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Exercise program in older patients with advanced CKD seen as feasible, safe
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BOSTON — A supervised exercise training program can be an option for older sedentary adults with CKD stage 3b-4, with adherence comparable to long-term exercise programs of healthier older adults, according to study results presented at the National Kidney Foundation Spring Clinical Meetings.
“Among older sedentary adults with CKD stage 3b-4 and a high burden of diabetes and cardiovascular disease, we showed they have markedly impaired cardiorespiratory fitness and lower extremity function. A program of 12 months of supervised exercise training is feasible, in terms of its adherence, and it is safe, with adherence comparable to other long-term exercise trials in healthier older adults,” Stephen L. Seliger, MD, MS, co-principal investigator and associate professor of medicine at the University of Maryland, said.
Seliger, along with Daniel Weiner, MD, MS, co-principal investigator and associate professor of medicine from Tufts University, presented results of the Aerobics, Weights, and Renal Disease (AWARD) Trial, a randomized controlled trial that assessed the impact of aerobic and resistance training for community-dwelling older adults with CKD stage 3b-4.
“This is a population with a lot of comorbidity. There is a need to see what we can do to improve their functioning. Sometimes, improvements in their functioning leads to improvements in everything else,” Weiner said.
Researchers followed 99 patients at the two sites for 12 months. Patients were age 50 years or older. The 49 patients in the exercise group participated in an in-center program of supervised aerobic and strength training three times per week for the first 6 months and twice weekly for the last 6 months. Exercise intervention was walking and jogging to obtain 70% to 80% of heart rate reserve. Strength training was ankle and wrist weights two times per week for 10 minutes.
The 50 patients in the control group participated in weekly group health education classes with stretching exercises at the end of the class for the first 6 months, which was reduced to monthly for the last 6 months of the study. Researchers assessed peak VO2, 6-minute walk test, the short physical performance battery and the timed up-and-go test at baseline, 6 and 12 months.
Overall, 86 patients completed at least part of the 6-month assessment and 78 patients completed the 12-month assessment, of which 74 patients were men and 58 patients had diabetes. Mean age was 68±8 years and eGFR was 33±11 mL/min/1.73 m2.
Researchers found total adherence was 59.5% in the first 6 months and was 48.9% for the second 6 months. Median individual adherence was 60.7% in the first 6 months and was 38.2% for the second 6 months, which Seliger said was due to patients who had dropped out or were unable to exercise.
“Overall, our exercise adherence appeared favorably to that reports in long-term trials of healthy older adults,” he said.
Seliger said VO2 over time improved about 10% in the mean VO2 in the exercise group, but there was little change in the health education group. At 6 months, the difference in VO2 was statistically significant, but not at 12 months because there were fewer patients in the study at that time. Researchers found a significantly better 6-minute walk test distance for patients in the exercise group compared with patients in the control group. There were also significant improvements in the timed up-and-go test for the exercise group, who maintained the performance over time. However, researchers did not see significant differences between groups in the short physical performance battery. There were no serious adverse events related to exercise training. – by Kristine Houck, MA, ELS
Reference:
Weiner D, et al. Poster 445. Presented at: National Kidney Foundation Spring Clinical Meetings; May 8-12, 2019; Boston.
Disclosures: Weiner reports he participates in advisory boards for Janssen, Akebia/Otsuka and Tricida; is medial director of clinical research for DCI; is editor-in-chief for Kidney Medicine and the Primer of Kidney Diseases; and is an ASN representative to Kidney Care Partners. Seliger reports he is associate editor of the Clinical Journal of the American Society of Nephrology; receives researching funding from Otsuka, Roche Diagnostics, Kadmon Corporation, Sanofi, Palladio Biosciences; and is a consultant for AbbVie.