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Effect of long-term exercise training on physical performance and cardiorespiratory function in adults with CKD: a randomized controlled trial
Weiner DE, Liu CK, Miao S, Fielding R, Katzel LI, Giffuni J, Well A, Seliger SL
American Journal of Kidney Diseases 2023 Jan;81(1):59-66
clinical trial
3/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: No. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

RATIONALE AND OBJECTIVE: The safety and efficacy of long-term exercise training in reducing physical functional loss in older adults with advanced CKD and co-morbidity is uncertain. STUDY DESIGN: Multi-center, parallel group, randomized controlled trial. SETTINGS AND PARTICIPANTS: Adults 55 years and older with CKD stage G3b-4 enrolled from centers in Baltimore and Boston. INTERVENTION: Twelve months of in-center supervised exercise training incorporating majority aerobic but also muscle strengthening activities or a group health education control intervention, randomly assigned in 1:1 ratio. OUTCOMES: Primary outcomes were cardiorespiratory fitness and submaximal gait at 6 and 12 months quantified by peak oxygen consumption (VO2peak) on graded exercise treadmill test and distance walked on the six-minute walk test, respectively. Secondary outcomes were changes in lower extremity function, renal function, glycemia, blood pressure, and body mass index. RESULTS: Among 99 participants, mean age was 68 years, 62% were African American, and mean eGFR 33 mL/min/1.73m2; 59% had diabetes and 29% had coronary artery disease. Among those randomized to exercise, 59% of exercise sessions were attended in the initial 6 months. Exercise was well tolerated without excess occurrence of adverse events. At 6 months, aerobic capacity was higher among exercise participants (17.9 +/- 5.5 versus 15.9 +/- 7.0 ml/kg/min, p = 0.03), but differences were not sustained at 12-months. The 6-minute walk distance improved more in the exercise (adjusted differences 98 feet, p = 0.02; p = 0.03 for treatment-by-time interaction). The exercise group had greater improvements on the get up and go test (p = 0.04) but not the short physical performance battery (p = 0.8). LIMITATIONS: Planned sample size was not reached. Loss to follow-up and dropout were greater than anticipated. CONCLUSIONS: Among adults >= 55 years with CKD stages G3b-4 and a high level of medical comorbidity, a 12-month program of in-center aerobic and resistance exercise training was safe and associated with improvements in physical functioning.
With permission from the National Kidney Foundation.

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