Resistance Training for Chronic Kidney Disease

(EPIC Trial)

Overseen By Robbie Grace

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: Wake Forest University Health Sciences

Disqualifiers: Dialysis, Walking device, Recent surgery, Diabetes, Others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

Duration: 12 weeks

30 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the study team or your doctor.

What data supports the effectiveness of the treatment High-Velocity Resistance Training for Chronic Kidney Disease?

Resistance training, which involves lifting and lowering weights, has been shown to increase muscle mass and strength, improve physical function, and slow muscle wasting in other conditions. It may also improve nutritional status and quality of life in patients with chronic kidney disease, although more research is needed to confirm these benefits specifically for this group. ^{1 2 3 4 5}

Is resistance training safe for people with chronic kidney disease?

Research shows that resistance training is generally safe for people with chronic kidney disease, including those who have had a kidney transplant. Studies found no adverse events like injuries or hospitalizations related to the exercise. ^{1 2 6 7 8}

How is High-Velocity Resistance Training different from other treatments for chronic kidney disease?

High-Velocity Resistance Training is unique because it focuses on performing resistance exercises at a fast pace, which may improve muscle strength and function more effectively than traditional slower resistance exercises. This approach is particularly novel for chronic kidney disease patients, as it may offer benefits in muscle health and overall physical function, which are not typically addressed by standard treatments. ^{4 8 9 10 11}

What is the purpose of this trial?

The goal of this pilot randomized controlled trial is to examine the feasibility and safety of a 12-week high-velocity resistance training (HVRT) intervention in older adults with chronic kidney disease (CKD) stages 4-5 and to generate preliminary data to inform a future study investigating the efficacy of HVRT for improving muscle power and physical function. Researchers will compare HVRT to an attention control condition consisting of weekly group sessions covering topics on healthy lifestyle. This study seeks to: 1. Determine whether implementing an HVRT intervention is feasible and safe for mobility-limited older adults with advanced CKD. 2. Collect preliminary data on the efficacy of HVRT for improving muscle power and physical function in mobility-limited older adults with advanced CKD.

Research Team

Eliott Arroyo, PhD

Principal Investigator

Wake Forest University Health Sciences

Eligibility Criteria

This trial is for older adults with advanced chronic kidney disease (stages 4-5) who have limited mobility. Participants should be interested in improving their muscle power and physical function.

Inclusion Criteria

My kidney function is severely reduced.

I do not plan to travel away from home for a long time during the study.

My physical performance score is 9 or higher.

Exclusion Criteria

I am on dialysis or expected to start within 6 months.

I rely on a device like a cane or walker to move around.

I have not had joint surgery in the past 6 months and do not plan to in the next 6 months.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo a 12-week high-velocity resistance training (HVRT) intervention or attend weekly group sessions as part of the attention control group

12 weeks

3 visits per week (in-person) for HVRT group; 1 visit per week (in-person) for control group

Follow-up

Participants are monitored for changes in physical function, body composition, quality of life, and cognitive function outcomes

1 week

1 visit (in-person)

Treatment Details

Interventions

• High-Velocity Resistance Training

Trial Overview The study tests a 12-week high-velocity resistance training program against weekly group sessions on healthy living. The goal is to see if the exercise program is doable, safe, and effective at boosting muscle strength and helping participants move better.

Participant Groups

Group I: High-Velocity Resistance Training (HVRT) Experimental Treatment 1 Intervention

Those assigned to HVRT will attend three small-group (two to five people) exercise sessions lasting 60-75 minutes per week consisting of upper- and lower-body movements performed with weighted vests, medicine balls, and resistance bands. For all exercises, the concentric phase (muscle-shortening portion) will be performed as quickly as possible while maintaining good form, followed by a 1-second pause and then the eccentric phase (lengthening portion) completed in a slow and controlled fashion. Following completion of the 12-week intervention, all participants will be asked to complete the same baseline tests to assess changes in physical function, body composition, quality of life, and cognitive function outcomes.

Group II: Control Group Active Control 1 Intervention

Participants randomized to the attention control group will receive dedicated contact, information, and motivation throughout the course of the intervention via weekly group sessions and informational handouts. Each in-person group meeting will last approximately one hour. These group sessions will take place in a classroom/conference room setting and include information on such topics as blood pressure, reading food labels, healthy eating, and memory. The class will be a PowerPoint presentation with incorporated question/answer, lively discussion, and group-bonding activities. Following completion of the 12-week intervention, all participants will be asked to complete the same baseline tests to assess changes in physical function, body composition, quality of life, and cognitive function outcomes.

Who Is Running the Clinical Trial?

Wake Forest University Health Sciences

Lead Sponsor

Trials

1,432

Recruited

2,506,000+

Findings from Research

Resistance or strength exercise training can significantly improve muscle mass, strength, and function in patients with chronic renal failure, potentially reversing malnutrition and delaying disease progression.

Even with low dietary protein intake, resistance training enhances protein metabolism and overall physical function, suggesting it could be a valuable, noninvasive treatment option for improving the quality of life in renal patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Potential benefits of resistance exercise training on nutritional status in renal failure. Castaneda, C., Grossi, L., Dwyer, J.[2019]

A 12-month supervised exercise program for older adults with advanced chronic kidney disease (CKD) was found to be safe and well-tolerated, with no significant increase in adverse events reported.

