Effect of long-term exercise training on physical performance and cardiorespiratory function in adults with ckd: a randomized controlled trial

Authors: WEINER, DANIEL - TUFTS MEDICAL CENTER; LIU, CHRISTINE - STANFORD UNIVERSITY; MIAO, SHIYUAN - TUFTS MEDICAL CENTER; FIELDING, ROGER - JEAN MAYER HUMAN NUTRITION RESEARCH CENTER ON AGING AT TUFTS UNIVERSITY; KATZEL, LESLIE - UNIVERSITY OF MARYLAND; GIFFUNI, JAMIE - UNIVERSITY OF MARYLAND; WELL, ANDREW - UNIVERSITY OF TEXAS AT AUSTIN; SELINGER, STEPHEN - UNIVERSITY OF MARYLAND

Submitted to: American Journal of Kidney Diseases
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/22/2022
Publication Date: 1/1/2023
Citation: Weiner, D., Liu, C.K., Miao, S., Fielding, R.A., Katzel, L., Giffuni, J., Well, A., Selinger, S. 2023. Effect of long-term exercise training on physical performance and cardiorespiratory function in adults with CDK: a randomized controlled trial. American Journal of Kidney Diseases. https://doi.org/10.1053/j.ajkd.2022.06.008.
DOI: https://doi.org/10.1053/j.ajkd.2022.06.008

Interpretive Summary: This study examined whether a structured program of aerobic and strength training exercise would affect cardiorespiratory fitness and physical function in older adults with advanced chronic kidney disease (CKD). Older adults with advanced CKD were randomized (by the flip of a coin) to receive 12 months of supervised aerobic and strength training or health education program. Participants who received the aerobic and strength training program demonstrated improvements in cardiorespiratory fitness and physical functioning. These results suggest that aerobic and resistance exercise training can positively impact fitness and physical functioning in older adults living with CKD.

Technical Abstract: The safety and efficacy of long-term exercise training in reducing physical functional loss in older adults with advanced CKD and co-morbidity is uncertain. Study Design: Multi-center, parallel group, randomized controlled trial. Settings and Participants: Adults 55 years and older with CKD stage G3b-4 enrolled from centers in Baltimore and Boston. Intervention: Twelve months of in-center supervised exercise training incorporating majority aerobic but also muscle strengthening activities or a group health education control intervention, randomly assigned in 1:1 ratio. Outcomes: Primary outcomes were cardiorespiratory fitness and submaximal gait at 6 and 12 months quantified by peak oxygen consumption (VO2peak) on graded exercise treadmill test and distance walked on the six-minute walk test, respectively. Secondary outcomes were changes in lower extremity function, renal function, glycemia, blood pressure, and body mass index. Results: Among 99 participants, mean age was 68 years, 62% were African American, and mean eGFR 33 mL/min/1.73m2; 59% had diabetes and 29% had coronary artery disease. Among those randomized to exercise, 59% of exercise sessions were attended in the initial 6 months. Exercise was well tolerated without excess occurrence of adverse events. At 6 months, aerobic capacity was higher among exercise participants (17.9=/-5.5 vs. 15.9=/-7.0 ml/kg/min, p=0.03), but differences were not sustained at 12-months. The 6-minute walk distance improved more in the exercise (adjusted differences: 98 feet, p=0.02; p=0.03 for treatment-by-time interaction). The exercise group had greater improvements on the get up and go test (p=0.04) but not the short physical performance battery (p=0.8). Limitations: Planned sample size was not reached. Loss to follow-up and dropout were greater than anticipated. Conclusions: Among adults >55 years with CKD stages G3b-4 and a high level of medical comorbidity, a 12-month program of in-center aerobic and resistance exercise training was safe and associated with improvements in physical functioning.