Exercise & Sports Science Australia (ESSA) position statement on exercise and chronic kidney disease

• Published in: Journal of science and medicine in sport 2013-09, Vol.16 (5), p.406-411
• Main Authors: Smart, Neil A, Williams, Andrew D, Levinger, Itamar, Selig, Steve, Howden, Erin, Coombes, Jeff S, Fassett, Robert G
• Format: Article
• Language: English
• Subjects: Chronic kidney disease; Diet; Exercise; Exercise training; Haemodialysis; Humans; Mortality; Peritoneal dialysis; Physical fitness; Physical Medicine and Rehabilitation; Renal Insufficiency, Chronic; Sports Medicine
• ISSN: 1440-2440; 1878-1861
• DOI: 10.1016/j.jsams.2013.01.005

Abstract Objectives Chronic kidney disease (CKD) is prevalent, affecting 13% of adult Australians and poses increased risk for cardiovascular morbidity and mortality. This position article provides evidence-based guidelines on the role of exercise training for CKD patients and provides recommendations for prescribing and delivering exercise training. Design Position stand. Methods Synthesis of published work within the field of exercise training and chronic kidney disease. Results Exercise training likely to provide benefits to CKD patients, including improvements in cardio-respiratory fitness, quality of life, sympatho-adrenal activity, muscle strength and increased energy intake and possible reduction in inflammatory biomarkers. Existing studies generally report small sample sizes, brief training periods and relatively high attrition rates. Exercise training appears to be safe for CKD patients with no deaths directly related to exercise training in over 30,000 patient-hours, although strict medical exclusion criteria in previous studies resulted in 25% of patients being excluded potentially impacting the generalisability of the findings. Conclusions Aerobic exercise at an intensity of >60% of maximum capacity is recommended to improve cardio-respiratory fitness. Few data are available on resistance training and it is unclear whether this form of training retards catabolic/inflammatory processes typical of CKD. However, it should be considered important due to its proven beneficial effects on bone density and muscle mass. Due to the high prevalence and incidence of co-morbidities in CKD patients, exercise training programs should be prescribed and delivered by individuals with appropriate qualifications and experience to recognise and accommodate co-morbidities and associated complications.