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Benefit and Risk of Exercise Training in Chronic Kidney Disease Patients

  • Masahiro KohzukiEmail author
  • Toshimi Sato
  • Chaeyoon Cho
  • Naoki Yoshida
Chapter
  • 23 Downloads

Abstract

Chronic kidney disease (CKD) is a worldwide public health problem. In CKD patients, exercise endurance is lowered, and this phenomenon becomes more distinct as the renal dysfunction advances. This is due to the combined effects of uremic acidosis, protein-energy wasting, and inflammatory cachexia, which lead to and are further aggravated by a sedentary lifestyle. Together, these factors result in a progressive downward spiral of deconditioning. This review focuses on the benefits and risks of exercise training in CKD patients. In Japan, we have established the Japanese Society of Renal Rehabilitation in 2011 to evaluate and promote renal rehabilitation (RR). We use a comprehensive approach to RR including physical exercise and psychological, vocational, and dietary counseling. RR is a feasible, effective, and safe secondary prevention strategy following CKD and offers a promising model for new field of rehabilitation. Urgent efforts should be made to increase the implementation rate of the RR.

Keywords

Chronic kidney disease Rehabilitation Exercise Cardio-renal syndrome Renal protection 

Notes

Conflict of Interest

The author declares no conflict of interest.

References

  1. 1.
    O’Hare AM, Tawney K, Bacchetti P, et al. Decreased survival among sedentary patients undergoing dialysis: results from the dialysis morbidity and mortality study wave 2. Am J Kidney Dis. 2003;41:447–54.CrossRefGoogle Scholar
  2. 2.
    Johansen KL. Exercise in the end-stage renal disease population. J Am Soc Nephrol. 2007;18:1845–54.CrossRefGoogle Scholar
  3. 3.
    Kohzuki M. Renal rehabilitation: present and future perspectives. In: Suzuki H, editor. Hemodialysis. London: Intech; 2013. p. 743–51.Google Scholar
  4. 4.
    Tentori F, Slder SJ, Thumma J. Physical exercise among participants in the Dialysis Outcomes and Practice Patterns Study (DOPPS): correlates and associated outcomes. Nephrol Dial Transplant. 2010;25:3050–62.CrossRefGoogle Scholar
  5. 5.
    Smart N, Steele M. Exercise training in haemodialysis patients: a systematic review and meta-analysis. Nephrology. 2011;16:626–32.PubMedGoogle Scholar
  6. 6.
    Sieverdes JC, Sui X, Lee DC, et al. Physical activity, cardiorespiratory fitness and the incidence of type 2 diabetes in a prospective study of men. Br J Sports Med. 2010;44:238–44.CrossRefGoogle Scholar
  7. 7.
    Blair SN, Kohl HW, Paffenbarger RS, et al. Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA. 1989;262:2395–401.CrossRefGoogle Scholar
  8. 8.
    Blair SN, Sallis RE, Hutber A, et al. Exercise therapy — the public health message. Scand J Med Sci Sports. 2012;22:24–8.CrossRefGoogle Scholar
  9. 9.
    Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100:126–31.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Kohzuki M. New ideas on limitations to VO2max: five major determinants for VO2max. Pulm Res Respir Med Open J. 2018;5(1):e1–2.  https://doi.org/10.17140/PRRMOJ-5-e010.CrossRefGoogle Scholar
  11. 11.
    Caso G, Garlick PJ. Control of muscle protein kinetics by acid-base balance. Curr Opin Clin Nutr Metab Care. 2005;8:73–6.CrossRefGoogle Scholar
  12. 12.
    Bailey JL, Wang X, England BK. The acidosis of chronic renal failure activates muscle proteolysis in rats by augmenting transcription of genes encoding proteins of the ATP-dependent ubiquitin-proteasome pathway. J Clin Invest. 1996;97:1447–53.CrossRefGoogle Scholar
