Effect of exercise in obese diabetic patients with chronic kidney disease
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Department of Internal Medicine, Cairo University Hospitals, Giza, Egypt
Submission date: 2021-05-24
Acceptance date: 2021-09-23
Publication date: 2022-06-20
Physiother Quart. 2023;31(1):6-12
Obesity is the most dangerous risk factor for kidney disease if it is coupled with diabetes mellitus and hypertension, and it has a direct impact on chronic kidney disease progression to end-stage renal disease. The present study was to document the effect of 3 months of aerobic exercises vs. resistance exercises in obese patients with diabetes and chronic kidney disease.

Overall, 84 patients (36 males and 48 females) who met the inclusion criteria were randomly assigned to 2 groups. Group 1 received aerobic exercises 3 times/week for 3 months, and group 2 was treated with resistance exercises 3 times/week for 3 months.

At baseline, no significant difference was found between the groups in body mass index, waist circumference, waist-to-hip ratio, blood pressure, heart rate, or blood glucose. The difference in exercise performance between the 2 groups prior to treatment was not significant, but after 3 months of treatment, there was a significant increase in exercise performance and improvement in the parameters of body mass index, waist circumference, waist-to-hip ratio, blood pressure, heart rate, and blood glucose within group 1 and group 2, with no significant difference between the 2 groups.

Aerobic exercise is effective in decreasing obesity and increasing physical performance in obese diabetic chronic kidney disease patients. Resistance exercises alone can also decrease obesity and increase physical performance. So, both types of exercises can be used in the treatment of obesity.

