Exercise training program improved physical function among older adults with CKD
A 12-month program of aerobic and resistance training was safe and improved physical function among older adults with chronic kidney disease, according to the results of this study.
“Exercise may reduce physical function losses or even improve physical function in older adults with CKD; however, most studies that have evaluated exercise in older adults with CKD have been modest in sample size, of relatively short duration, and either focused on individuals receiving dialysis or individuals with earlier stages of CKD,” Daniel E. Weiner, MD, MS, from the department of medicine at Tufts Medical Center in Boston, and colleagues wrote.
In a multicenter, parallel group, randomized, controlled trial, researchers examined 99 adults with stages Gb to G4 CKD (mean age was 68 years; 62% were African American; mean eGFR 33 mL/min/1.73 m2; 59% had diabetes; 29% had coronary artery disease). All patients were enrolled from centers in Baltimore and Boston.
Researchers randomized patients in a 1:1 ratio to either the exercise intervention group or a health education control group. Patients in the exercise intervention group were assigned to thrice weekly in-center exercise training for the first 6 months. Exercise consisted of aerobic and muscle strengthening activities. Then, patients finished the 6-month maintenance phase during which one of the weekly sessions could be completed at home. Patients logged at-home exercise.
Patients in the health education group attended weekly sessions for 6 months and then monthly sessions during the maintenance phase. Educational content consisted of healthy diet, CKD, diabetes and blood pressure management.
Researchers used peak oxygen consumption, which was graded using exercise treadmill tests, and distance walked in the 6-minute walk test to measure the cardiorespiratory fitness and submaximal gait of patients at 6 and 12 months.
A total of 31 patients dropped out of the study, were lost to follow-up or were unable to complete the final 12-month follow-up.
Among patients in the exercise intervention group, 59% of the sessions were attended during the first 6 months. Researchers identified increased aerobic capacity among the exercise group compared with the control group at 6 months, but this finding was not sustained at 12 months. Similarly, the exercise group showed improvements in the 6-minute walk distance and on the timed get up and go test. However, the exercise group did not show improvements on the short physical performance battery.
“Of note, the study was not designed to detect differences in ‘hard’ clinical outcomes, such as hospitalization or death. However, the similar rates of serious adverse events between the two randomized intervention groups does support the overall safety of the long-term supervised exercise training program,” Weiner and colleagues wrote. They added, “In conclusion, a 12-month program of supervised aerobic and resistance exercise training in adults at least 55 years with stage G3b and G4 CKD is safe, feasible and effective at improving physical performance, albeit with a higher-than-expected drop-out.”
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