Effectiveness of exercise therapy in managing muscle atrophy in chronic kidney disease: a systematic review of randomized control trials

Abstract

Background: Chronic kidney disease (CKD) results in progressive muscle atrophy, functional impairment, and reduced quality of life (QoL). While exercise therapy represents a potential intervention, research shows contradictory results regarding its efficacy in different populations of CKD. This systematic review evaluates the impact of exercise therapy on muscle mass, muscle strength, functional capacity, cardiovascular endurance, and QoL of patients with CKD. Methods: Systematic searching was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library with no date restriction to cover all relevant studies between 1992 and 2024. We included randomized controlled trials (RCTs) examining the effects of resistance, aerobic, or combined exercise training on CKD-related muscle atrophy, strength, functional capacity, or QoL in adults with CKD stages 3–5. Studies carried out among renal transplant recipients, non-randomized trials, case reports, and narrative reviews were all excluded. Quality was assessed using the Cochrane Risk of Bias 2 (ROB2) tool. Results: Nine RCTs enrolling 580 participants met the inclusion criteria, involving pre-dialysis and dialysis patients. Muscle strength and mass were significantly increased by moderate resistance training, particularly in dialysis patients, while functional capacity and cardiovascular endurance were better improved by aerobic and combined training, with the latter showing more improvement in pre-dialysis patients. Physical, psychological, and social domains of QoL improved. Interventions differed across studies and encompassed resistance, aerobic, and combined training administered over an 8–24 week period, with frequencies spanning from two to five sessions per week. Exercise interventions, particularly those conducted on dialysis and home programs, were well tolerated with minimal side effects such as muscle discomfort and transient fatigue but without serious adverse events. Conclusions: Resistance exercise and combined exercise therapy are effective and safe for the prevention of muscle atrophy and functional improvement in patients with CKD. Future research should aim to address long-term outcomes, consistent exercise protocols, and new models of delivery, such as telerehabilitation and wearables, to promote adherence. Trial registration: PROSPERO, CRD42024627749.