Boosting physical activity lowers CKD risk in patients with diabetes

Key takeaways:

• Increasing weekly MVPA by 63 minutes or more was linked to a 33% lower risk for progression to CKD.
• Researchers said adults with overweight or obesity and diabetes should have 67 minutes of MVPA 7 days a week.

High weekly averages of moderate to vigorous physical activity, or MVPA, were associated with a reduced risk for progression to chronic kidney disease, according to researchers.

“Short-term interventional exercise has been shown to improve renal function in people with diabetes and mild renal dysfunction,” Mengyi Liu, from Southern Medical University in China, and colleagues wrote in the British Journal of Sports Medicine.

However, they pointed out that longer term associations between physical activity and chronic kidney disease (CKD) in patients with overweight or obesity and type 2 diabetes, as well as the role physical activity accumulation plays, are less understood.

In the study, the researchers analyzed the data from 1,746 participants (mean age, 58 years; 59% women) in the Look AHEAD trial — a randomized study in the United States that evaluated the cardiovascular effects of an intensive lifestyle intervention in patients with diabetes.

Levels of MPVA were measured at the trial’s baseline and during the 1st, 4th and 8th year.

Over a median of 12 years of follow-up, 567 trial participants (32.5%) experienced progression to CKD.

A weekly MVPA average was associated with a 9% (HR = 0.91; 95% CI, 0.86-0.96) reduced risk for progression to CKD for every 100 minutes of exercise. The risk reduction was even greater — 19% (HR = 0.81; 95% CI, 0.72-0.91) — if the increased MVPA each week was achieved in bouts lasting 10 minutes or more.

A significantly lower risk for CKD progression was seen in participants who exercised for 328.8 to 469.2 minutes or greater per week vs. those who exercised for less than 220.3 minutes a week.

Liu and colleagues also noted that, from baseline to the 4th year, increasing the weekly MVPA by 63 minutes or more was associated with a 33% lower risk for progression to CKD compared with the largest decrease in MVPA of 198 minutes a week.

The researchers pointed out that because of the observational nature of the study and the possibility of reverse causation, casualty could not be determined.

Still, they wrote that the findings have important public health implications because they suggest “that maintaining a high level of MVPA, regardless of length of the bout, may have renal benefit for adults with overweight or obesity and type 2 diabetes.”

Liu and colleagues said that adults with overweight or obesity and type 2 diabetes should set a goal of doing 67 minutes of MVPA daily, 7 days a week, “such as brisk walk, slow cycling, jogging, slow sweeping, slow swimming and so on, to reach 469 minutes a week” to ultimately reduce the risk for CKD progression.

References:

• High weekly physical activity levels linked to lower kidney disease risk in diabetes + overweight/obesity. https://www.bmj.com/company/newsroom/high-weekly-physical-activity-levels-linked-to-lower-kidney-disease-risk-in-diabetes-overweight-obesity/. Published Feb. 6, 2024. Accessed Feb. 6, 2024.
• Liu M, et al. Br J Sports Med. 2024;doi:10.1136/bjsports-2023-107564.