Exercise for Chronic Kidney Disease

Overseen By Justin Sprick, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of North Texas, Denton, TX

Disqualifiers: Heart failure, COPD, Uncontrolled hypertension, others

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 36

Duration: 12 weeks

40 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

The purpose of this study is to test whether or not regular exercise training may improve brain blood flow regulation in patients with chronic kidney disease (CKD).

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What safety data exists for exercise in chronic kidney disease treatment?

The safety of exercise in chronic kidney disease (CKD) has been evaluated in several studies. Exercise training has been shown to increase exercise capacity, improve muscle strength and function, decrease blood pressure, and improve inflammation and oxidative stress biomarkers. However, most studies are small, non-randomized, and non-controlled, and the effects on kidney function, cardiovascular disease, and quality of life are not well known. A single-armed interventional study in Japanese patients with stable CKD evaluated the effectiveness and safety of modest exercise, suggesting it is safe. More research is needed to develop evidence-based exercise guidelines for CKD patients. ^{1 2 3 4 5}

Is exercise a promising treatment for chronic kidney disease?

Yes, exercise is a promising treatment for chronic kidney disease. It improves physical strength, endurance, and quality of life for patients at all stages of the disease. Exercise can also reduce healthcare costs and help patients feel more in control of their health. ^{6 7 8 9 10}

What data supports the idea that Exercise for Chronic Kidney Disease is an effective treatment?

The available research shows that exercise can significantly improve the quality of life for people with chronic kidney disease (CKD). It helps reduce inflammation, depression, and the need for hospitalization, while also improving nutrition and overall health. Exercise is beneficial at all stages of CKD and empowers patients to take control of their health. Additionally, a study involving a 12-week exercise program showed positive impacts on patients' physical abilities and quality of life, suggesting that exercise should be a key part of CKD care. ^{10 11 12 13 14}

Are You a Good Fit for This Trial?

This trial is for people with moderate to severe chronic kidney disease (stages III-IV). It's not suitable for those with heart failure, lung issues like COPD, uncontrolled blood pressure problems, pregnant women or those planning pregnancy, and individuals already exercising regularly.

Inclusion Criteria

I have moderate to severe kidney disease.

I have moderate to severe kidney disease.

Exclusion Criteria

Pregnancy or plans to become pregnant

I have chronic obstructive pulmonary disease.

You can't ride a stationary bike.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo exercise training or stretching exercises 3 times per week for 12 weeks

12 weeks

36 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Exercise
• Stretching

Trial Overview The study is looking at how regular exercise might help the brain control blood flow in patients with chronic kidney disease. Participants will engage in supervised exercise routines including cycling and stretching exercises.

How Is the Trial Designed?

Group I: Exercise Training Experimental Treatment 1 Intervention

Participants will exercise 3 times a week on a stationary bicycle. Exercise intensity will begin at low levels (50% of maximal heart rate reserve) and increase as tolerated to a maximum of 80% of maximal heart rate reserve. Exercise time will progress from an initial 20 minutes per session to a maximum of 45 minutes per session.

Group II: Stretching Placebo Group 1 Intervention

Participants will undergo progressive whole body stretching and balance exercises. This type of low intensity exercise is designed not to increase heart rate but rather to improve joint mobility and the ability to perform activities of daily living. This will serve as the control group to the exercise group. The control group will come in for stretching sessions 3 times per week for 20-45 minutes.

Who Is Running the Clinical Trial?

University of North Texas, Denton, TX

Lead Sponsor

Trials

13

Recruited

7,100+

Published Research Related to This Trial

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]

In a study of 130 patients with chronic kidney disease, those on renal substitution therapy for less than 6 months engaged in more physical activity compared to those diagnosed longer, suggesting early intervention may encourage activity levels.

