The Role of Physical Activity in Chronic Kidney Disease in the Presence of Diabetes Mellitus: A Prospective Cohort Study

Wang, I‐Kuan; Tsai, Min-Kuang; Liang, Ching‐Chung; Yen, Tzung‐Hai; Huang, Chiu‐Ching; Wen, Sung-Feng; Wen, Chi‐Pang

doi:10.1159/000357133

Cited by 15 publications

(21 citation statements)

References 77 publications

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“…Despite these clear benefits, the implementation of ET in patients with CKD is limited, and physical performance remains poor. As recently shown, low levels of physical activity are strongly associated with allcause mortality in both predialysis and ESRD patients (18)(19)(20). In line with this finding, peak oxygen consumption (VO 2 peak), a parameter for exercise capacity (physical fitness), seems to be a very strong predictor of survival in ESRD (21).…”

Section: Et In Ckd: Current Clinical Evidence Exercise Capacity and Msupporting

confidence: 59%

Vascular Effects of Exercise Training in CKD

Craenenbroeck

Kouidi

et al. 2014

Clinical Journal of the American Society of Nephrology

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Cardiovascular disease remains the main cause of morbidity and mortality in patients with CKD, an observation that cannot be explained by the coexistence of traditional risk factors alone. Recently, other mechanisms, such as alterations in nitric oxide bioavailability, impaired endothelial repair mechanisms, inflammation, and oxidative stress (all characteristic in CKD), have gained much attention as mediators for the increased cardiovascular risk. Regular physical training is a valuable nonpharmacological intervention for primary and secondary prevention of cardiovascular disease. Likewise, the benefits of exercise training on exercise capacity and quality of life are increasingly recognized in patients with CKD. Furthermore, exercise training could also influence potential reversible mechanisms involved in atherosclerosis and arteriosclerosis. After discussing briefly the general concepts of vascular disease in CKD, this review provides an overview of the current evidence for the effects of exercise training at both clinical and preclinical levels. It concludes with some practical considerations on exercise training in this specific patient group.

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Section: Et In Ckd: Current Clinical Evidence Exercise Capacity and Msupporting

confidence: 59%

Vascular Effects of Exercise Training in CKD

Craenenbroeck

Kouidi

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…The time spent in leisure time PA was assessed by the validated MJ PA questionnaire in 1997 and subsequent health visits5 15–17 20) (online supplementary file 1). Participants were asked to report the intensity, frequency and duration of PA that they did during the past weeks, with several examples of activity types given for four intensity categories: light (eg, slow walking), moderate (eg, brisk walking), medium vigorous (eg, jogging) or high vigorous (eg, running).…”

Section: Methodsmentioning

confidence: 99%

Physical activity less than the recommended amount may prevent the onset of major biological risk factors for cardiovascular disease: a cohort study of 198 919 adults

et al. 2018

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ObjectivesWe examined the dose–response relationship between physical activity (PA) and incidence of cardiovascular disease (CVD) risk factors in adults in Taiwan.MethodsThis study included 1 98 919 participants, aged 18–97 years, free of CVD, cancer and diabetes at baseline (1997–2013), who were followed until 2016. At baseline, participants were classified into five PA levels: inactive’ (0 metabolic equivalent of task (MET)-h/week), ‘lower insufficiently active’ (0.1–3.75 MET-h/week), ‘upper insufficiently active’ (3.75–7.49 MET-h/week), ‘active’ (7.5–14.99 MET-h/week) and ‘highly active’ (≥15 MET-h/week]. CVD risk factors were assessed at baseline and at follow-up by physical examination and laboratory tests. Analyses were performed with Cox regression and adjusted for the main confounders.ResultsDuring a mean follow-up of 6.0±4.5 years (range 0.5–19 years), 20 447 individuals developed obesity, 19 619 hypertension, 21 592 hypercholesterolaemia, 14 164 atherogenic dyslipidaemia, 24 275 metabolic syndrome and 8548 type 2 diabetes. Compared with inactive participants, those in the upper insufficiently active (but not active) category had a lower risk of obesity (HR 0.92; 95% CI 0.88 to 0.95), atherogenic dyslipidaemia (0.96; 0.90 to 0.99), metabolic syndrome (0.95; 0.92 to 0.99) and type 2 diabetes (0.91; 0.86 to 0.97). Only highly active individuals showed a lower incidence of CVD risk factors than their upper insufficiently active counterparts.ConclusionCompared with being inactive, doing half the recommended amount of PA is associated with a lower incidence of several common biological CVD risk factors. Given these benefits, half the recommended amount of PA is an evidence based target for inactive adults.

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“…Multiple physiologic benefits are associated with physical activity, and an association between physical activity levels and mortality risk has been shown in many studies of both nondialysis‐dependent and dialysis‐dependent CKD patients, with physical activity measured by accelerometer, activity questionnaires, or a single question . An association between gait speed and mortality risk has also been shown in CKD patients, and an association between measured gait speed and mortality has been reported for the ACTIVE‐ADIPOSE study participants who are the focus of this paper .…”

Section: Discussionmentioning

confidence: 70%

Lower C‐reactive protein and better hemodialysis survival are associated with regular exercise activity: Longitudinal outcomes from the ACTIVE‐ADIPOSE special study

Kutner¹,

Zhang

Huang

et al. 2016

Hemodialysis International

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Introduction Cross-sectional and longitudinal studies in the general population have shown that a physically active lifestyle may have anti-inflammatory properties, but evidence from studies conducted with maintenance hemodialysis (HD) patients is limited. Methods A multicenter prospective cohort of 755 HD participants aged 20-92 was evaluated in a USRDS special study 2009-2013. Kilocalories/week (kcal/week) of leisure time physical activity (LTPA) was estimated from the Minnesota Leisure Time Activity questionnaire. Predialysis serum samples were obtained concurrent with LTPA report date. Generalized estimating equations (GEE) examined association of participants' LTPA and log-normalized CRP across 24 months. Cox proportional hazards models investigated LTPA and survival over a median follow-up of 718 days. Findings Baseline median CRP concentration was lower for participants with 500+ kcal/week LTPA vs. those with <500 kcal/week LTPA (3.4 mg/L vs. 4.6 mg/L; P = 0.03). Participants who reported lower LTPA (<500 kcal/week) at both baseline and 12 months had a borderline significant increase in CRP concentration (within-group change 4.8 [1.9-10.4] to 5.8 [1.6-15.7]; P = 0.08). Lower LTPA was associated with higher log CRP over 24 months in adjusted GEE analyses (β coefficient = 0.16 [95% CI 0.02-0.31]; P = 0.03). 67/364 (18%) and 43/391 (11%) deaths occurred, respectively, among participants reporting <500 vs. 500+ kcal/week LTPA [adjusted mortality hazard ratio 1.63 (CI, 1.07, 2.47)]. Discussion The data suggest that increased estimated levels of LTPA, a physical activity/exercise opportunity widely applicable to HD patients, may be associated with lower CRP concentration as well as better survival outcome.

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The Role of Physical Activity in Chronic Kidney Disease in the Presence of Diabetes Mellitus: A Prospective Cohort Study

Cited by 15 publications

References 77 publications

Vascular Effects of Exercise Training in CKD

Vascular Effects of Exercise Training in CKD

Physical activity less than the recommended amount may prevent the onset of major biological risk factors for cardiovascular disease: a cohort study of 198 919 adults

Lower C‐reactive protein and better hemodialysis survival are associated with regular exercise activity: Longitudinal outcomes from the ACTIVE‐ADIPOSE special study

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