, Prakash M, Froelicher V, et al. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 2002 Mar 14; 346 (11): 793–801

    Article  PubMed  Google Scholar 

  9. Myers J, Do D, Herbert W, et al. A nomogram to predict exercise capacity from a specific activity questionnaire and clinical data. Am J Cardiol 1994 Mar 15; 73 (8): 591–6

    Article  PubMed  CAS  Google Scholar 

  10. Kokkinos P, Manolis A, Pittaras A, et al. Exercise capacity and mortality in hypertensive men with and without additional risk factors. Hypertension 2009 Mar; 53 (3): 494–9

    Article  PubMed  CAS  Google Scholar 

  11. Sietsema KE, Amato A, Adler SG, et al. Exercise capacity as a predictor of survival among ambulatory patients with end-stage renal disease. Kidney Int 2004 Feb; 65 (2): 719–24

    Article  PubMed  Google Scholar 

  12. Sharman JE, Stowasser M. Australian association for exercise and sports science position statement on exercise and hypertension. J Sci Med Sport 2009 Mar; 12 (2): 252–7

    Article  PubMed  Google Scholar 

  13. Beavers KM, Brinkley TE, Nicklas BJ. Effect of exercise training on chronic inflammation. Clin Chim Acta 2010 Jun 3; 411 (11–12): 785–93

    Article  PubMed  CAS  Google Scholar 

  14. Gillespie LD, Gillespie WJ, Robertson MC, et al. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 2003; (4): CD000340

  15. Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, et al. American College of Sports Medicine position stand: exercise and physical activity for older adults. Med Sci Sports Exerc 2009 Jul; 41 (7): 1510–30

    Article  PubMed  Google Scholar 

  16. Blumenthal JA, Babyak MA, Moore KA, et al. Effects of exercise training on older patients with major depression. Arch Intern Med 1999 Oct 25; 159 (19): 2349–56

    Article  PubMed  CAS  Google Scholar 

  17. Harper CR, Jacobson TA. Managing dyslipidemia in chronic kidney disease. J Am Coll Cardiol 2008 Jun 24; 51 (25): 2375–84

    Article  PubMed  CAS  Google Scholar 

  18. Levin A. Clinical epidemiology of cardiovascular disease in chronic kidney disease prior to dialysis. Semin Dial 2003 Mar–Apr; 16 (2): 101–5

    Article  PubMed  Google Scholar 

  19. Coresh J, Astor BC, Greene T, et al. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003 Jan; 41 (1): 1–12

    Article  PubMed  Google Scholar 

  20. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002 Feb; 39 (2 Suppl. 1): S1–266

  21. Chadban SJ, Briganti EM, Kerr PG, et al. Prevalence of kidney damage in Australian adults: the AusDiab kidney study. J Am Soc Nephrol 2003 Jul; 14 (7 Suppl 2): S131–8

    Article  PubMed  Google Scholar 

  22. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions. West Sussex: John Wiley & Sons Ltd, 2008

    Google Scholar 

  23. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700

    Article  PubMed  Google Scholar 

  24. Cook SA, MacLaughlin H, Macdougall IC. A structured weight management programme can achieve improved functional ability and significant weight loss in obese patients with chronic kidney disease. Nephrol Dial Transplant 2008 Jan; 23 (1): 263–8

    Article  PubMed  Google Scholar 

  25. Castaneda C, Gordon PL, Parker RC, et al. Resistance training to reduce the malnutrition-inflammation complex syndrome of chronic kidney disease. Am J Kidney Dis 2004 Apr; 43 (4): 607–16

    Article  PubMed  Google Scholar 

  26. Castaneda C, Gordon PL, Uhlin KL, et al. Resistance training to counteract the catabolism of a low-protein diet in patients with chronic renal insufficiency: a randomized, controlled trial. Ann Intern Med 2001 Dec 4; 135 (11): 965–76

    PubMed  CAS  Google Scholar 

  27. Heiwe S, Clyne N, Tollback A, et al. Effects of regular resistance training on muscle histopathology and morphometry in elderly patients with chronic kidney disease. Am J Phys Med Rehabil 2005 Nov; 84 (11): 865–74

    Article  PubMed  Google Scholar 

  28. Heiwe S, Tollback A, Clyne N. Twelve weeks of exercise training increases muscle function and walking capacity in elderly predialysis patients and healthy subjects. Nephron 2001 May; 88 (1): 48–56

    Article  PubMed  CAS  Google Scholar 

  29. Clyne N, Ekholm J, Jogestrand T, et al. Effects of exercise training in predialytic uremic patients. Nephron 1991; 59 (1): 84–9

    Article  PubMed  CAS  Google Scholar 

  30. Boyce ML, Robergs RA, Avasthi PS, et al. Exercise training by individuals with predialysis renal failure: cardiorespiratory endurance, hypertension, and renal function. Am J Kidney Dis 1997 Aug; 30 (2): 180–92