Higher levels of moderate and vigorous physical activity were linked to better physical functioning and general health perceptions, particularly in women and patients diagnosed between 7 to 18 months, indicating that physical activity can enhance quality of life in chronic kidney disease patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Association of physical activity with quality of life in patients with chronic kidney disease]. Pinillos-Patiño, Y., Herazo-Beltrán, Y., Gil Cataño, J., et al.[2021]

Increased physical activity significantly improves the quality of life for patients with chronic kidney disease (CKD) and end-stage renal disease, helping to reduce inflammation, depression, and healthcare costs.

Exercise training is recommended as a crucial component of care for CKD patients at all stages, empowering them to take control of their health and improve their functional capacity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The benefits of exercise for CKD patients. Maddux, DW., West, C.[2013]

A 12-week renal rehabilitation program for chronic kidney disease (CKD) patients led to significant improvements in exercise capacity (21-44%) and reductions in anxiety (15%) and depression (29%) among those who completed the program.

The study highlighted that self-reported fitness levels were linked to program completion, with pre-dialysis and post-transplant patients showing better adherence compared to those requiring haemodialysis, who had the highest dropout rate.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of a pragmatic exercise rehabilitation programme in chronic kidney disease. Greenwood, SA., Lindup, H., Taylor, K., et al.[2022]

A 10-week exercise rehabilitation program for individuals with chronic kidney disease (CKD) did not show a significant difference in physical function improvement after one year compared to nonattenders and a control group, indicating the need for further research on long-term effectiveness.

However, participants who attended the program were more likely to maintain regular exercise habits after one year, suggesting potential benefits in promoting sustained physical activity among CKD patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of an exercise rehabilitation program on physical function over 1 year in chronic kidney disease: an observational study. Hargrove, N., Tays, Q., Storsley, L., et al.[2022]

In a study of 811 patients with chronic kidney disease (CKD) stages 3-4, higher levels of physical activity did not show a significant association with reduced long-term mortality, as 24.6% of participants died during follow-up.

The study analyzed various types of physical activity (indoor, exercise, and outdoor) but found no substantial impact on mortality rates, suggesting that more research is needed to explore the effects of physical activity on CKD outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association of physical activity with mortality in chronic kidney disease. Chen, JL., Lerner, D., Ruthazer, R., et al.[2022]

In a study of 4508 Taiwanese chronic kidney disease (CKD) patients, those who engaged in high levels of physical activity (≥7.5 MET-h/week) had significantly lower risks of all-cause mortality, end-stage renal disease (ESRD), and major adverse cardiovascular events (MACE) compared to inactive individuals.

The research found that while increasing physical activity reduced risks, benefits plateaued at around 15 MET-h/week, suggesting that moderate activity (7.5 to <15 MET-h/week) is optimal for improving health outcomes in CKD patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dose-response effects of physical activity on all-cause mortality and major cardiorenal outcomes in chronic kidney disease. Kuo, CP., Tsai, MT., Lee, KH., et al.[2022]

In a study of 1909 adults with chronic kidney disease (CKD) followed for a median of 5.9 years, engaging in moderate-vigorous physical activity (MVPA) was linked to a lower risk of all-cause mortality and cardiovascular events, highlighting its potential benefits for this population.

Specifically, a high amount of MVPA was associated with a reduced risk of progressing to end-stage kidney disease, suggesting that tailored physical activity plans could significantly improve health outcomes for individuals with CKD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Moderate-Vigorous Physical Activity and Clinical Outcomes in Adults with Nondialysis Chronic Kidney Disease. Kim, JH., Hyun, YY., Lee, KB., et al.[2023]

Exercise training has shown potential benefits for patients with chronic kidney disease (CKD), including increased exercise capacity, improved muscle strength, reduced blood pressure, and better inflammation and oxidative stress markers, based on a review of ten clinical trials.

However, most of these studies were small and lacked control groups, and the effects of exercise on kidney function, cardiovascular health, and quality of life in CKD patients remain unclear, highlighting the need for further research to establish comprehensive exercise guidelines.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise training in chronic kidney disease patients. Howden, EJ., Fassett, RG., Isbel, NM., et al.[2022]

A 6-month exercise program for 47 patients with chronic kidney disease (CKD) significantly improved physical performance, as shown by increased daily steps and better scores in various physical tests, without harming kidney function.

