Advertisement

Sports Medicine

, Volume 35, Issue 6, pp 485–499 | Cite as

Exercise and Chronic Kidney Disease

Current Recommendations
  • Kirsten L. Johansen
Review Article

Abstract

Patients with chronic kidney disease (CKD) are inactive and have reduced physical functioning and performance. Aerobic exercise interventions have been shown to increase maximal oxygen consumption in selected patients. In addition, preliminary evidence, although mixed, suggests that aerobic exercise training can improve blood pressure control, lipid profiles and mental health in this population. A few larger studies are now available showing that aerobic training can also improve physical functioning and performance. The impact on survival or hospitalisation has not been determined. Resistance exercise training, although less studied, appears to increase muscle strength and size and may also improve functioning. There have been several reports of successful combined exercise interventions, but the designs have not allowed evaluation of the relative benefits of aerobic and resistance training on physical functioning. Despite the evidence that exercise is safe and beneficial in patients with CKD, dialysis patients remain inactive, and exercise assessment, counselling and training is not widely offered to patients with CKD.

Studies of the barriers to patient participation in exercise and to provider assessment and recommendations are needed so that more widely generalisable interventions can be developed. However, in the interim, patients should be encouraged to participate in moderate physical activity to meet the US Surgeon General’s recommendations. Patients who are weak can benefit from strength-training interventions. Resistance and aerobic exercise programmes should be initiated at relatively low intensity in patients with CKD and progressed as slowly as tolerated in order to avoid injury and discontinuation of exercise. For patients on haemodialysis, incorporation of exercise into the dialysis session may increase patient participation and tolerance of exercise.

Keywords

Chronic Kidney Disease Exercise Training Exercise Programme Aerobic Exercise Gait Speed 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

This work was supported by a grant from the National Institutes of Health (DK-56182). There are no conflicts of interest to report.