    Article  PubMed  CAS  Google Scholar 

  31. Eidemak I, Haaber AB, Feldt-Rasmussen B, et al. Exercise training and the progression of chronic renal failure. Nephron 1997; 75 (1): 36–40

    Article  PubMed  CAS  Google Scholar 

  32. Pechter U, Ots M, Mesikepp S, et al. Beneficial effects of water-based exercise in patients with chronic kidney disease. Int J Rehabil Res 2003 Jun; 26 (2): 153–6

    Article  PubMed  Google Scholar 

  33. Leehey DJ, Moinuddin I, Bast JP, et al. Aerobic exercise in obese diabetic patients with chronic kidney disease: a randomized and controlled pilot study. Cardiovasc Diabetol 2009; 8: 62

    Article  PubMed  Google Scholar 

  34. Balakrishnan VS, Rao M, Menon V, et al. Resistance training increases muscle mitochondrial biogenesis in patients with chronic kidney disease. Clin J Am Soc Nephrol 2010 Jun; 5 (6): 996–1002

    Article  PubMed  CAS  Google Scholar 

  35. Toyama K, Sugiyama S, Oka H, et al. Exercise therapy correlates with improving renal function through modifying lipid metabolism in patients with cardiovascular disease and chronic kidney disease. J Cardiol 2010 Sep; 56 (2): 142–6

    Article  PubMed  Google Scholar 

  36. Mustata S, Groeneveld S, Davidson W, et al. Effects of exercise training on physical impairment, arterial stiffness and health-related quality of life in patients with chronic kidney disease: a pilot study. Int Urol Nephrol 2011; 43 (4): 133–41

    Article  Google Scholar 

  37. Morris CK, Myers J, Froelicher VF, et al. Nomogram based on metabolic equivalents and age for assessing aerobic exercise capacity in men. J Am Coll Cardiol 1993 Jul; 22 (1): 175–82

    Article  PubMed  CAS  Google Scholar 

  38. Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol 1998 Dec; 9 (12 Suppl): S16–23

    PubMed  CAS  Google Scholar 

  39. Oliveira RB, Myers J, Araujo CG, et al. Maximal exercise oxygen pulse as a predictor of mortality among male veterans referred for exercise testing. Eur J Cardiovasc Prev Rehabil 2009 Jun; 16 (3): 358–64

    Article  PubMed  Google Scholar 

  40. Munhoz EC, Hollanda R, Vargas JP, et al. Flattening of oxygen pulse during exercise may detect extensive myocardial ischemia. Med Sci Sports Exerc 2007 Aug; 39 (8): 1221–6

    Article  PubMed  Google Scholar 

  41. Macaluso A, De Vito G. Muscle strength, power and adaptations to resistance training in older people. Eur J Appl Physiol 2004 Apr; 91 (4): 450–72

    Article  PubMed  Google Scholar 

  42. Sarnak MJ, Greene T, Wang X, et al. The effect of a lower target blood pressure on the progression of kidney disease: long-term follow-up of the modification of diet in renal disease study. Ann Intern Med 2005 Mar 1; 142 (5): 342–51

    PubMed  Google Scholar 

  43. Tanaka H, Bassett Jr DR, Howley ET, et al. Swimming training lowers the resting blood pressure in individuals with hypertension. J Hypertens 1997 Jun; 15 (6): 651–7

    Article  PubMed  CAS  Google Scholar 

  44. Fletcher GF, Blair SN, Blumenthal J, et al. Statement on exercise. Benefits and recommendations for physical activity programs for all Americans: a statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart association. Circulation 1992 Jul; 86 (1): 340–4

    Article  PubMed  CAS  Google Scholar 

  45. Ikeda T, Gomi T, Sasaki Y. Effects of swim training on blood pressure, catecholamines and prostaglandins in spontaneously hypertensive rats. Jpn Heart J 1994 Mar; 35 (2): 205–11

    Article  PubMed  CAS  Google Scholar 

  46. Epstein M. Renal effects of head-out water immersion in humans: a 15-year update. Physiol Rev 1992 Jul; 72 (3): 563–621

    PubMed  CAS  Google Scholar 

  47. Kohzuki M, Kamimoto M, Wu XM, et al. Renal protective effects of chronic exercise and antihypertensive therapy in hypertensive rats with chronic renal failure. J Hypertens 2001 Oct; 19 (10): 1877–82

    Article  PubMed  CAS  Google Scholar 

  48. Fassett RG, Robertson IK, Ball MJ, et al. Effect of atorvastatin on kidney function in chronic kidney disease: a randomised double-blind placebo-controlled trial. Atherosclerosis 2010 Nov; 213 (1): 218–24

    Article  PubMed  CAS  Google Scholar 

  49. Irving RA, Noakes TD, Irving GA, et al. The immediate and delayed effects of marathon running on renal function. J Urol 1986 Dec; 136 (6): 1176–80