Participants in the exercise group showed significant improvements in physical functioning, including a greater distance walked in the 6-minute walk test and better performance on the Timed Up and Go Test, indicating that exercise can enhance physical capabilities in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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., et al.[2023]

Recent evidence supports the use of exercise-based rehabilitation for individuals with chronic kidney disease (CKD), highlighting its potential to improve health-related quality of life and overall outcomes.

There is a growing commitment within the kidney research community to implement practical exercise interventions, including options for prehabilitation and post-transplant rehabilitation, as well as tailored programs for those undergoing hemodialysis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise as a therapeutic intervention in chronic kidney disease: are we nearly there yet? Castle, EM., Billany, RE., Lightfoot, CJ., et al.[2023]

A 6-month home-based exercise program significantly improved physical functioning in patients with Stage 4 chronic kidney disease (CKD), as evidenced by a greater increase in the incremental shuttle walking test compared to a control group.

The exercise program also enhanced health-related quality of life (HRQOL) in several domains, including work status and social interaction, while showing potential benefits on kidney function and related biomarkers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Home-based aerobic exercise and resistance training for severe chronic kidney disease: a randomized controlled trial. Uchiyama, K., Adachi, K., Muraoka, K., et al.[2022]

A 10-week supervised resistance exercise program significantly improved health-related quality of life and physical performance in 16 kidney transplant recipients, with notable enhancements in specific quality of life domains and physical tests like the 6-minute walk distance and handgrip strength.

The exercise intervention was safe, with no reported adverse events or injuries, indicating that resistance training can be a beneficial and safe rehabilitation strategy for kidney transplant patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of a resistance training program in kidney transplant recipients: A randomized controlled trial. Hernández Sánchez, S., Carrero, JJ., Morales, JS., et al.[2021]

Resistance training (RT) has been shown to significantly improve muscle strength and quality of life in chronic kidney patients undergoing hemodialysis, based on a review of 21 studies.

All studies reviewed reported positive outcomes related to biochemical parameters, physical capacity, and body composition, highlighting the potential benefits of incorporating RT into the care of hemodialysis patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Resistance training in hemodialysis patients: a review. Bessa, B., de Oliveira Leal, V., Moraes, C., et al.[2015]

Combined exercise training is the most effective modality for improving aerobic capacity and controlling arterial blood pressure in adults requiring haemodialysis for end-stage renal disease, based on a systematic review of 33 trials with 1254 participants.

Aerobic training specifically improved haemodialysis efficiency, but no exercise modality was superior to control for this outcome, highlighting the unique benefits of different training types for various health metrics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Combined training is the most effective training modality to improve aerobic capacity and blood pressure control in people requiring haemodialysis for end-stage renal disease: systematic review and network meta-analysis. Scapini, KB., Bohlke, M., Moraes, OA., et al.[2019]

In a study of 26 chronic kidney disease patients, blood flow restriction training led to significant increases in the diameter of the radial artery, indicating potential benefits for vascular health, but did not outperform conventional exercise without blood flow restriction.

Both blood flow restriction and control groups showed increases in cephalic vein diameter, suggesting that physical training is beneficial for vascular adaptations in patients with arteriovenous fistulas.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does blood flow restriction training increase the diameter of forearm vessels in chronic kidney disease patients? A randomized clinical trial. Barbosa, JB., Maia, TO., Alves, PS., et al.[2019]

References

1. United States pubmed.ncbi.nlm.nih.gov

Potential benefits of resistance exercise training on nutritional status in renal failure. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Effect of Long-term Exercise Training on Physical Performance and Cardiorespiratory Function in Adults With CKD: A Randomized Controlled Trial. [2023]

3. England pubmed.ncbi.nlm.nih.gov

Exercise as a therapeutic intervention in chronic kidney disease: are we nearly there yet? [2023]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Progressive Resistance Training in End-Stage Renal Disease: Systematic Review. [2018]

5. Germany pubmed.ncbi.nlm.nih.gov

Home-based aerobic exercise and resistance training for severe chronic kidney disease: a randomized controlled trial. [2022]

6. Denmark pubmed.ncbi.nlm.nih.gov

Effects of a resistance training program in kidney transplant recipients: A randomized controlled trial. [2021]

7. Canada pubmed.ncbi.nlm.nih.gov

Effectiveness of a resistance exercise program for lower limbs in chronic renal patients on hemodialysis: A randomized controlled trial. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Resistance training in hemodialysis patients: a review. [2015]

9. Netherlands pubmed.ncbi.nlm.nih.gov

Combined training is the most effective training modality to improve aerobic capacity and blood pressure control in people requiring haemodialysis for end-stage renal disease: systematic review and network meta-analysis. [2019]

10. United States pubmed.ncbi.nlm.nih.gov

Does blood flow restriction training increase the diameter of forearm vessels in chronic kidney disease patients? A randomized clinical trial. [2019]

11. Italy pubmed.ncbi.nlm.nih.gov

Effects of resistance training on patients with End-Stage Renal Disease: an umbrella review with meta-analysis of the pooled findings. [2023]