References

  1. 1.
    Johansen K, Chertow G, Ng A, et al. Physical activity levels in patients on hemodialysis and healthy sedentary controls. Kidney Int 2000; 57 (6): 2564–70PubMedCrossRefGoogle Scholar
  2. 2.
    Boyce M, Robergs R, Avasthi P, et al. Exercise training by individuals with predialysis renal failure: cardiorespiratory endurance, hypertension, and renal function. Am J Kidney Dis 1997; 30 (2): 180–92PubMedCrossRefGoogle Scholar
  3. 3.
    Castaneda C, Gordon P, Uhlin K, et al. Resistance training to counteract the catabolism of a low-protein diet in patients with chronic renal inusufficiency: a randomized, controlled trial. Ann Intern Med 2001; 135 (11): 965–76PubMedGoogle Scholar
  4. 4.
    Painter P, Messer-Rehak D, Hanson P, et al. Exercise capacity in hemodialysis, CAPD, and renal transplant patients. Nephron 1986; 42: 47–51PubMedCrossRefGoogle Scholar
  5. 5.
    Moore G, Brinker K, Stray-Gundersen J, et al. Determinants of V̇O2peak in patients with end-stage renal disease: on and off dialysis. Med Sci Sports Exerc 1993; 25 (1): 18–23PubMedCrossRefGoogle Scholar
  6. 6.
    Latos D, Strimel D, Drews M, et al. Acid-base and electrolyte changes following maximal and submaximal exercise in hemodialysis patients. Am J Kidney Dis 1987; 10 (6): 439–45PubMedGoogle Scholar
  7. 7.
    Shalom R, Blumenthal J, Williams R, et al. Feasibility and benefits of exercise training in patients on maintenance dialysis. Kidney Int 1984; 25: 958–63PubMedCrossRefGoogle Scholar
  8. 8.
    Goldberg A, Geltman E, Hagberg J, et al. Therapeutic benefits of exercise training for hemodialysis patients. Kidney Int 1983; 24 Suppl. 16: S303–9Google Scholar
  9. 9.
    Goldberg A, Hagberg J, Delmez J, et al. Metabolic effects of exercise training in hemodialysis patients. Kidney Int 1980; 18: 754–61PubMedCrossRefGoogle Scholar
  10. 10.
    Johansen K, Painter P, Kent-Braun J, et al. Validation of questionnaires to estimate physical activity and functioning in ESRD. Kidney Int 2001; 59 (3): 1121–7PubMedCrossRefGoogle Scholar
  11. 11.
    DeOreo P. Hemodialysis patient-assessed functional health status predicts continued survival, hospitalization, and dialysis-attendance compliance. Am J Kidney Dis 1997; 30 (2): 204–12PubMedCrossRefGoogle Scholar
  12. 12.
    Johansen K, Chertow G, Silva MD, et al. Determinants of physical performance in ambulatory patients on hemodialysis. Kidney Int 2001; 60 (4): 1586–91PubMedCrossRefGoogle Scholar
  13. 13.
    Churchill D, Torrance G, Taylor D, et al. Measurement of quality of life in end-stage renal disease: the time trade-off approach. Clin Invest Med 1987; 10 (1): 14–20PubMedGoogle Scholar
  14. 14.
    O’Hare A, Tawney K, Bacchetti P, et al. Decreased survival among sedentary patients undergoing dialysis: results from the dialysis morbidity and mortality study wave 2. Am J Kidney Dis 2003; 41 (2): 447–54PubMedCrossRefGoogle Scholar
  15. 15.
    United States Renal Data System. USRDS 2003 annual data report: atlas of end-stage renal disease in the United States. Bethesda (MD): National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2003Google Scholar
  16. 16.
    Sarnak M, Levey A, Schoolworth A, et al. Kidney disease as a specific risk factor for development of cardiovascular disease. Hypertension 2003; 42 (5): 1050–65PubMedCrossRefGoogle Scholar
  17. 17.
    Painter P, Krasnoff J. End-stage metabolic disease: renal failure and liver failure. 2nd ed. Champaign (IL): Human Kinetics, 2003Google Scholar
  18. 18.
    Johansen K, Sakkas G, Doyle J, et al. Exercise counseling practices among nephrologists caring for patients on dialysis. Am J Kidney Dis 2003; 41 (1): 171–8PubMedCrossRefGoogle Scholar
  19. 19.
    Barnea H, Drory Y, Iaina A, et al. Exercise tolerance in patients on chronic hemodialysis. Isr J Med Sci 1980; 16 (1): 17–21PubMedGoogle Scholar
  20. 20.
    Beasley C, Smith D, Neale T. Exercise capacity in chronic renal failure patients managed by continuous ambulatory peritoneal dialysis. Aust NZ J Med 1986; 16: 5–10CrossRefGoogle Scholar
  21. 21.
    Kettner-Melsheimer A, Weiss M, Huber W. Physical work capacity in chronic renal disease. Int J Artif Organs 1987; 10: 23–30PubMedGoogle Scholar
  22. 22.
    Zabetakis P, Gleim G, Pasternack F, et al. Long-duration submaximal exercise conditioning in hemodialysis patients. Clin Nephrol 1982; 18 (1): 17–22PubMedGoogle Scholar
  23. 23.
    Painter P, Nelson-Worel J, Thornbery MHD, et al. Effects of exercise training during hemodialysis. Nephron 1986; 43: 87–92PubMedCrossRefGoogle Scholar
  24. 24.