The program led to reductions in body weight, waist circumference, and blood pressure, while also decreasing proteinuria in some patients, suggesting that exercise is beneficial for CKD patients to prevent muscle wasting.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness and safety of modest exercise in Japanese patients with chronic kidney disease: a single-armed interventional study. Hamada, M., Yasuda, Y., Kato, S., et al.[2022]

Exercise training significantly improves maximal exercise capacity, muscle strength, and endurance in patients with chronic kidney disease (CKD) across all stages, including those on dialysis and post-transplant.

Starting exercise training during the predialysis stage is ideal, as it helps combat muscle catabolism, weight loss, and enhances overall quality of life, making it a crucial part of CKD patient care prescribed by nephrologists.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Physical working capacity and muscle strength in chronic renal failure are improved by exercise]. Clyne, N.[2006]

An exercise program combining supervised training and home-based training significantly improved physical fitness in patients with chronic kidney disease (CKD), as shown by increased metabolic equivalent tasks (METs) and 6-minute walk distance after 10 months.

The study found no serious adverse events related to the exercise training, indicating that this intervention is safe for patients with CKD, although the study was not specifically designed to assess safety outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise training in CKD: efficacy, adherence, and safety. Howden, EJ., Coombes, JS., Strand, H., et al.[2022]

Patients with chronic kidney disease (CKD) who are on dialysis typically have low exercise capacity and physical functioning, but regular exercise training can significantly improve these aspects.

Despite the clear benefits of exercise for CKD patients, the nephrology community has not yet integrated exercise recommendations into standard care practices, highlighting a need for better implementation of exercise counseling in treatment plans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing exercise: what do we know? Where do we go? Painter, P.[2022]

Regular exercise training for at least 8 weeks is associated with significant improvements in health outcomes for adults with chronic kidney disease (CKD), including better aerobic capacity, muscular functioning, cardiovascular function, walking capacity, and health-related quality of life, based on a systematic review of 41 trials involving 928 participants.

The majority of the evidence comes from studies focused on dialysis patients and primarily aerobic exercise programs, highlighting the need for more research on resistance training and long-term outcomes to enhance exercise rehabilitation strategies for CKD patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise training in adults with CKD: a systematic review and meta-analysis. Heiwe, S., Jacobson, SH.[2022]

Citations

1. England pubmed.ncbi.nlm.nih.gov

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

2. Chile pubmed.ncbi.nlm.nih.gov

[Association of physical activity with quality of life in patients with chronic kidney disease]. [2021]

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

The benefits of exercise for CKD patients. [2013]

4. England pubmed.ncbi.nlm.nih.gov

Evaluation of a pragmatic exercise rehabilitation programme in chronic kidney disease. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Effect of an exercise rehabilitation program on physical function over 1 year in chronic kidney disease: an observational study. [2022]

6. Italy pubmed.ncbi.nlm.nih.gov

Association of physical activity with mortality in chronic kidney disease. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Dose-response effects of physical activity on all-cause mortality and major cardiorenal outcomes in chronic kidney disease. [2022]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Moderate-Vigorous Physical Activity and Clinical Outcomes in Adults with Nondialysis Chronic Kidney Disease. [2023]

9. New Zealand pubmed.ncbi.nlm.nih.gov

Exercise training in chronic kidney disease patients. [2022]

10. Japan pubmed.ncbi.nlm.nih.gov

The effectiveness and safety of modest exercise in Japanese patients with chronic kidney disease: a single-armed interventional study. [2022]

11. Sweden pubmed.ncbi.nlm.nih.gov

[Physical working capacity and muscle strength in chronic renal failure are improved by exercise]. [2006]

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

Exercise training in CKD: efficacy, adherence, and safety. [2022]

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

Implementing exercise: what do we know? Where do we go? [2022]

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

Exercise training in adults with CKD: a systematic review and meta-analysis. [2022]