What did we do?

The aim of this study was to examine the combined effect of an aerobic exercise programme, modelled on cardiac rehabilitation programmes, with traditional high load resistance training. We intended to identify whether the combination of these exercise modalities would improve patients’ cardiorespiratory fitness and protect cardiac function as well as increase muscle mass, or whether the combination is conflicting and no benefit is gained.  This helps us determine the best way to deliver programmes such as this to CKD patients.

In this study, 54 patients with CKD stage 3b-5 took part in a 12 week aerobic programme alone or in combination with resistance exercise. Patients exercised 3x/week for ~30 minutes.

What we found and what does it mean?

  • Aerobic exercise (AE) and combined exercise (CE) resulted in significant increases in knee extensor strength of 16% and 48% respectively, which were greater after combined exercise.

  • AE and CE resulted in 5% and 9% increases in quadriceps volume, respectively, which were greater after CE.

  • Both AE and CE increased distance walked in the incremental shuttle walk test.

  • Exercise reduced the total number of symptoms reported by 17% and had favourable effects on fatigue in both groups.

  • AE reduced the frequency of ‘itching’, ‘impotence’ and ‘shortness of breath’ symptoms, and the intrusiveness for symptoms of ‘sleep disturbance’, ‘loss of muscular strength/power’, ‘muscle spasm/stiffness’ and ‘restless legs’.

  • The addition of resistance exercise in the CE group saw a reduction in ‘loss of muscular strength/power’

Overall, we found that in non-dialysis CKD, the addition of resistance exercise to aerobic exercise confers greater increases in muscle mass and strength than aerobic exercise alone. Doing any form of exercise helped reduce the number and impact of symptoms.

What’s next?

We have shown that exercise when supervised is effective in CKD patients. The next steps are to improve access for patients, as well as looking at exercises they can do at home. In particular, exercises to improve muscle mass.

Evidence

Details of the trial can be found here. Results are published in several publications including this open access article. Publications from the ExTra CKD trial can be viewed here. A press release from the Univeristy of Leicester discusses the study here.