Exercise in Individuals With CKD

Kirsten L. Johansen, MD; Patricia Painter, PhD

Disclosures

Am J Kidney Dis. 2012;59(1):126-134. 

In This Article

Physical Performance and Functioning in Patients With CKD

Several studies of patients with CKD stages 3-5 clearly show that peak oxygen consumption (VO2peak) is lower compared with population norms or healthy control groups, averaging 50%-80% of healthy levels (Table 1).[4–6,8–11,13] The range of VO2peak values reported in several CKD cohorts in Table 1 suggests that many patients with CKD are limited in performing activities such as housework and shopping (ie, do not have the exercise capacity to sustain these activities). Or in another frame of reference, many individuals with CKD would meet Social Security criteria for cardiovascular disability based on their low VO2peak values.[14] In addition, a group from Sweden studied other measures of physical performance in 55 patients with an average estimated glomerular filtration rate (eGFR) of 12 mL/min/1.73m2 for men and 11 mL/min/1.73 m2 for women[15] and found that performance was decreased compared with healthy population norms for all tests, including grip strength (78% ± 25% for men and 84% ± 22% for women), rising from a chair (9% of men and 26% of women unable to rise even once without using the arms), timed "get up and go" test (73% of men and 70% of women needing >10 seconds), and maximum gait speed (80% ±19% for men and 82% ± 18% for women).

Padilla et al[16] showed that physical performance, measured by VO2peak, 6-minute walk test, comfortable and maximal gait speed, and sit-to-stand test, was decreased compared with normative values in 55 patients with eGFR of 29.9 ± 17.0 mL/min/1.73 m2. In addition, self-reported physical functioning based on the Physical Functioning scale and Physical Component Summary (PCS) measure of the 36-Item Short- Form Health Survey (SF-36) were low.

Self-reported function was also measured at baseline in the LORD (Lipid Lowering and Onset of Renal Disease) Study, which enrolled 120 patients with CKD stages 2–4.[17] Self-reported physical functioning in LORD participants was lower than population norms, but considerably better than that of hemodialysis patients (PCS scores, 46, 50, and 36, respectively).[18] Kusek et al[19] studied self-reported functioning in 1,094 participants in AASK (African American Study of Kidney Disease and Hypertension) with an average eGFR of 45.7 ± 13.0 mL/min/1.73 m2. They found that SF-36 PCS score was lower for these participants (43.4 ± 10.9) than population norms (50 ± 10) and also was lower in those with lower eGFRs. In addition, in univariate and multivariable analyses, PCS score was significantly higher in those who reported that they currently exercise than those who did not exercise. AASK participants reported worse physical functioning than hypertensive African Americans without CKD, but better functioning than hemodialysis patients from the Hemodialysis (HEMO) Study.

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