    Lennon D, Shrago E, Madden M, et al. Carnitine status, plasma lipid profiles, and exercise capacity of dialysis patients: effects of a submaximal exercise program. Metabolism 1986; 35 (8): 728–35PubMedCrossRefGoogle Scholar
  25. 25.
    Ross D, Grabeau G, Smith S, et al. Efficacy of exercise for end-stage renal disease patients immediately following high-efficiency hemodialysis: a pilot study. Am J Nephrol 1989; 9: 376–83PubMedCrossRefGoogle Scholar
  26. 26.
    Akiba T, Matsui N, Shinohara S, et al. Effects of recombinant human erythropoietin and exercise training on exercise capacity in hemodialysis patients. Artif Organs 1995; 19 (12): 1262–8PubMedCrossRefGoogle Scholar
  27. 27.
    Painter P, Moore G, Carlson L, et al. Effects of exercise training plus normalization of hematocrit on exercise capacity and health-related quality of life. Am J Kidney Dis 2002; 39 (2): 257–65PubMedCrossRefGoogle Scholar
  28. 28.
    Koufaki P, Mercer T, Naish P. Effects of exercise training on aerobic and functional capacity of end-stage renal disease. Clin Physiol Funct Imaging 2002; 22 (2): 115–24PubMedCrossRefGoogle Scholar
  29. 29.
    Suh M, Jung H, Kim S, et al. Effects of regular exercise on anxiety, depression, and quality of life in maintenance hemodialysis patients. Renal Failure 2002; 24 (3): 337–45PubMedCrossRefGoogle Scholar
  30. 30.
    Violan M, Pomes T, Maldonado S, et al. Exercise capacity in hemodialysis and renal transplant patients. Transplant Proc 2002; 34: 417–8PubMedCrossRefGoogle Scholar
  31. 31.
    Sakkas G, Sargeant A, Mercer T, et al. Changes in muscle morphology in dialysis patients after 6 months of aerobic exercise training. Nephrol Dial Transplant 2003; 18: 1854–61PubMedCrossRefGoogle Scholar
  32. 32.
    Clyne N, Ekholm J, Jogestrand T, et al. Effects of exercise training in predialytic uremic patients. Nephron 1991; 59 (1): 84–9PubMedCrossRefGoogle Scholar
  33. 33.
    Moore G, Parsons D, Stray-Gundersen J, et al. Uremic myopathy limits aerobic capacity in hemodialysis patients. Am J Kidney Dis 1993; 22 (2): 277–87PubMedGoogle Scholar
  34. 34.
    Miller B, Cress C, Johnson M, et al. Exercise during hemodialysis decreases the use of antihypertensive medications. Am J Kidney Dis 2002; 39 (4): 826–33CrossRefGoogle Scholar
  35. 35.
    Carney R, Templeton B, Hong B, et al. Exercise training reduces depression and increases the performance of pleasant activities in hemodialysis patients. Nephron 1987; 47: 194–8PubMedCrossRefGoogle Scholar
  36. 36.
    Kouidi E, Iacovides A, Iordanidis P, et al. Exercise renal rehabilitation program: psychosocial effects. Nephron 1997; 77: 152–8PubMedCrossRefGoogle Scholar
  37. 37.
    Painter P, Carlson L, Carey S, et al. Physical functioning and health-related quality-of-life changes with exercise training in hemodialysis patients. Am J Kidney Dis 2000; 35 (3): 482–92PubMedCrossRefGoogle Scholar
  38. 38.
    Painter P, Carlson L, Carey S, et al. Low-functioning hemodialysis patients improve with exercise training. Am J Kidney Dis 2000; 36 (3): 600–8PubMedCrossRefGoogle Scholar
  39. 39.
    Painter P, Hector L, Ray K, et al. A randomized trial of exercise training after renal transplantation. Transplant 2002; 74 (1): 42–8CrossRefGoogle Scholar
  40. 40.
    Guralnik J, Simonsick E, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994; 49 (2): M85–94CrossRefGoogle Scholar
  41. 41.
    Potter J, Evans A, Duncan G. Gait speed and activities of daily living function in geriatric patients. Arch Phys Med Rehabil 1995; 76: 997–9PubMedCrossRefGoogle Scholar
  42. 42.
    Johansen K, Shubert T, Doyle J, et al. Muscle atrophy in patients receiving hemodialysis: Effects on muscle strength, muscle quality, and physical function. Kidney Int 2003; 63 (1): 201–7CrossRefGoogle Scholar
  43. 43.
    Bohannon R, Smith J, Barnhard R. Grip strength in end stage renal disease. Percept Mot Skills 1994; 79 (3 Pt 2): 1523–6PubMedCrossRefGoogle Scholar
  44. 44.
    Fahal I, Ahmad R, Edwards R. Muscle weakness in continuous ambulatory peritoneal dialysis patients. Peritoneal Dial Int 1996; 16 Suppl. 1: S419–23Google Scholar
  45. 45.
    Spindler A, Paz S, Berman A, et al. Muscular strength and bone mineral density in haemodialysis patients. Nephrol Dial Transplant 1997; 12 (1): 128–32PubMedCrossRefGoogle Scholar
  46. 46.
    McElroy A, Silver M, Morrow L, et al. Proximal and distal muscle weakness in patients receiving hemodialysis for chronic uremia. Phys Ther 1970; 50 (10): 1467–81PubMedGoogle Scholar
  47. 47.