    PubMed  CAS  Google Scholar 

  50. Stokke O. Clinical chemical changes in physical activity. Scand J Soc Med Suppl 1982; 29: 93–101

    PubMed  CAS  Google Scholar 

  51. Mingels A, Jacobs L, Kleijnen V, et al. Cystatin Camarker for renal function after exercise. Int J Sports Med 2009 Sep; 30 (9): 668–71

    Article  PubMed  CAS  Google Scholar 

  52. Stevens LA, Coresh J, Schmid CH, et al. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD. Am J Kidney Dis 2008 Mar; 51 (3): 395–406

    Article  PubMed  CAS  Google Scholar 

  53. Pedersen BK, Saltin B. Evidence for prescribing exercise as therapy in chronic disease. Scand J Med Sci Sports 2006 Feb; 16 Suppl. 1: 3–63

    Article  PubMed  Google Scholar 

  54. Witko-Sarsat V, Friedlander M, Capeillere-Blandin C, et al. Advanced oxidation protein products as a novel marker of oxidative stress in uremia. Kidney Int 1996 May; 49 (5): 1304–13

    Article  PubMed  CAS  Google Scholar 

  55. Locatelli F, Canaud B, Eckardt KU, et al. Oxidative stress in end-stage renal disease: an emerging threat to patient outcome. Nephrol Dial Transplant 2003 Jul; 18 (7): 1272–80

    Article  PubMed  CAS  Google Scholar 

  56. Blacher J, Safar ME, Guerin AP, et al. Aortic pulse wave velocity index and mortality in end-stage renal disease. Kidney Int 2003 May; 63 (5): 1852–60

    Article  PubMed  Google Scholar 

  57. Pollock ML, Franklin BA, Balady GJ, et al. AHA Science Advisory. Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription. An advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association: position paper endorsed by the American College of Sports Medicine. Circulation 2000 Feb 22; 101 (7): 828–33

    Article  PubMed  CAS  Google Scholar 

  58. Yeun JY, Levine RA, Mantadilok V, et al. C-Reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis 2000 Mar; 35 (3): 469–76

    Article  PubMed  CAS  Google Scholar 

  59. Zimmermann J, Herrlinger S, Pruy A, et al. Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int 1999 Feb; 55 (2): 648–58

    Article  PubMed  CAS  Google Scholar 

  60. Suliman ME, Qureshi AR, Carrero JJ, et al. The long pentraxin PTX-3 in prevalent hemodialysis patients: associations with comorbidities and mortality. QJM 2008 May; 101 (5): 397–405

    Article  PubMed  CAS  Google Scholar 

  61. Shah VO, Scariano J, Waters D, et al. Mitochondrial DNA deletion and sarcopenia. Genet Med 2009 Mar; 11 (3): 147–52

    Article  PubMed  CAS  Google Scholar 

  62. Nordenfelt I, Adolfsson L, Nilsson JE, et al. Reference values for exercise tests with continuous increase in load. Clin Physiol 1985 Apr; 5 (2): 161–72

    Article  PubMed  CAS  Google Scholar 

  63. Cheema B, Abas H, Smith B, et al. Progressive exercise for anabolism in kidney disease (PEAK): a randomized, controlled trial of resistance training during hemodialysis. J Am Soc Nephrol 2007 May; 18 (5): 1594–601

    Article  PubMed  Google Scholar 

  64. Molsted S, Eidemak I, Sorensen HT, et al. Five months of physical exercise in hemodialysis patients: effects on aerobic capacity, physical function and self-rated health. Nephron Clin Pract 2004; 96 (3): c76–81

    Article  PubMed  Google Scholar 

  65. Whaley M, editor. ACSM’s guidelines for exercise testing and presciption. 7th ed. Baltimore (MD): Lippincott Williams & Wilkins, 2006

    Google Scholar 

  66. Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 2007 Aug 28; 116 (9): 1094–105

    Article  PubMed  Google Scholar 

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Acknowledgements

No funding has been received to assist in the preparation of the review. The authors have no conflicts of interest to declare that are directly relevant to the content of this review.

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Authors and Affiliations

  1. School of Human Movement Studies, the University of Queensland, Brisbane, Queensland, Australia

    Erin J. Howden, Robert G. Fassett & Jeff S. Coombes

  2. School of Medicine, the University of Queensland, Brisbane, Queensland, Australia

    Erin J. Howden, Robert G. Fassett & Nicole M. Isbel

  3. Centre for Clinical Research Excellence — Vascular and Metabolic Health, Brisbane, Queensland, Australia

    Erin J. Howden, Nicole M. Isbel & Jeff S. Coombes

  4. Renal Medicine, Royal Brisbane and Women’s Hospital, the University of Queensland, Brisbane, Queensland, Australia

    Robert G. Fassett

  5. Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia

    Nicole M. Isbel

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  1. Erin J. Howden
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Correspondence to Erin J. Howden.

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Howden, E.J., Fassett, R.G., Isbel, N.M. et al. Exercise Training in Chronic Kidney Disease Patients. Sports Med 42, 473–488 (2012). https://doi.org/10.2165/11630800-000000000-00000

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