Schoolwerth AC, Engelgau MM, Hostetter TH, Rufo KH, Chianchiano D, McClellan WM, et al. Chronic kidney disease: a public health problem that needs a public health action plan. Prev Chronic Dis. 2006;3(2):A57.
Kovesdy CP, Furth SL, Zoccali C. Obesity and kidney disease: hidden consequences of the epidemic. Can J Kidney Health Dis. 2017;4:1–10; doi: 10.1177/2054358117698669.
Tsujimoto T, Sairenchi T, Iso H, Irie F, Yamagishi K, Wa­tanabe H, et al. The dose-response relationship between body mass index and the risk of incident stage 3 chronic kidney disease in a general Japanese population: the Ibaraki prefectural health study (IPHS). J Epidemiol. 2014;24(6):444–451; doi: 10.2188/jea.je20140028.
Abbaspoor Z, Miryan M, Haghighi-Zadeh MH, Rashidi H, Sharifipoor F, Amani R. The prevalence of determinants of obesity, metabolic syndrome and overweight in middle-aged urban women living in a megacity. Fam Med Prim Care Rev. 2020;22(1):7–12; doi: 10.5114/fmpcr.2020.92499.
Elsayed EF, Sarnak MJ, Tighiouart H, Griffith JL, Kurth T, Salem DN, et al. Waist-to-hip ratio, body mass index, and subsequent kidney disease and death. Am J Kidney Dis. 2008;52(1):29–38; doi: 10.1053/j.ajkd.2008.02.363.
Lu JL, Kalantar-Zadeh K, Ma JZ, Quarles LD, Kovesdy CP. Association of body mass index with outcomes in patients with CKD. J Am Soc Nephrol. 2014;25(9):2088–2096; doi: 10.1681/ASN.2013070754.
Reis JP, Araneta MR, Wingard DL, Macera CA, Lindsay SP, Marshall SJ. Overall obesity and abdominal adiposity as predictors of mortality in U.S. white and black adults. Ann Epidemiol. 2009;19(2):134–142; doi: 10.1016/j.annepidem.2008.10.008.
World Health Organization. Waist circumference and waist-hip ratio: report of a WHO expert consultation. Geneva: World Health Organization; 2008. Available from: http://whqlibdoc.who.int/publi....
Kovesdy CP, Furth SL, Zoccali C. Obesity and kidney disease: hidden consequences of the epidemic. Braz J Med Biol Res. 2017;50(5):e6075; doi: 10.1590/1414-431X20166075.
Sharma K. The link between obesity and albuminuria: adiponectin and podocyte dysfunction. Kidney Int. 2009;76(2):145–148; doi: 10.1038/ki.2009.137.
Adey D, Kumar R, McCarthy JT, Nair KS. Reduced synthesis of muscle proteins in chronic renal failure. Am J Physiol Endocrinol Metab. 2000;278(2):219–225; doi: 10.1152/ajpendo.2000.278.2.E219.
Suárez-Carmona W, Sánchez-Oliver AJ, González-Jurado JA. Pathophysiology of obesity: current view [in Spanish]. Rev Chil Nutr. 2017;44(3):226–233; doi: 10.4067/s0717-75182017000300226.
Beddhu S, Baird BC, Zitterkoph J, Neilson J, Greene T. Physical activity and mortality in chronic kidney disease (NHANES III). Clin J Am Soc Nephrol. 2009;4(12):1901–1906; doi: 10.2215/CJN.01970309.
Hallan S, de Mutsert R, Carlsen S, Dekker FW, Aasarød K, Holmen J. Obesity, smoking, and physical inactivity as risk factors for CKD: are men more vulnerable? Am J Kidney Dis. 2006;47(3):396–405; doi: 10.1053/j.ajkd.2005.11.027.
Sietsema KE, Amato A, Adler SG, Brass EP. Exercise capacity as a predictor of survival among ambulatory patients with end-stage renal disease. Kidney Int. 2004;65(2):719–724; doi: 10.1111/j.1523-1755.2004.00411.x.
Youssef MK, Philips MV. Effect of exercise in patients with diabetic kidney disease. Int J Ther Rehabil. 2016;23(10):472–479; doi: 10.12968/ijtr.2016.23.10.472.
Hernandez HJ, Obamwonyi G, Harris-Love MO. Physical therapy considerations for chronic kidney disease and secondary sarcopenia. J Funct Morphol Kinesiol. 2018;3(1):5; doi: 10.3390/jfmk3010005.
Hiraki K, Yasuda T, Hotta C, Izawa KP, Morio Y, Watanabe S, et al. Decreased physical function in pre-dialysis patients with chronic kidney disease. Clin Exp Nephrol. 2013;17(2):225–231; doi: 10.1007/s10157-012-0681-8.
De Groot M, Kushnick M, Doyle T, Merrill J, McGlynn M, Shubrook J, et al. A model of community-based behavioral intervention for depression in diabetes: program ACTIVE. Diabetes Spectr. 2010;23(1):18–25; doi: 10.2337/diaspect.23.1.18.
KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Inter Suppl. 2013;3(1):1–150. Available from: https://kdigo.org/wp-content/u....
Painter P, Roshanravan B. The association of physical activity and physical function with clinical outcomes in adults with chronic kidney disease. Curr Opin Nephrol Hypertens. 2013;22(6):615–623; doi: 10.1097/MNH.0b013e328365b43a.
Cheema BSB, Fiatarone Singh MA. Exercise training in patients receiving maintenance hemodialysis: a systematic review of clinical trials. Am J Nephrol. 2005;25(4):352–364; doi: 10.1159/000087184.
Greenwood SA, Lindup H, Taylor K, Koufaki P, Rush R, Macdougall IC, et al. Evaluation of a pragmatic exercise rehabilitation programme in chronic kidney disease. Nephrol Dial Transplant. 2012;27(Suppl. 3):iii126–iii134; doi: 10.1093/ndt/gfs272.
Roshanravan B, Robinson-Cohen C, Patel KV, Ayers E, Littman AJ, de Boer IH, et al. Association between physical performance and all-cause mortality in CKD. J Am Soc Nephrol. 2013;24(5):822–830; doi: 10.1681/ASN.2012070702.
Youssef MK. Efficacy of neuromuscular electric stimulation versus aerobic exercise on uremic restless legs syndrome. Int J Ther Rehabil. 2019;26(10):1–12; doi: 10.12968/ ijtr.2017.0132.
Koufaki P, Kouidi E. Current best evidence recommendations on measurement and interpretation of physical function in patients with chronic kidney disease. Sports Med. 2010;40(12):1055–1074; doi: 10.2165/11536880-000000000-00000.
Dong J, Sundell MB, Pupim LB, Wu P, Shintani A, Ikizler TA. The effect of resistance exercise to augment long-term benefits of intradialytic oral nutritional supplementation in chronic hemodialysis patients. J Ren Nutr. 2011;21(2):149–159; doi: 10.1053/j.jrn.2010.03.004.
Nybo L, Sundstrup E, Jakobsen MD, Mohr M, Hornstrup T, Simonsen L, et al. High-intensity training versus traditional exercise interventions for promoting health. Med Sci Sports Exerc. 2010;42(10):1951–1958; doi: 10.1249/MSS.0b013e3181d99203.
Robinson-Cohen C, Littman AJ, Duncan GE, Weiss NS, Sachs MC, Ruzinski J, et al. Physical activity and change in estimated GFR among persons with CKD. J Am Soc Nephrol. 2014;25(2):399–406; doi: 10.1681/ASN.2013040392.
Greenwood SA, Koufaki P, Mercer TH, MacLaughlin HL, Rush R, Lindup H, 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; doi: 10.1053/j.ajkd.2014.07.015.
Cook SA, MacLaughlin H, Macdougall IC. A structured weight management programme can achieve improved functional ability and significant weight loss in obese patients with chronic kidney disease. Nephrol Dial Transplant. 2008;23(1):263–268; doi: 10.1093/ndt/gfm511.
Hiraki K, Shibagaki Y, Izawa KP, Hotta C, Wakamiya A, Sakurada T, 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; doi: 10.1186/s12882-017-0613-7.
Chudyk A, Petrella RJ. Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis. Diabetes Care. 2011;34(5):1228–1237; doi: 10.2337/dc10-1881.
Umpierre D, Ribeiro PAB, Kramer CK, Leitão CB, Zucatti ATN, Azevedo MJ, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011;305(17):1790–1799; doi: 10.1001/jama.2011.576.
Heiwe S, Tollbäck A, Clyne N. Twelve weeks of exercise training increases muscle function and walking capacity in elderly predialysis patients and healthy subjects. Nephron. 2001;88(1):48–56; doi: 10.1159/000045959.
Orcy RB, Dias PS, Seus TL, Barcellos FC, Bohlke M. Combined resistance and aerobic exercise is better than resistance training alone to improve functional performance of haemodialysis patients – results of a randomized controlled trial. Physiother Res Int. 2012;17(4):235–243; doi: 10.1002/pri.1526.
Headley S, Germain M, Milch C, Pescatello L, Coughlin MA, Nindl BC, et al. Exercise training improves HR responses and VO2peak in predialysis kidney patients. Med Sci Sports Exerc. 2012;44(12):2392–2399; doi: 10.1249/MSS.0b013e318268c70c.
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