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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether regular exercise can improve brain blood flow in people with chronic kidney disease (CKD). Participants will either engage in regular exercise on a stationary bike or participate in stretching and balance exercises for comparison. The trial aims to determine if the exercise group demonstrates better brain blood flow regulation than the stretching group. It suits individuals with CKD stages III-IV who aren't already exercising more than 20 minutes twice a week and can use a stationary bike. As an unphased trial, it provides a unique opportunity to contribute to research that could enhance health outcomes for CKD patients.

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.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that exercise is safe for people with chronic kidney disease (CKD). Studies have found that both supervised and home-based exercise programs are well-tolerated by patients. These programs help improve physical abilities and are safe for those with stages 3–4 CKD. Although less research exists on exercise for CKD compared to other conditions, experts still recommend physical activity for people with stable CKD. Starting slowly and gradually increasing intensity as comfort allows is important. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Researchers are excited about exercise training for chronic kidney disease because it offers a non-drug approach to managing the condition. Unlike standard treatments that often rely on medications to control symptoms and slow disease progression, exercise training uses physical activity to potentially improve cardiovascular health and overall well-being. This method emphasizes a gradually increasing workout intensity, which could enhance kidney function and quality of life without the side effects commonly associated with pharmaceuticals. Additionally, incorporating exercise could empower patients by providing them with an active role in their health management.

What evidence suggests that exercise might be an effective treatment for chronic kidney disease?

This trial will compare two interventions for people with chronic kidney disease (CKD): Exercise Training and Stretching. Studies have shown that regular exercise, similar to the Exercise Training in this trial, can greatly benefit people with CKD. Exercise not only enhances physical fitness but may also slow the disease's progression. Research suggests that exercise improves blood flow, potentially benefiting brain health in CKD patients. Additionally, exercise is linked to a better quality of life and can help manage other health issues related to CKD. Overall, evidence supports that exercise offers many health benefits for those with CKD. ^{1 4 6 7 8}

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

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]

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 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]

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]

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]

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 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]

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]

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]

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]

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]

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]

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11519309/

Physical activity and exercise in chronic kidney disease Overall, the statements affirm that regular physical activity and exercise training offer numerous benefits to CKD patients, including improved physical ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11743718/

The impact of different exercise modalities on chronic kidney ... This study sought to summarize the effects of different exercise modalities on the main outcomes impacted by CKD.

3. kireports.org kireports.org/article/S2468-0249(24)01862-X/fulltext

Review of Exercise Interventions to Improve Clinical ... The potential benefits of exercise training in CKD range from slowing disease progression to improving comorbidities and quality of life.

4. bmcnephrol.biomedcentral.com bmcnephrol.biomedcentral.com/articles/10.1186/s12882-021-02618-1

Clinical practice guideline exercise and lifestyle in chronic ... It is well documented that patients with CKD suffer from a reduced exercise capacity and poor levels of physical functioning which leads to a ...

5. sciencedirect.com sciencedirect.com/science/article/pii/S246802492401862X

Review of Exercise Interventions to Improve Clinical ... The potential benefits of exercise training in CKD range from slowing disease progression to improving comorbidities and quality of life.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8101627/

Exercise training in chronic kidney disease—effects ... There is convincing evidence that exercise training improves physical function measured as aerobic capacity, muscle endurance strength and balance at all ages ...

7. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0272638614012803

Exercise Training in CKD: Efficacy, Adherence, and Safety The findings from the present study suggest that an exercise program that includes a supervised and home-based training phase is effective, adhered to, and safe ...

8. ajkd.org ajkd.org/article/S0272-6386(22)00824-1/abstract

Effect of Long-term Exercise Training on Physical ... The safety and efficacy of long-term exercise training in reducing physical functional loss in older adults with advanced CKD and comorbidity is uncertain.