Physical activity and cardiorenal health-from associations to interventional studies

Clustering of traditional and kidney-specific risk factors leads to elevated cardiovascular disease (CVD) risk across the trajectory of chronic kidney disease (CKD) and transplantation. As kidney function declines, the prevalence of CVD, cardiovascular events, and mortality increases. This review considers recent evidence for the association between physical activity (PA) and exercise and cardiorenal health, and the effectiveness of interventions for the prevention and management of cardiorenal decline across the CKD spectrum. Evidence supports a beneficial dose-response effect of PA in the prevention of incident CKD, and growing evidence in prevalent CKD patients for the attenuation of kidney function decline, and a reduction in CVD risk, morbidity, and mortality. Broadly speaking, across the trajectory of CKD, the literature supports the efficacy of exercise interventions for improving cardiorespiratory fitness and aspects of cardiorenal health. The mechanisms underlying improvements indicate differential effects on traditional and non-traditional risk factors for CKD progression and CVD. To date, there is limited transfer of these findings into clinical care, although the evaluation of available evidence has led to the development of the first detailed clinical practice guideline for exercise and lifestyle in CKD. There is a lack of large-scale multicentre randomized controlled trials, and trials exploring hard clinical outcomes and long-term effects of exercise on cardiorenal outcomes. However, research should also address the challenges of implementing programmes of exercise and PA as part of routine care in combination with addressing the shortfall in literature to improve cardiorenal outcomes in all patients with CKD.