According to the Centers for Disease Control, only 23% of adults above the age of 18 years old meet the recommended guidelines for aerobic and muscle strengthening exercise. In the chronic kidney disease (CKD) and end stage renal disease (ESRD) population subset, the percentages are likely even lower due to a common misconception that they cannot exercise.

In reality, exercise is likely key to helping people living with CKD and ESRD improve their health outcomes and quality of life*. Below we explore the research on different types of physical activity and associated health benefits for CKD and ESRD.

*If you are living with a chronic disease or are unsure about what level and type of exercise is appropriate for you, please consult a doctor before beginning an exercise program.

The Effects of Different Physical Activities on Atrial Fibrillation in Patients with Hypertension and Chronic Kidney Disease

Purpose: Atrial fibrillation (a-fib) is common and sympathetic hyperactivity impacts progression, maintenance, and aggravation of arrhythmia.  Endurance exercise training has been shown to lower sympathetic activity and is well-tolerated by patients with CKD.

Design: Using implantable cardiac monitors, 50 CKD patients with hypertension (HTN) were followed over a 3-year period while participating in High Intensity Interval Training (HIIT) or moderate exercise programs to evaluate the effects of the physical activity on a-fib occurrence and impact on improving renal function.

Outcome: A-fib onset was higher in patients who engaged in HIIT compared to those who engaged in moderate exercise.

Conclusion:  In CKD patients with HTN, improvements in a-fib onset, renal function and some heart function parameters were more evident in participants who engaged in moderate compared to those who engaged in HIIT during 3 years of follow-up.

Limitations: Small study population (50); further research is needed and for a longer period of time

Key Points:

  • Sympathetic hyperactivity impacts development, maintenance, and aggravation of arrhythmias.
  • Endurance training can reduce sympathetic activity
  • Endurance training is well-tolerated by patients with CKD
  • Physical activity lowers cardiovascular morbidity and mortality
  • Physical inactivity is a major risk factor for cardiovascular disease

A Walking Intervention to Increase Weekly Steps in Dialysis Patients: A Pilot Randomized Controlled Trial

Purpose: Since dialysis patients report extremely low physical activity, a pilot was scheduled to see about feasibility of a pedometer-based intervention to evaluate its impact on physical activity, symptoms & cardiovascular risk.

Design: Randomized and controlled trial with 60 dialysis patients – included both hemodialysis (HD) and peritoneal dialysis (PD). Participants were randomly assigned to pedometer with weekly step goals (pedometer was provided along with weekly counseling call in which research personnel advised on ways to incorporate more walking) OR usual care for 3 months.

Outcome: Primary outcome: step counts measured via pedometer; secondary outcome was physical performance. Intervention participants (n=30) increased their average daily steps by 2,256 more than the control participants (n=30). Heart rate variability increased by 14.94 in the intervention group compared to the control group (statistically significant). No other statistically significant differences between the groups with physical performance.

Conclusion:  Intervention of pedometers and weekly counseling resulted in increased step counts during the pilot, but the increase was not sustained after the intervention was discontinued. Heart rate variability improved in patients assigned to the intervention compared with controls, but the intervention did not improve symptoms or endothelial function.

Limitations:  The Northern California study setting may limit generalizability; Walking does not capture the full spectrum of physical activity

Key Points:

  • Since patients on dialysis report very low levels of physical activity:
  • Extremely low levels of physical activity are associated with poor functional status and higher mortality
  • This was a pilot study to determine feasibility of participation & impact of step increase with pedometer use
  • Clinical relevance: pedometer-based interventions has been shown to increase step counts in dialysis patient; weekly counseling and goals contributes to this
  • Limitation: pilot was only for 3 months, limited number of participants (60), very small number of PD participants compared to HD and intervention participants went back to their previous levels of activity after the pilot concluded

As these studies show, exercise can be an important component of managing CKD, ESRD, and associated co-morbidities. At the same time, it may be difficult for patients to adhere to even low-impact exercise without support. When working with this patient population, it is important for healthcare providers to incorporate discussions of physical activity into regular practice and collaborate with patients on ways to successfully bring more activity to their daily lives.

To learn more about exercise, hypertension, and kidney disease, check out these resources:

Thank you to our guest bloggers Chelsea Moore, RDN, LD; Gina Bogart, RD, LD; and Kathleen Meyer, RD, LD for their contributions and thorough evaluation of the research.

References

  • Centers for Disease Control and Prevention. (2021, June 11). FASTSTATS – exercise or physical activity. Centers for Disease Control and Prevention. Retrieved October 26, 2021, from https://www.cdc.gov/nchs/fastats/exercise.htm.
  • Kiuchi, M. G., Chen, S., & Hoye, N. A. (2017). The effects of different physical activities on atrial fibrillation in patients with hypertension and chronic kidney disease. Kidney research and clinical practice, 36(3), 264.
  • Sheshadri, A., Kittiskulnam, P., Lazar, A. A., & Johansen, K. L. (2020). A walking intervention to increase weekly steps in dialysis patients: a pilot randomized controlled trial. American Journal of Kidney Diseases, 75(4), 488-496.