Efficacy of three types of exercise therapy on non-dialysis chronic kidney diseases: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LI Yangyang ¹ , LI Tian ¹ , ZHAO Xianghu ^1,2 , MENG Yi ¹ , LI Jiahang ¹ , SANG Jing ¹ ,  YANG Yi ³

1. Graduate School, Wuhan Sports University, Wuhan 430079, P. R. China;
2. Department of Rehabilitation, Zhongda Hospital, Southeast University, Nanjing 210009, P. R. China;
3. Fitness Monitoring and Chronic Disease Intervention Research Center, Wuhan Sports University, Wuhan 430079, P. R. China;

Corresponding author：

YANG Yi, Email: yangyi999999@foxmail.com

Keywords：

Exercise therapy; Non-dialysis chronic kidney disease; Network meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.202206086

Video：

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Objective To systematically review the efficacy of aerobic training, resistance training and aerobic training combined with resistance training on non-dialysis patients with chronic kidney diseases. Methods PubMed, The Cochrane Library, EMbase, EBSCO, Web of Science, VIP, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of three types of exercise therapy on patients with chronic kidney disease from January 2012 to January 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, network meta-analysis was performed by using RevMan 5.4 software and R software. Results A total of 22 RCTs involving 1 633 patients were included. The results of network meta-analysis showed that: compared with the control group, aerobic training, and resistance training reduced resting systolic blood pressure; aerobic training, resistance training reduced resting diastolic blood pressure; aerobic training reduced total cholesterol levels; aerobic training improved peak oxygen uptake; aerobic training combined with resistance training improved six-minute walking test. Aerobic training, resistance training, and aerobic training combined with resistance training improved glomerular filtration rate. The probability sorting results showed that aerobic training had the most significant effect on the improvement of peak oxygen uptake, C-reactive protein, total cholesterol, low-density lipoproteins, and high-density lipoproteins; resistance training had the most significant effect on the improvement of systolic blood pressure, diastolic blood pressure and glomerular filtration rate; aerobic exercise combined with resistance training had the most significant effect on the improvement of body mass index, triglycerides, and six-minute walking test. Conclusion Current evidence shows that aerobic training has an advantage in reducing total cholesterol levels and increasing peak oxygen uptake, resistance training has an advantage in improving blood pressure and glomerular filtration rate and aerobic training combined with resistance training has an advantage in improving walking ability of patients with non-dialysis chronic kidney disease.

Citation： LI Yangyang, LI Tian, ZHAO Xianghu, MENG Yi, LI Jiahang, SANG Jing, YANG Yi. Efficacy of three types of exercise therapy on non-dialysis chronic kidney diseases: a network meta-analysis. Chinese Journal of Evidence-Based Medicine, 2023, 23(1): 34-40. doi: 10.7507/1672-2531.202206086 Copy

