Exercise GUIDELINES

Exercise training has not been shown to retard the progression of renal insufficiency. (Level II Evidence; single, small, underpowered trial; clinically relevant outcome; negative effect) Background Chronic kidney disease (CKD) is typically associated with sarcopenia and a reduction in exercise tolerance. In rat models of CKD, augmented exercise has been shown to be renoprotective (Kohzuki et al 2001). The objective of this guideline is to assess the available clinical trials of the effects of enhanced physical activity on renal function decline in patients with CKD. Search strategy Databases searched: Medline (1999 to November Week 2, 2003). MeSH terms for kidney disease were combined with MeSH terms and text words for exercise training. The results were then combined with the Cochrane highly sensitive search strategy for randomised controlled trials and MeSH terms and text words for identifying metaanalyses and systematic reviews. The Cochrane Renal Group Specialised Register of Randomised Controlled Trials was also searched for relevant trials not indexed by Medline. Date of search: 16 December 2003. What is the evidence? There is one randomised controlled trial (RCT). Eidemak et al (1997) randomised 30 patients with moderate-to-severe CKD (median GFR 25 mL/min/1.73 m 2, range 10–43) to physical training (30 minutes of bicycling daily or an equal amount of other physical activities) or to maintenance of usual lifestyle. Over a median follow-up time of 20 months, median maximal work capacity increased significantly in the exercise group, but not in the controls. However, no change in GFR decline was observed between the 2 groups. The chief limitation of the study was its lack of statistical power.