O54
Exercise training improves kidney function, cardiovascular health, cardio-respiratory
fitness and quality of life in patients with progressive stages 3-4 chronic kidney disease:
A randomised controlled pilot study
Sharlene A. Greenwood1, Pelagia Koufaki2, Helen MacLaughlin1, Herolin Lindup1,
Christopher Jones1, Robert Rush2, Iain C. Macdougall1, Bruce M. Hendry1, Thomas H.
Mercer2*, Hugh Cairns1*
King’s College Hospital, London, UK, 2Queen Margaret University, Edinburgh, UK
1
Introduction: The leading cause of death in patients with chronic kidney disease (CKD) is
cardiovascular disease (CVD), regardless of whether there is progression to stage 5 CKD.
Exercise capacity, which is predictive of all-cause mortality and cardiovascular disease risk in
both health and disease, is significantly reduced in pre-dialysis patients. This pilot and
feasibility study examined the effect of 12 months of moderate-intensity exercise training and
motivational interviewing on kidney function, indices of cardiovascular risk, and quality of
life in patients with progressing stages 3-4 CKD.
Methods: 18 patients (age, 18–80 yrs) were randomly assigned to either exercise (Ex, n = 8)
or usual care (UC, n = 10) for 12 months. The Ex group received a session of motivational
interviewing and an individually-tailored supervised exercise prescription, consisting of
resistance and aerobic training (3 days per week), whereas individuals in the UC group
received standard of care and were instructed not to start a structured exercise program during
the study. Estimated glomerular filtration rate (eGFR), Pulse Wave Velocity (PWV), cardiorespiratory fitness (VO2peak), waist circumference, resting heart rate, blood pressure, plasma
lipids, high sensitivity C-reactive protein (hs CRP), quality of life as assessed by the shortform 36 (SF-36) were assessed at baseline, 6 and 12 months. Change in kidney function
(eGFR) was determined by linear regression as the slope per year for each individual. The
difference between the slope in the 12 months prior to the study start date and the 12-month
study period was compared with Independent t-Test analysis to determine if the changes in
slope differed between the EX and UC groups. All other data were analysed with univariate
analysis using the baseline values as the covariate. Pearson correlations were performed
between change in main outcome measures, and other secondary outcome measures.
Results: There were no statistically significant differences in any of the parameters at
baseline between the groups. The 12-month exercise intervention led to a significant
improvement in kidney function (5.02±5.51 ml/min/year p<0.02) in the Ex group compared
with a continued decline in kidney function in the UC group (-2.34±6.4ml/min/year, p<0.02)
when comparing the 12 months pre-intervention with the 12-month intervention period. This
was accompanied by a significant mean reduction in pulse wave velocity of 2.30±0.33 m/sec
(p<0.001) between the Ex and UC groups at 12 months (Ex=-1.58±0.87 m/s
UC=+0.98±0.69 m/s). There was a significant correlation (p<0.001) between the
improvement in eGFR and PWV in the Ex group at 12 months. There was a significant mean
difference in VO2peak of 5.7ml/kg/min (p<0.01) when comparing the Ex group and the UC
group at 12 months (Ex=20.1±5.8 ml/kg/min to 23±5.3 ml/kg/min, UC= 18.3±4.6 to 16.2±5
ml/kg/min (p<0.01). There was also a mean significant difference of -7.08±2.18cm (p<0.01)
in waist circumference between the Ex and UC groups at 12 months (Ex=-5.43±1.61cm,
UC=+2.37±1.45cm). This improvement in waist girth was correlated with a significant
improvement in VO2peak (p=0.05). There was an observed improvement in the SF36 scores
of 4.46 points (45.99±8.45 to 50.45±7.47) in the Ex group compared with a mean decrease of
4 points (50.77±3.14 to 46.75±6.92) in the UC group.
Conclusion and relevance: A 12-month aerobic and resistance training programme has the
potential to improve kidney function, VO2peak, PWV, waist circumference and quality of life
in patients with progressing stages 3–4 CKD. This small study suggests that not only may
exercise be beneficial in this patient population, but not intervening is potentially damaging
both in terms of loss of physical function and a potential increase in mortality rate.