Background
Exercise training is a recognised safe therapy for chronic health conditions but is not commonly prescribed for people with chronic kidney disease (CKD) many of whom are sedentary. Growing awareness of the importance of exercise has led to randomised controlled trials (RCTs) comparing an exercise intervention group to a usual care group in CKD. As new ideas emerge and the number of trials increases, it becomes increasingly challenging to stay current with all the information, determine what is pertinent, interpret the results, and decide how the information could be integrated into overall CKD therapy. Systematic reviews (SRs) and meta-analyses (MAs) offer an effective framework for gathering, analysing, and critically evaluating studies.
Research objective
This research aimed to evaluate the effect of exercise training on health parameters in people with CKD providing evidence to support its integration into CKD therapy.
Methodology
An initial scoping review of SRs/MAs of RCTs mapped and synthesised evidence on exercise’s effect on health outcomes in CKD. Subsequent research syntheses using SRs and meta-analytical techniques addressed gaps in the literature.
Findings and Results
A scoping review found limited evidence of exercise benefits across various health outcomes in CKD. Aerobic and combined exercise improved peak VO2 and body mass index in pre-dialysis CKD. For those on dialysis, exercise positively affected peak VO2, the six-minute walk test, sit-to-stand test, physical component (PCS) score, depression, dialysis adequacy, and systolic and diastolic blood pressure (SBP & DBP).
However, exercise did not improve several health outcomes including estimated glomerular filtration rate (eGFR), SBP, or DBP in pre-dialysis CKD patients; or handgrip strength, the mental component summary score (MCS), other domains of the Health-Related Quality of Life (HRQoL) questionnaire, cardiovascular risk factors, inflammatory markers, or relevant biochemical levels in dialysis patients.
An imbalance in evidence synthesis was noted, with more SRs/MAs on people requiring dialysis than those in pre-dialysis stages. A SR/MA on pre-dialysis CKD showed exercise improved aerobic capacity, functional ability, HRQoL, eGFR, serum cystatin-C, resting heart rate, waist circumference, triglycerides, glycosylated haemoglobin, and interleukin-6 levels.
A further SR/MA focused on dialysis patients found that supervised, inter-dialytic or intra-dialytic exercise, including aerobic or resistance training at moderate intensity for up to 26 weeks, significantly improved both MCS and PCS.
Conclusion
This thesis provides evidence supporting integration of exercise training into CKD therapy. Exercise can significantly improve some key health parameters, particularly in those undergoing dialysis, despite some limitations. These findings advocate for broader adoption of exercise therapy in clinical practice to enhance CKD outcomes and support the development of evidence-based guidelines for CKD management.