  13. 13.
    Mitch WE. Influence of metabolic acidosis on nutrition. Am J Kidney Dis. 1997;29:16–8.CrossRefGoogle Scholar
  14. 14.
    Fahal IH. Uraemic sarcopenia: aetiology and implications. Nephrol Dial Transplant. 2014;29:1655–65.CrossRefGoogle Scholar
  15. 15.
    Kolb EM. Erythropoietin elevates VO2, max but not voluntary wheel running in mice. J Exp Biol. 2010;213:510–9.  https://doi.org/10.1242/jeb.029074.CrossRefPubMedGoogle Scholar
  16. 16.
    Kohzuki M. Renal rehabilitation: Difinition and evidence. In: Kohzuki M, editor. Renal Rehabilitation. Tokyo: Ishiyaku Publishers; 2012. p. 10–7.Google Scholar
  17. 17.
    Kohzuki M, Kamimoto M, Wu XM, et al. Renal protective effects of chronic exercise and antihypertensive therapy in hypertensive rats with chronic renal failure. J Hypertens. 2001;19:1877–82.CrossRefGoogle Scholar
  18. 18.
    Kanazawa M, Kawamura T, Li L, et al. Combination of exercise and enalapril enhances renoprotective and peripheral effects in rats with renal ablation. Am J Hypertens. 2006;19:80–6.CrossRefGoogle Scholar
  19. 19.
    Tufescu A, Kanazawa M, Ishida A, et al. Combination of exercise and losartan enhances renoprotective and peripheral effects in spontaneously type 2 diabetes mellitus rats with nephropathy. J Hypertens. 2008;26:312–21.CrossRefGoogle Scholar
  20. 20.
    Ito D, Cao P, Kakihana T, et al. Chronic running exercise alleviates early progression of nephropathy with upregulation of nitric oxide synthases and suppression of glycation in Zucker diabetic rats. PLoS One. 2015;10(9):e0138037.  https://doi.org/10.1371/journal.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Baria F, Kamimura MA, Aoike DT, et al. Randomized controlled trial to evaluate the impact of aerobic exercise on visceral fat in overweight chronic kidney disease patients. Nephrol Dial Transplant. 2014;29:857–64.CrossRefGoogle Scholar
  22. 22.
    Greenwood SA, Koufaki P, Mercer TH, et al. Effect of exercise training on estimated GFR, vascular health, and cardiorespiratory fitness in patients with CKD: a pilot randomized controlled trial. Am J Kidney Dis. 2015;65:425–34.CrossRefGoogle Scholar
  23. 23.
    Chen IR, Wang SM, Liang CC, et al. Association of walking with survival and RRT among patients with CKD stages 3-5. Clin J Am Soc Nephrol. 2014;9:1183–9.CrossRefGoogle Scholar
  24. 24.
    Sato T, Kohzuki M, Ono M, et al. Association between physical activity and change in renal function in patients after acute myocardial infarction. PLoS One. 2019;14(2):e0212100.  https://doi.org/10.1371/journal.pone.0212100.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Séronie-Vivien S, Delanaye P, Piéroni L, et al. Cystatin C: current position and future prospects. Clin Chem Lab Med. 2008;46:1664–86.PubMedGoogle Scholar
  26. 26.
    Poortmans JR, Gulbis B, De Bruyn E, et al. Limitations of serum values to estimate glomerular filtration rate during exercise. Br J Sports Med. 2012;47:1166–70.  https://doi.org/10.1136/bjsports-2012-090976.CrossRefPubMedGoogle Scholar
  27. 27.
    Robinson-Cohen C, Littman AJ, et al. Physical activity and change in estimated GFR among persons with CKD. J Am Soc Nephrol. 2014;25:399–406.CrossRefGoogle Scholar
  28. 28.
    JCS Joint Working Group. Guidelines for Rehabilitation in Patients With Cardiovascular Disease (JCS 2012). Circ J. 2014;78:2022–93.CrossRefGoogle Scholar
  29. 29.
