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Exercise Training and Progression of Chronic Kidney Disease: The GFR-Exercise (GFR-Ex) Randomized Controlled
Mark David Davies1, Juliet Briggs2,3, Abdulfattah Alejmi4
1Institute for Applied Human Physiology, School of Psychology and Sport Science, Bangor University, Bangor, UK, mark.davies25@wales.nhs.uk.
American Journal of Nephrology
|February 5, 2026
Summary
A 12-month exercise program for chronic kidney disease (CKD) patients was safe and feasible, showing a trend to slow Glomerular Filtration Rate (GFR) decline. Estimated GFR (eGFR) closely matched measured GFR (mGFR).
Area of Science:
- Nephrology
- Exercise Physiology
- Clinical Trials
Background:
- Assessing the feasibility of a 12-month exercise intervention for individuals with stage 3-4 chronic kidney disease (CKD).
- Investigating the program's potential to slow the decline in measured Glomerular Filtration Rate (mGFR) and estimated Glomerular Filtration Rate (eGFR).
Purpose of the Study:
- To evaluate the safety and feasibility of a home-based aerobic and resistance exercise program in patients with progressive CKD.
- To determine the effect of exercise training on GFR decline and the agreement between mGFR and eGFR.
Main Methods:
- A multicenter randomized controlled trial involving participants with stage 3-4 CKD.
- Feasibility assessed via recruitment, retention, adherence, and adverse events. GFR changes and mGFR vs. eGFR differences were analyzed.
- Qualitative interviews explored participant experiences and support needs.
Main Results:
- 74 participants were randomized; 34 completed the 12-month study. Recruitment and retention rates were low (11% eligibility, 43% 12-month retention).
- The exercise program was safe with no exercise-related harms reported. Median adherence was 69%.
- Exercise showed a trend towards attenuating GFR decline (mGFR: 36.1 vs. 33.8 ml/min/1.73m²). eGFR closely agreed with mGFR (difference -1.6 ml/min/1.73m²).
Conclusions:
- A 12-month exercise training program is safe and feasible for progressive CKD patients.
- Exercise demonstrated a potential to slow GFR decline, with good agreement between eGFR and mGFR.
- Future trials should incorporate patient support and utilize eGFR as a primary outcome.
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