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Effect of a 3-Year Lifestyle Intervention in Patients with Chronic Kidney Disease: A Randomized Clinical Trial
Kassia S Beetham1,2, Rathika Krishnasamy3,4, Tony Stanton4,5,6
1School of Behavioural and Health Science, Australian Catholic University, Brisbane, Queensland, Australia.
Insights
Supervised lifestyle interventions significantly improve physical activity and exercise capacity in chronic kidney disease (CKD) patients. A 3-year program doubled guideline adherence and enhanced fitness.
Area of Science:
- Nephrology
- Exercise Physiology
- Public Health
Background:
- Chronic kidney disease (CKD) impacts physical activity and fitness.
- Lifestyle interventions show promise for managing CKD complications.
- Supervised programs are key to improving patient outcomes.
Purpose of the Study:
- To evaluate a 3-year supervised lifestyle intervention's efficacy in improving cardiorespiratory and exercise capacity in stage 3-4 CKD patients.
- To assess the intervention's impact on physical activity, cardiorespiratory fitness, exercise capacity, and neuromuscular fitness.
- To compare outcomes between the intervention group and usual care.
Main Methods:
- A randomized clinical trial involving 160 patients with stage 3-4 CKD.
- Intervention group received 3 years of multidisciplinary lifestyle support, including supervised exercise.
- Outcomes measured included physical activity (METs), cardiorespiratory fitness (VO2peak), exercise capacity, and neuromuscular fitness.
Main Results:
- The intervention doubled the percentage of patients meeting physical activity guidelines (29% to 63%).
- Significant improvements in peak oxygen consumption (VO2peak) and exercise capacity (METs) were observed at 12 months.
- Sustained improvements in exercise capacity and blunted declines in neuromuscular function were noted at 36 months.
Conclusions:
- A 3-year supervised lifestyle intervention effectively increases physical activity in CKD patients.
- The intervention improves exercise capacity and mitigates declines in cardiorespiratory and neuromuscular fitness.
- Multidisciplinary lifestyle support is crucial for enhancing the well-being of CKD patients.
Background:
Supervised lifestyle interventions have the potential to significantly improve physical activity and fitness in patients with CKD.
Methods:
To assess the efficacy of a lifestyle intervention in patients with CKD to improve cardiorespiratory fitness and exercise capacity over 36 months, we conducted a randomized clinical trial, enrolling 160 patients with stage 3-4 CKD, with 81 randomized to usual care and 79 to a 3-year lifestyle intervention. The lifestyle intervention comprised care from a multidisciplinary team, including a nephrologist, nurse practitioner, exercise physiologist, dietitian, diabetes educator, psychologist, and social worker. The exercise training component consisted of an 8-week individualized and supervised gym-based exercise intervention followed by 34 months of a predominantly home-based program. Self-reported physical activity (metabolic equivalent of tasks [METs] minutes per week), cardiorespiratory fitness (peak O2 consumption [VO2peak]), exercise capacity (maximum METs and 6-minute walk distance) and neuromuscular fitness (grip strength and get-up-and-go test time) were evaluated at 12, 24, and 36 months.
Results:
The intervention increased the percentage of patients meeting physical activity guideline targets of 500 MET min/wk from 29% at baseline to 63% at 3 years. At 12 months, both VO2peak and METs increased significantly in the lifestyle intervention group by 9.7% and 30%, respectively, without change in the usual care group. Thereafter, VO2peak declined to near baseline levels, whereas METs remained elevated in the lifestyle intervention group at 24 and 36 months. After 3 years, the intervention had increased the 6-minute walk distance and blunted declines in the get-up-and-go test time.
Conclusions:
A 3-year lifestyle intervention doubled the percentage of CKD patients meeting physical activity guidelines, improved exercise capacity, and ameliorated losses in neuromuscular and cardiorespiratory fitness.
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