Activity interventions decrease sedentary behavior in patients with CKD
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Sit less, interact, move more interventions can increase physical activity, reducing the duration of sedentary behavior in patients with chronic kidney disease, according to a study.
However, activity progress was difficult to sustain, according to researchers.
“In an analysis of National Health and Nutrition Examination Survey, patients with chronic kidney disease spent more than two-thirds of their awake time in sedentary activities, and longer sedentary duration was associated with mortality,” Kate Lyden, PhD, of the department of kinesiology at University of Massachusetts, Amherst, and colleagues wrote. “Compared with patients with nondialysis-requiring CKD, those on maintenance hemodialysis had 3.4-fold higher odds of being sedentary. Thus, sedentary behavior is very common in CKD, is more common with more advanced kidney failure and associates with mortality risk in this population.”
In this single-center pilot open-label randomized controlled trial, authors implemented sit less, interact, move more (SLIMM) interventions that involved patients getting up from a sitting or lying position while awake at least once every hour to engage in light-intensity activities. Researchers conducted baseline and follow-up visits every 4 weeks for 24 weeks in total. For inclusion in the study, patients had a CKD diagnosis (stage 2 CKD with eGFR of 60 to less than 90 mL/min per 1.73 m² with a urine albumin-creatinine ratio greater than 30 mg/g, stage 3 or 4 CKD with eGFR of 15 to less than 60 mL/min per 1.73 m², on maintenance hemodialysis or kidney transplant), a BMI of 25 kg/m² to 39.9 kg/m² and the ability to perform the SLIMM interventions (gait speed greater than or at 0.7 m/s and able to walk at or above 250 m in a 6-minute walk test). The 106 eligible participants (mean age of 68 years) were randomized into either standard of care or SLIMM intervention groups.
Researchers analyzed participants at each follow-up for improvements in stepping and decreases in sedentary duration. These did not change in the standard of care group. In the SLIMM intervention group, 37.3% of participants experienced an average decrease in sedentary durations of 43 minutes, an average increase in stepping durations of 16 minutes and an average increase of 1,265 steps each day. However, these improvements peaked by week 20 and attenuated by week 24. SLIMM participants who achieved activity improvements saw significantly reduced BMI (21.1kg/m2) and body fat. BMI and body fat did not change in the standard of care group.
"Even if only a third of patients with CKD become less sedentary, the public health implications are potentially significant as health consequences of sedentary behavior have been compared with that of smoking,” Lyden and colleagues wrote. “It is well known that smoking cessation interventions have low success rates but still are recommended in national guidelines. Furthermore, achieving the SLIMM intervention goal will result in weekly energy expenditure comparable with those achieved with weekly moderate/vigorous activities.”
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