1.	白雪莲, 张佳宜, 项国梁, 等. 中国成人慢性肾脏病患病率的Meta分析. 中国医药科学, 2022, 12(9): 49-53.
2.	Du J, Hu Z, Mitch WE. Molecular mechanisms activating muscle protein degradation in chronic kidney disease and other catabolic conditions. Eur J Clin Invest, 2005, 35(3): 157-163.
3.	Chen IR, Wang SM, Liang CC, et al. Association of walking with survival and RRT among patients with CKD stages 3-5. Clin J Am Soc Nephrol, 2014, 9(7): 1183-1189.
4.	Akbari A, Clase CM, Acott P, et al. Canadian society of nephrology commentary on the KDIGO clinical practice guideline for CKD evaluation and management. Am J Kidney Dis, 2015, 65(2): 177-205.
5.	MacKinnon HJ, Wilkinson TJ, Clarke AL, et al. The association of physical function and physical activity with all-cause mortality and adverse clinical outcomes in nondialysis chronic kidney disease: a systematic review. Ther Adv Chronic Dis, 2018, 9(11): 209-226.
6.	Aoike DT, Baria F, Kamimura MA, et al. Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease. Int Urol Nephrol, 2015, 47(2): 359-367.
7.	Sovatzidis A, Chatzinikolaou A, Fatouros IG, et al. Intradialytic cardiovascular exercise training alters redox status, reduces inflammation and improves physical performance in patients with chronic kidney disease. Antioxidants (Basel), 2020, 9(9): 868.
8.	Youssef MK, Philips MV. Effect of exercise in patients with diabetic kidney disease. Int J Ther Rehabil, 2016, 23(10): 472-479.
9.	Yuenyongchaiwat K, Namdang P, Vasinsarunkul P, et al. Effectiveness of inspiratory muscle training on respiratory fitness and breathlessness in chronic renal failure: a randomized control trial. Physiother Res Int, 2021, 26(1): e1879.
10.	Wu L, Liu Y, Wu L, et al. Effects of exercise on markers of inflammation and indicators of nutrition in patients with chronic kidney disease: a systematic review and meta-analysis. Int Urol Nephrol, 2022, 54(4): 815-826.
11.	Howden EJ, Leano R, Petchey W, et al. Effects of exercise and lifestyle intervention on cardiovascular function in CKD. Clin J Am Soc Nephrol, 2013, 8(9): 1494-1501.
12.	Gould DW, Graham-Brown MP, Watson EL, et al. Physiological benefits of exercise in pre-dialysis chronic kidney disease. Nephrology (Carlton), 2014, 19(9): 519-527.
13.	Indridason OS, Thorsteinsdóttir I, Pálsson R. Advances in detection, evaluation and management of chronic kidney disease. Laeknabladid, 2007, 93(3): 201-207.
14.	Powell KE, Paluch AE, Blair SN. Physical activity for health: What kind How much? How intense? On top of what? Annu Rev Public Health, 2011, 32: 349-365.
15.	Aydemir N, Pike MM, Alsouqi A, et al. Effects of diet and exercise on adipocytokine levels in patients with moderate to severe chronic kidney disease. Nutr Metab Cardiovasc Dis, 2020, 30(8): 1375-1381.
16.	Barcellos FC, Del Vecchio FB, Reges A, et al. Exercise in patients with hypertension and chronic kidney disease: a randomized controlled trial. J Hum Hypertens, 2018, 32(6): 397-407.
17.	Beetham KS, Howden EJ, Krishnasamy R, et al. Feasibility of higher intensity exercise in patients with chronic kidney disease. J Sports Med Phys Fitness, 2018, 58(1-2): 127-134.
18.	Corrêa HL, Neves RVP, Deus LA, et al. Low-load resistance training with blood flow restriction prevent renal function decline: The role of the redox balance, angiotensin 1-7 and vasopressin. Physiol Behav, 2021, 230: 113295.
19.	Corrêa HL, Neves RVP, Deus LA, et al. Blood flow restriction training blunts chronic kidney disease progression in humans. Med Sci Sports Exerc, 2021, 53(2): 249-257.
20.	Greenwood SA, Koufaki P, Mercer TH, et al. Effect of exercise training on estimated GFR, vascular health, and cardiorespiratory fitness in patients with CKD: a pilot randomized controlled trial. Am J Kidney Dis, 2015, 65(3): 425-434.
21.	Headley S, Germain M, Milch C, et al. Exercise training improves HR responses and V˙O2peak in predialysis kidney patients. Med Sci Sports Exerc, 2012, 44(12): 2392-2399.