    Fahal I, Bell G, Bone J, et al. Physiological abnormalities of skeletal muscle in dialysis patients. Nephrol Dial Transplant 1997; 12: 119–27PubMedCrossRefGoogle Scholar
  48. 48.
    Diesel W, Voakes T, Swanepoel C, et al. Isokinetic muscle strength predicts maximum exercise tolerance in renal patients on chronic hemodialysis. Am J Kidney Dis 1990; 16 (2): 109–14PubMedGoogle Scholar
  49. 49.
    Headley S, Germain M, Mailloux P, et al. Resistance training improves strength and functional measures in patients with end-stage renal disease. Am J Kidney Dis 2002; 40 (2): 355–64PubMedCrossRefGoogle Scholar
  50. 50.
    Computer Retrieval of Information on Scientific Projects (CRISP) [online]. Available from URL: http://www.crisp.cit.nih.gov [Accessed 2005 May 10]
  51. 51.
    Kouidi E, Albani M, Natsis K, et al. The effects of exercise training on muscle atrophy in haemodialysis patients. Nephrol Dialysis Transplant 1998; 13 (3): 685–99CrossRefGoogle Scholar
  52. 52.
    Mercer T, Crawford C, Gleeson N, et al. Low-volume exercise rehabilitation improves functional capacity and self-reported functional status of dialysis patients. Am J Phys Med Rehabil 2002; 81 (3): 162–7PubMedCrossRefGoogle Scholar
  53. 53.
    DePaul V, Moreland J, Eager T, et al. The effectiveness of aeorbic and muscle strength training in patients receiving hemodialysis and EPO: a randomized controlled trial. Am J Kidney Dis 2002; 40 (6): 1219–29PubMedCrossRefGoogle Scholar
  54. 54.
    Borg G. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14 (5): 377–81PubMedGoogle Scholar
  55. 55.
    Heiwe S, Tollback A, Clyne N. Twelve weeks of exercise training increases muscle function and walking capacity in elderly predialysis patients and healthy subjects. Nephron 2001; 88 (1): 48–56PubMedCrossRefGoogle Scholar
  56. 56.
    Podsiadlo D, Richardson S. The timed ‘Up & Go’: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39: 142–8PubMedGoogle Scholar
  57. 57.
    Copley J, Lindberg J. The risks of exercise. Adv Ren Replace Ther 1999; 6 (2): 165–71PubMedGoogle Scholar
  58. 58.
    Alem A, Sherrard D, Gillen D, et al. Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 2000; 58 (1): 396–9PubMedCrossRefGoogle Scholar
  59. 59.
    Shah M. Simultaneous bilateral quadriceps tendon rupture in renal patients. Clin Nephrol 2002; 58 (2): 118–21PubMedGoogle Scholar
  60. 60.
    Jones N, Kjellstrand C. Spontaneous tendon ruptures in patients on chronic dialysis. Am J Kidney Dis 1996; 28 (6): 861–6PubMedCrossRefGoogle Scholar
  61. 61.
    Ryuzaki M, Konishi K, Kasuga A, et al. Spontaneous rupture of the quadriceps tendon in patients on maintenance hemodialysis-report of three cases with clinicopathological observations. Clin Nephrol 1989; 32 (3): 144–8PubMedGoogle Scholar
  62. 62.
    VanCamp S, Peterson R. Cardiovascular complications of outpatient cardiac rehabilitation programs. JAMA 1986; 256: 1160–3CrossRefGoogle Scholar
  63. 63.
    Haskell W. Cardiovascular complications during exercise training of cardiac patients. Circulation 1978; 57: 920–4PubMedCrossRefGoogle Scholar
  64. 64.
    Gibbons L, Mitchell T, Gonzalez V. The safety of exercise testing. Prim Care 1994; 21 (3): 611–29PubMedGoogle Scholar
  65. 65.
    Thompson P, Funk E, Carleton R, et al. Incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA 1982; 247 (18): 2535–8PubMedCrossRefGoogle Scholar
  66. 66.
    American College of Sports Medicine. Guidelines for exercise testing and prescription. 5th ed. Philadelphia (PA): Williams & Wilkins, 1995Google Scholar
  67. 67.
    Tawney K, Tawney P, Hladik G, et al. The Life Readiness Program: a physical rehabilitation program for patients on hemodialysis. Am J Kidney Dis 2000; 36 (3): 581–91PubMedCrossRefGoogle Scholar
  68. 68.
    Office of the US Surgeon General. Physical activity and health: a report of the Surgeon General. Washington, DC: US Department of Health and Human Services, National Center for Chronic Disease Prevention and Health Promotion, 1996Google Scholar
  69. 69.
    Konstantinidou E, Koukouvou G, Kouidi E, et al. Exercise training in patients with end-stage renal disease on hemodialysis: comparison of three rehabilitation programs. J Rehabil Med 2002; 34: 40–5PubMedCrossRefGoogle Scholar
  70. 70.
    Reeves N, Maganaris C, Narici M. Effect of strength training on human patella tendon mechanical properties of older individuals. J Physiol 2003; 548 (Pt 3): 971–81PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  • Kirsten L. Johansen
    • 1
  1. 1.Department of MedicineUniversity of California San Francisco and San Francisco VA Medical CenterSan FranciscoUSA

Personalised recommendations