Kidney disease patients can benefit from simple and structured exercise

Simple yet structured exercise can significantly improve kidney disease patients' quality of life as well as decrease their pain, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The findings suggest that kidney disease care can and should include exercise as part of an integrative medical approach that emphasizes living well even with chronic illnesses.

Many patients with chronic kidney disease (CKD) report that they have a decreased quality of life because of pain, depression, insomnia, and physical discomforts such as restless leg syndrome and neuropathy.

James Wasserman, MD (Maine Medical Center) and his colleagues looked to see whether a prescribed exercise program could improve physical function as well as quality of life for patients. A total of 107 patients with CKD stages 3 or 4 participated in the study, with 59 undergoing the exercise program and 48 receiving usual care. The overwhelming majority (73%) of those assigned to the exercise group completed the program, which consisted of guided aerobic exercise (treadmill walking and/or stationary cycling) and weight training with free weights, done twice weekly at local physical therapy or cardiac rehabilitation facilities. Additionally, exercise participants were given pedometers and encouraged to walk 5,000 to 10,000 steps per day.

The study showed that a 12-week course of exercise done in a monitored and supervised setting similar to a cardiac rehab center was effective in improving physical function and quality of life. Also, the exercise program decreased pain as assessed by patient questionnaires.

"Kidney specialists who take care of people with chronic kidney disease and end-stage renal disease have been thoroughly trained to use medicines and technology in a "disease-oriented" model of patient care, and we've been able to use these medicines and technologies like dialysis to help people live longer, but we've hit a wall of sorts in helping people live better with their chronic and incurable kidney disease," said Dr. Wasserman. "I think that is why leaders in academic nephrology and the nephrology community in general are now beginning to explore the limitations of this 'disease-oriented' approach, and consider applying a more 'patient-centered' approach to care that emphasizes additional ways to address patients' needs and the importance of living well with chronic disease."

In an accompanying editorial, Manisha Jhamb, MD, MPH (University of Pittsburgh School of Medicine) and Daniel Weiner, MD, MS (Tufts-New England Medical Center) noted that while several questions remain, "the results of this study add substantially to the current knowledge of the effects and efficacy of exercise in people with CKD and have important clinical and research implications." They added that the study highlights that "the time has come for the nephrology community to catch up to our cardiology and pulmonary colleagues by adding renal rehabilitation programs to the list of widely available and frequently accessed resources for patients with chronic medical conditions."