22.	Headley S, Germain M, Wood R, et al. Short-term aerobic exercise and vascular function in CKD stage 3: a randomized controlled trial. Am J Kidney Dis, 2014, 64(2): 222-229.
23.	Hellberg M, Höglund P, Svensson P, et al. Comparing effects of 4 months of two self-administered exercise training programs on physical performance in patients with chronic kidney disease: RENEXC - A randomized controlled trial. PLoS One, 2018, 13(12): e0207349.
24.	Hellberg M, Höglund P, Svensson P, et al. Randomized controlled trial of exercise in CKD-the RENEXC study. Kidney Int Rep, 2019, 4(7): 963-976.
25.	Hiraki K, Shibagaki Y, Izawa KP, et al. Effects of home-based exercise on pre-dialysis chronic kidney disease patients: a randomized pilot and feasibility trial. BMC Nephrol, 2017, 18(1): 198.
26.	Huppertz N, Beetham KS, Howden EJ, et al. A 12-month lifestyle intervention does not improve cardiac autonomic function in patients with chronic kidney disease. Auton Neurosci, 2020, 224: 102642.
27.	Leehey DJ, Collins E, Kramer HJ, et al. Structured exercise in obese diabetic patients with chronic kidney disease: a randomized controlled trial. Am J Nephrol, 2016, 44(1): 54-62.
28.	Miele EM, Headley SAE, Germain M, et al. High-density lipoprotein particle pattern and overall lipid responses to a short-term moderate-intensity aerobic exercise training intervention in patients with chronic kidney disease. Clin Kidney J, 2017, 10(4): 524-531.
29.	Shi ZM, Wen HP, Liu FR, et al. The effects of tai chi on the renal and cardiac functions of patients with chronic kidney and cardiovascular diseases. J Phys Ther Sci, 2014, 26(11): 1733-1736.
30.	Tang Q, Yang B, Fan F, et al. Effects of individualized exercise program on physical function, psychological dimensions, and health-related quality of life in patients with chronic kidney disease: A randomized controlled trial in China. Int J Nurs Pract, 2017, 23(2): e12519.
31.	Uchiyama K, Adachi K, Muraoka K, et al. Home-based aerobic exercise and resistance training for severe chronic kidney disease: a randomized controlled trial. J Cachexia Sarcopenia Muscle, 2021, 12(6): 1789-1802.
32.	Zhou Y, Hellberg M, Hellmark T, et al. Twelve months of exercise training did not halt abdominal aortic calcification in patients with CKD - a sub-study of RENEXC-a randomized controlled trial. BMC Nephrol, 2020, 21(1): 233.
33.	孔艳华, 王金海, 周玉森, 等. 抗阻训练对2型糖尿病患者早期糖尿病肾病的影响. 临床内科杂志, 2017, 34(7): 479-481.
34.	梁丰, 晁敏, 王尊, 等. 不同运动方式对慢性肾脏病患者肾功能及心血管疾病相关危险因素的影响. 中国康复医学杂志, 2016, 31(11): 1234-1238.
35.	梁丰, 霍文璟, 欧阳刚, 等. 不同运动方式训练对慢性肾脏病患者运动功能的影响. 中国康复理论与实践, 2018, 24(2): 208-213.
36.	周方, 赵志刚, 王磊, 等. 中等强度有氧运动对慢性肾病患者峰值摄氧量和无氧阈的影响. 中国康复医学杂志, 2017, 32(5): 525-529.
37.	史亚丽, 刘新生, 王瑞元. 有氧运动对中老年人血糖, 胰岛素及血脂的影响. 体育科学, 2004, (4): 26-27.
38.	Wang AY, Wang M, Woo J, et al. Inflammation, residual kidney function, and cardiac hypertrophy are interrelated and combine adversely to enhance mortality and cardiovascular death risk of peritoneal dialysis patients. J Am Soc Nephrol, 2004, 15(8): 2186-2194.
39.	Yao Q, Axelsson J, Heimburger O, et al. Systemic inflammation in dialysis patients with end-stage renal disease: causes and consequences. Minerva Urol Nefrol, 2004, 56(3): 237-248.
40.	Kelley GA, Kelley KS. Effects of aerobic exercise on C-reactive protein, body composition, and maximum oxygen consumption in adults: a meta-analysis of randomized controlled trials. Metabolism, 2006, 55(11): 1500-1507.
41.	Sietsema KE, Amato A, Adler SG, et al. Exercise capacity as a predictor of survival among ambulatory patients with end-stage renal disease. Kidney Int, 2004, 65(2): 719-724.
42.	徐琴娟, 胡雁飞, 胡化刚. 不同运动方式对改善维持性血液透析患者步行能力的网状Meta分析. 解放军护理杂志, 2021, 38(7): 1-5.
43.	Evangelidis N, Tong A, Manns B, et al. Developing a set of core outcomes for trials in hemodialysis: an international Delphi survey. Am J Kidney Dis, 2017, 70(4): 464-475.
44.	李娟, 唐东辉, 陈巍. 有氧运动结合抗阻训练对男性肥胖青少年心血管功能的改善及可能机制. 体育科学, 2013, 33(8): 6.

