Supervised exercise training at the gym followed by home-based exercise significantly improves exercise capacity in patients with chronic kidney disease (CKD) who are at risk of cardiovascular disease, an Australian study finds.

The study was a secondary analysis of the Longitudinal Assessment of Numerous Discrete Modifications of Atherosclerotic Risk Factors in Kidney Disease 3 (LANDMARK 3) trial. Patients had non-dialysis CKD stage 3 or above and at least 1 cardiovascular risk factor, such as elevated blood pressure or lipid levels, overweight, or poor diabetic control.

Participants were screened with an exercise stress test before joining the exercise program. A multidisciplinary team monitored their health, including a nurse practitioner, exercise physiologist, dietitian, psychologist, diabetes educator, and social worker.

More than 80 CKD patients were randomly assigned to the intervention or usual care. The exercise prescription consisted of 8 weeks of supervised training at the gym followed by 10 months of home-based training. The goal was 150 minutes per week of moderate-intensity aerobic and resistance exercise. Aerobic activities included walking, jogging, cycling, or rowing. For resistance exercises, participants performed the wall squat, bench press, lunge, wall pushup, seated row, bicep and tricep extension, and bridge holds.

The routine was adjusted for individuals with co-morbid conditions. People with arthritis, for example, were trained in a swimming pool to reduce stress on their joints.

According to results published in the American Journal of Kidney Diseases (2015; 65(4):583-591), exercise training for 12 months significantly improved participants' activity level (METs) and exercise capacity. The gains were supported by increases in distance for the 6-minute walk test and improvements in body composition. Notably, lower limb strength was preserved in the intervention group, while it declined in the control group.

“With this team approach, we found that patients were able to exercise safely,” revealed the research team led by Nicole M. Isbel, PhD, of Princess Alexandra Hospital in Queensland, Australia. “The paucity of information regarding the safety and effect of training may be a barrier to the lack of recommendations by nephrologists for patients with CKD to perform physical activity. Therefore, results from this study should encourage nephrologists to ensure that exercise is recommended routinely to all patients with CKD.”

Adherence to the exercise training was 70% and decreased after 6 months. Ongoing supervision may be more effective, according to the researchers, and should be evaluated in future studies.

1. Howden, EJ, et al. American Journal of Kidney Diseases,2015 Apr;65(4):583-91;doi: 10.1053/j.ajkd.2014.09.017.
   

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