    American College of Sports Medicine. In: Riebe D, Ehrman JK, Liguori G, editors. ACSM’s guidelines for exercise testing and prescription. 10th ed. South Holland: Wolters Kluwer; 2018. p. 334–8.Google Scholar
  30. 30.
    K/DOQI Workshop. K/DOQI clinical practice guidelines dor cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005;45(Suppl 3):S1–S153.Google Scholar
  31. 31.
    Delgado C, Johansen KL. Barriers to exercise participation among dialysis patients. Nephrol Dial Transplant. 2012;27:1152–7.CrossRefGoogle Scholar
  32. 32.
    Delgado C, Johansen KL. Deficient counseling on physical activity among nephrologists. Nephron Clin Pract. 2010;116:cc336, 330.CrossRefGoogle Scholar
  33. 33.
    Konstantinidou E, Koukouvou G, Kouidi E, et al. Exercise training in patients with end-stage renal disease on hemodialysis: comparison of three rehabilitation programs. J Rehabil Med. 2002;34:40–5.CrossRefGoogle Scholar
  34. 34.
    Wilund KR, Painter P. Formation of an exercise in CKD working group. Am J Kidney Dis. 2016;67(5):812.  https://doi.org/10.1053/j.ajkd.2015.12.026.CrossRefPubMedGoogle Scholar
  35. 35.
    Krause R, WGRR-European Working Group on Renal Rehabilitation and Exercise Physiology (Affiliated to the ERA-EDTA). Nephrologists’ view on exercise training in chronic kidney disease (results of the questionnaire at the WCN 2003). Clin Nephrol. 2004;61(Suppl 1):S2–4.PubMedGoogle Scholar
  36. 36.
    Schrag WF, Campbell M, Ewert J, et al. Multidisciplinary team renal rehabilitation: interventions and outcomes. Adv Ren Replace Ther. 1999;6:282–8.CrossRefGoogle Scholar
  37. 37.
    Kohzuki M, Yamagata K, Shibagaki Y et al. (2019) Japanese Society of Renal Rehabilitation. JSRR. http://jsrr.jimdo.com/ (in Japanese).
  38. 38.
    National Kidney Foundation. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppl. 2012;2:337–414.CrossRefGoogle Scholar
  39. 39.
    Japanese Society of Renal Rehabilitation. Guideline for renal rehabilitation. Renal replacement therapy (in Japanese). Tokyo: Nankodo; 2018. p. 1–87.Google Scholar
  40. 40.
    Yamagata K, Hoshino J, Sugiyama H, et al. Clinical practice guideline for renal rehabilitation: systematic reviews and recommendations of exercise therapies in patients with kidney diseases. Renal Replace Ther. 2019;5:28.CrossRefGoogle Scholar
  41. 41.
    Williams AD, Fassett RG, Coombes JS. Exercise in CKD: why is it important and how should it be delivered? Am J Kidney Dis. 2014;64:329–31.CrossRefGoogle Scholar
  42. 42.
    Didsbury M, McGee RG, Tong A, et al. Exercise training in solid organ transplant recipients. Transplantation. 2013;95:679–87.CrossRefGoogle Scholar
  43. 43.
    Zelle DM, Klaassen G, van Adrichem E, et al. Physical inactivity: a risk factor and target for intervention in renal care. Nat Rev Nephrol. 2017;13:152–68.CrossRefGoogle Scholar
  44. 44.
    Kohzuki M. Paradigm shift in rehabilitation medicine in the era of multimorbidity and multiple disabilities (MMD). Phys Med Rehabil Int. 2014;1(2):id1006.Google Scholar
  45. 45.
    Kohzuki M, Sakata Y, Kawamura T, et al. A paradigm shift in rehabilitation medicine: from “adding life to years” to “adding life to years and years to life”. Asian J Human Serv. 2012;2:1–8.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Masahiro Kohzuki
    • 1
    Email author
  • Toshimi Sato
    • 1
  • Chaeyoon Cho
    • 1
  • Naoki Yoshida
    • 1
  1. 1.Department of Internal Medicine and Rehabilitation ScienceTohoku University Graduate School of MedicineSendaiJapan

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