1. 白雪莲, 张佳宜, 项国梁, 等. 中国成人慢性肾脏病患病率的Meta分析. 中国医药科学, 2022, 12(9): 49-53.
2. Du J, Hu Z, Mitch WE. Molecular mechanisms activating muscle protein degradation in chronic kidney disease and other catabolic conditions. Eur J Clin Invest, 2005, 35(3): 157-163.
3. Chen IR, Wang SM, Liang CC, et al. Association of walking with survival and RRT among patients with CKD stages 3-5. Clin J Am Soc Nephrol, 2014, 9(7): 1183-1189.
4. Akbari A, Clase CM, Acott P, et al. Canadian society of nephrology commentary on the KDIGO clinical practice guideline for CKD evaluation and management. Am J Kidney Dis, 2015, 65(2): 177-205.
5. MacKinnon HJ, Wilkinson TJ, Clarke AL, et al. The association of physical function and physical activity with all-cause mortality and adverse clinical outcomes in nondialysis chronic kidney disease: a systematic review. Ther Adv Chronic Dis, 2018, 9(11): 209-226.
6. Aoike DT, Baria F, Kamimura MA, et al. Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease. Int Urol Nephrol, 2015, 47(2): 359-367.
7. Sovatzidis A, Chatzinikolaou A, Fatouros IG, et al. Intradialytic cardiovascular exercise training alters redox status, reduces inflammation and improves physical performance in patients with chronic kidney disease. Antioxidants (Basel), 2020, 9(9): 868.
8. Youssef MK, Philips MV. Effect of exercise in patients with diabetic kidney disease. Int J Ther Rehabil, 2016, 23(10): 472-479.
9. Yuenyongchaiwat K, Namdang P, Vasinsarunkul P, et al. Effectiveness of inspiratory muscle training on respiratory fitness and breathlessness in chronic renal failure: a randomized control trial. Physiother Res Int, 2021, 26(1): e1879.
10. Wu L, Liu Y, Wu L, et al. Effects of exercise on markers of inflammation and indicators of nutrition in patients with chronic kidney disease: a systematic review and meta-analysis. Int Urol Nephrol, 2022, 54(4): 815-826.
11. Howden EJ, Leano R, Petchey W, et al. Effects of exercise and lifestyle intervention on cardiovascular function in CKD. Clin J Am Soc Nephrol, 2013, 8(9): 1494-1501.
12. Gould DW, Graham-Brown MP, Watson EL, et al. Physiological benefits of exercise in pre-dialysis chronic kidney disease. Nephrology (Carlton), 2014, 19(9): 519-527.
13. Indridason OS, Thorsteinsdóttir I, Pálsson R. Advances in detection, evaluation and management of chronic kidney disease. Laeknabladid, 2007, 93(3): 201-207.
14. Powell KE, Paluch AE, Blair SN. Physical activity for health: What kind How much? How intense? On top of what? Annu Rev Public Health, 2011, 32: 349-365.
15. Aydemir N, Pike MM, Alsouqi A, et al. Effects of diet and exercise on adipocytokine levels in patients with moderate to severe chronic kidney disease. Nutr Metab Cardiovasc Dis, 2020, 30(8): 1375-1381.
16. Barcellos FC, Del Vecchio FB, Reges A, et al. Exercise in patients with hypertension and chronic kidney disease: a randomized controlled trial. J Hum Hypertens, 2018, 32(6): 397-407.
17. Beetham KS, Howden EJ, Krishnasamy R, et al. Feasibility of higher intensity exercise in patients with chronic kidney disease. J Sports Med Phys Fitness, 2018, 58(1-2): 127-134.
18. Corrêa HL, Neves RVP, Deus LA, et al. Low-load resistance training with blood flow restriction prevent renal function decline: The role of the redox balance, angiotensin 1-7 and vasopressin. Physiol Behav, 2021, 230: 113295.
19. Corrêa HL, Neves RVP, Deus LA, et al. Blood flow restriction training blunts chronic kidney disease progression in humans. Med Sci Sports Exerc, 2021, 53(2): 249-257.
20. Greenwood SA, Koufaki P, Mercer TH, et al. Effect of exercise training on estimated GFR, vascular health, and cardiorespiratory fitness in patients with CKD: a pilot randomized controlled trial. Am J Kidney Dis, 2015, 65(3): 425-434.
21. Headley S, Germain M, Milch C, et al. Exercise training improves HR responses and V˙O2peak in predialysis kidney patients. Med Sci Sports Exerc, 2012, 44(12): 2392-2399.
22. Headley S, Germain M, Wood R, et al. Short-term aerobic exercise and vascular function in CKD stage 3: a randomized controlled trial. Am J Kidney Dis, 2014, 64(2): 222-229.
