MP463EFFECTS OF 1-YEAR SELF-ADMINISTERED EXERCISE ON PHYSICAL PERFORMANCE IN CKD 3B-5 - THE RENEXC TRIAL

Abstract

INTRODUCTION AND AIMS: Exercise training has been shown to be beneficial in patients with chronic kidney disease (CKD). Most studies are in dialysis patients and limited by a short observation time. Our primary aim was to study whether CKD patients could improve their physical performance and maintain the effects after 1 year of self-administered exercise training and compare two different exercise regimes: endurance training in combination with either strength or balance training. METHODS: RENEXC was an interventional, prospective, controlled, randomised trial with an observation period of 12 months. Prevalent and incident adults with an estimated GFR <30 ml/min/1.73m2, irrespective of co-morbidity and age were recruited from one centre and randomised either to endurance and strength (SG) or endurance and balance (BG) training. INTERVENTIONS: Each patient was prescribed an individualised exercise-training programme. The intensity of the exercises was kept constant using the Borg scale for rate of perceived exertion (RPE, max 20) within 13 - 15 (“somewhat strenuous” to “strenuous”). The exercise training was self-administered at home or at a nearby gym. The recommended exercise time was 150 minutes per week. Physical performance was assessed at baseline and after 4, 8 and 12 months by 6 Minutes' Walk, Stair Climbing, 30 seconds Sit to Stand, Heel Rises, Toe Lifts, Quadriceps and Handgrip Strength, Functional Reach, Berg's Balance Scale and Moberg's Picking-up test with open and closed eyes. STATISTICAL ANALYSES: In mixed model analyses the results of the physical performance at baseline, 4, 8 and 12 months were evaluated using the main effects of time, treatment, and their interaction as fixed effects and subjects as random effects. RESULTS: 216 patients were screened, 151 patients were included (53 women, 98 men), median age was 70 years [range 19 - 87], median measured GFR was 22 [range 8 - 55] ml/min/1.73 m2. Both groups (SG, BG) showed statistically significant improvements in 6 Minutes' Walk (p<0.001), Stair climbing (p<0.001), 30 seconds Sit to Stand (p<0.001), Heel Rises (p<0.001), Toe Lifts (p<0.001), Quadriceps Strength (p<0.001), Functional Reach (p<0.001) and the Picking-up test (p<0.001). No changes could be found for Handgrip Strength or Berg's Balance Scale. There were no interaction effects per training modality. CONCLUSIONS: One year of self-administered endurance training in combination with either strength or balance exercises improved overall endurance, muscle strength and endurance, balance and fine motor skills in patients with CKD 3b-5 regardless of the training modality. Handgrip Strength and Berg's Balance scale were maintained. Thus, showing the value of exercise training as an integral part of nephrological care.