Exercise Training in Adults With CKD: A Systematic Review and Meta-analysis

Background Whether exercise can affect health outcomes in people with chronic kidney disease (CKD) and what the optimal exercise strategies are for patients with CKD remain uncertain. Study Design Systematic review and meta-analysis of randomized controlled trials. Setting & Population Adults with CKD stages 2-5, dialysis therapy, or a kidney transplant. Selection Criteria for Studies Trials evaluating regular exercise training outcomes identified by searches in Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science, BIOSIS, PEDro, AMED, AgeLine, PsycINFO, and KoreaMed, without language restriction. Intervention Regular exercise training for at least 8 weeks. Outcomes Vary by study but could include aerobic capacity, muscular functioning, cardiovascular function, walking capacity, and health-related quality of life. Treatment effects were summarized as standardized difference with 95% CIs using random-effects meta-analysis. Results 41 trials (928 participants) comparing exercise training with sham exercise or no exercise were included; overall, improved aerobic capacity, muscular functioning, cardiovascular function, walking capacity, and health-related quality of life were associated with various exercise interventions, although the preponderance of data were for dialysis patients and used aerobic exercise programs. Limitations Unclear or high risk of bias in 32% of the trials, few trial data concerning resistance training, and limited data for several important outcomes. Conclusions Regular exercise training generally is associated with improved health outcomes in individuals with CKD. Correctly designed exercise rehabilitation may be an effective part of care for adults with CKD. Future studies should examine longer term outcomes and strategies to translate exercise done in a supervised setting to the home setting for broader applicability. Whether exercise can affect health outcomes in people with chronic kidney disease (CKD) and what the optimal exercise strategies are for patients with CKD remain uncertain. Systematic review and meta-analysis of randomized controlled trials. Adults with CKD stages 2-5, dialysis therapy, or a kidney transplant. Trials evaluating regular exercise training outcomes identified by searches in Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science, BIOSIS, PEDro, AMED, AgeLine, PsycINFO, and KoreaMed, without language restriction. Regular exercise training for at least 8 weeks. Vary by study but could include aerobic capacity, muscular functioning, cardiovascular function, walking capacity, and health-related quality of life. Treatment effects were summarized as standardized difference with 95% CIs using random-effects meta-analysis. 41 trials (928 participants) comparing exercise training with sham exercise or no exercise were included; overall, improved aerobic capacity, muscular functioning, cardiovascular function, walking capacity, and health-related quality of life were associated with various exercise interventions, although the preponderance of data were for dialysis patients and used aerobic exercise programs. Unclear or high risk of bias in 32% of the trials, few trial data concerning resistance training, and limited data for several important outcomes. Regular exercise training generally is associated with improved health outcomes in individuals with CKD. Correctly designed exercise rehabilitation may be an effective part of care for adults with CKD. Future studies should examine longer term outcomes and strategies to translate exercise done in a supervised setting to the home setting for broader applicability.