23. Hellberg M, Höglund P, Svensson P, et al. Comparing effects of 4 months of two self-administered exercise training programs on physical performance in patients with chronic kidney disease: RENEXC - A randomized controlled trial. PLoS One, 2018, 13(12): e0207349.
24. Hellberg M, Höglund P, Svensson P, et al. Randomized controlled trial of exercise in CKD-the RENEXC study. Kidney Int Rep, 2019, 4(7): 963-976.
25. Hiraki K, Shibagaki Y, Izawa KP, et al. Effects of home-based exercise on pre-dialysis chronic kidney disease patients: a randomized pilot and feasibility trial. BMC Nephrol, 2017, 18(1): 198.
26. Huppertz N, Beetham KS, Howden EJ, et al. A 12-month lifestyle intervention does not improve cardiac autonomic function in patients with chronic kidney disease. Auton Neurosci, 2020, 224: 102642.
27. Leehey DJ, Collins E, Kramer HJ, et al. Structured exercise in obese diabetic patients with chronic kidney disease: a randomized controlled trial. Am J Nephrol, 2016, 44(1): 54-62.
28. Miele EM, Headley SAE, Germain M, et al. High-density lipoprotein particle pattern and overall lipid responses to a short-term moderate-intensity aerobic exercise training intervention in patients with chronic kidney disease. Clin Kidney J, 2017, 10(4): 524-531.
29. Shi ZM, Wen HP, Liu FR, et al. The effects of tai chi on the renal and cardiac functions of patients with chronic kidney and cardiovascular diseases. J Phys Ther Sci, 2014, 26(11): 1733-1736.
30. Tang Q, Yang B, Fan F, et al. Effects of individualized exercise program on physical function, psychological dimensions, and health-related quality of life in patients with chronic kidney disease: A randomized controlled trial in China. Int J Nurs Pract, 2017, 23(2): e12519.
31. Uchiyama K, Adachi K, Muraoka K, et al. Home-based aerobic exercise and resistance training for severe chronic kidney disease: a randomized controlled trial. J Cachexia Sarcopenia Muscle, 2021, 12(6): 1789-1802.
32. Zhou Y, Hellberg M, Hellmark T, et al. Twelve months of exercise training did not halt abdominal aortic calcification in patients with CKD - a sub-study of RENEXC-a randomized controlled trial. BMC Nephrol, 2020, 21(1): 233.
33. 孔艳华, 王金海, 周玉森, 等. 抗阻训练对2型糖尿病患者早期糖尿病肾病的影响. 临床内科杂志, 2017, 34(7): 479-481.
34. 梁丰, 晁敏, 王尊, 等. 不同运动方式对慢性肾脏病患者肾功能及心血管疾病相关危险因素的影响. 中国康复医学杂志, 2016, 31(11): 1234-1238.
35. 梁丰, 霍文璟, 欧阳刚, 等. 不同运动方式训练对慢性肾脏病患者运动功能的影响. 中国康复理论与实践, 2018, 24(2): 208-213.
36. 周方, 赵志刚, 王磊, 等. 中等强度有氧运动对慢性肾病患者峰值摄氧量和无氧阈的影响. 中国康复医学杂志, 2017, 32(5): 525-529.
37. 史亚丽, 刘新生, 王瑞元. 有氧运动对中老年人血糖, 胰岛素及血脂的影响. 体育科学, 2004, (4): 26-27.
38. Wang AY, Wang M, Woo J, et al. Inflammation, residual kidney function, and cardiac hypertrophy are interrelated and combine adversely to enhance mortality and cardiovascular death risk of peritoneal dialysis patients. J Am Soc Nephrol, 2004, 15(8): 2186-2194.
39. Yao Q, Axelsson J, Heimburger O, et al. Systemic inflammation in dialysis patients with end-stage renal disease: causes and consequences. Minerva Urol Nefrol, 2004, 56(3): 237-248.
40. Kelley GA, Kelley KS. Effects of aerobic exercise on C-reactive protein, body composition, and maximum oxygen consumption in adults: a meta-analysis of randomized controlled trials. Metabolism, 2006, 55(11): 1500-1507.
41. Sietsema KE, Amato A, Adler SG, et al. Exercise capacity as a predictor of survival among ambulatory patients with end-stage renal disease. Kidney Int, 2004, 65(2): 719-724.
42. 徐琴娟, 胡雁飞, 胡化刚. 不同运动方式对改善维持性血液透析患者步行能力的网状Meta分析. 解放军护理杂志, 2021, 38(7): 1-5.
43. Evangelidis N, Tong A, Manns B, et al. Developing a set of core outcomes for trials in hemodialysis: an international Delphi survey. Am J Kidney Dis, 2017, 70(4): 464-475.
44. 李娟, 唐东辉, 陈巍. 有氧运动结合抗阻训练对男性肥胖青少年心血管功能的改善及可能机制. 体育科学, 2013, 33(8): 6.

Chinese Journal of Evidence-Based Medicine

Efficacy of three types of exercise therapy on non-dialysis chronic kidney diseases: a network meta-analysis

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