Effect of structured, moderate exercise on kidney function decline in sedentary older adults: An ancillary analysis of the LIFE study randomized clinical trial

Authors: SHILPAK, MICHAEL - UNIVERSITY OF CALIFORNIA SAN FRANCISCO (UCSF); SHESHADRI, ANOOP - UNIVERSITY OF CALIFORNIA SAN FRANCISCO (UCSF); HSU, FANG-CHI - WAKE FOREST SCHOOL OF MEDICINE; CHEN, SHYH-HUEI - CALIFORNIA PACIFIC MEDICAL CENTER RESEARCH INSTITUTE; JOTWANI, VASANTHA - UNIVERSITY OF CALIFORNIA SAN FRANCISCO (UCSF); TRANAH, GREGORY - CALIFORNIA PACIFIC MEDICAL CENTER; FIELDING, ROGER - JEAN MAYER HUMAN NUTRITION RESEARCH CENTER ON AGING AT TUFTS UNIVERSITY; LIU, CHRISTINE - JEAN MAYER HUMAN NUTRITION RESEARCH CENTER ON AGING AT TUFTS UNIVERSITY; IX, JOACHIM - UNIVERSITY OF CALIFORNIA; COCA, STEVEN - THE ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI

Submitted to: JAMA Internal Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/15/2022
Publication Date: 5/2/2022
Citation: Shilpak, M.G., Sheshadri, A., Hsu, F., Chen, S., Jotwani, V., Tranah, G., Fielding, R.A., Liu, C., Ix, J., Coca, S. 2022. Effect of structured, moderate exercise on kidney function decline in sedentary older adults: An ancillary analysis of the LIFE study randomized clinical trial. JAMA Internal Medicine. 182(6):650-659. https://doi.org/10.1001/jamainternmed.2022.1449.
DOI: https://doi.org/10.1001/jamainternmed.2022.1449

Interpretive Summary: Kidney function declines with advancing age. Observational evidence suggests that people who engage in regular physical activity have a slower rate of decline in their kidney function. We examined whether a moderate-intensity exercise intervention can affect the rate of change in kidney function in older adults. We examined data from the Lifestyle Interventions and Independence For Elders (LIFE) randomized clinical trial which enrolled 1199 community-dwelling, sedentary adults aged 70 to 89 years with mobility limitations. Subjects were assigned by the flip of a coin to a moderate-intensity physical activity and exercise (strength, flexibility) intervention or a health education control intervention for 2 years. We found that the physical activity and exercise intervention resulted in a lower decline in kidney function over 2 years compared with the health education arm. Physical activity may be a useful intervention to slow the rate of kidney function decline with advancing age.

Technical Abstract: Importance: Observational evidence suggests that higher physical activity is associated with slower kidney function decline; however, to our knowledge, no large trial has evaluated whether activity and exercise can ameliorate kidney function decline in older adults. Objective: To evaluate whether a moderate-intensity exercise intervention can affect the rate of estimated glomerular filtration rate per cystatin C (eGFRCysC) change in older adults. Design, Setting, and Participants: This ancillary analysis of the Lifestyle Interventions and Independence For Elders randomized clinical trial enrolled 1199 community-dwelling, sedentary adults aged 70 to 89 years with mobility limitations and available blood specimens. The original trial was conducted across 8 academic centers in the US from February 2010 through December 2013. Data for this study were analyzed from March 29, 2021, to February 28, 2022. Interventions: Structured, 2-year, partially supervised, moderate-intensity physical activity and exercise (strength, flexibility) intervention compared with a health education control intervention with 2-year follow-up. Physical activity was measured by step count and minutes of moderate-intensity activity using accelerometers. Main Outcomes and Measures: The primary outcome was change in eGFRCysC. Rapid eGFRCysC decline was defined by the high tertile threshold of 6.7%/y. Results: Among the 1199 participants in the analysis, the mean (SD) age was 78.9 (5.2) years, and 800 (66.7%) were women. At baseline, the 2 groups were well balanced by age, comorbidity, and baseline eGFRCysC. The physical activity and exercise intervention resulted in statistically significantly lower decline in eGFRCysC over 2 years compared with the health education arm (mean difference, 0.96 mL/min/1.73 m2; 95% CI, 0.02-1.91 mL/min/1.73 m2) and lower odds of rapid eGFRCysC decline (odds ratio, 0.79; 95% CI, 0.65-0.97). Conclusions and Relevance: Results of this ancillary analysis of a randomized clinical trial showed that when compared with health education, a physical activity and exercise intervention slowed the rate of decline in eGFRCysC among community-dwelling sedentary older adults. Clinicians should consider targeted recommendation of physical activity and moderate-intensity exercise for older adults as a treatment to slow decline in eGFRCysC.