title: Effects of a renal rehabilitation exercise program in patients with CKD: a randomized, controlled trial.
abstract: OBJECTIVE
  Patients with CKD have a high prevalence of cardiovascular disease associated with or exacerbated by inactivity. This randomized, controlled study investigated whether a renal rehabilitation exercise program for patients with stages 3 or 4 CKD would improve their physical function and quality of life.
  
  
  METHODS
  In total, 119 adults with CKD stages 3 and 4 were randomized, and 107 of these patients proceeded to usual care or the renal rehabilitation exercise intervention consisting of usual care plus guided exercise two times per week for 12 weeks (24 sessions). Physical function was determined by three well established performance-based tests: 6-minute walk test, sit-to-stand test, and gait-speed test. Health-related quality of life was assessed by the RAND 36-Item Short Form Health Survey.
  
  
  RESULTS
  At baseline, no differences in self-reported level of activity, 6-minute walk test, and sit-to-stand test scores were observed between the usual care (n=48) and renal rehabilitation exercise (n=59) groups, although baseline gait-speed test score was higher in the renal rehabilitation exercise group (P<0.001). At follow-up, the renal rehabilitation exercise group but not the usual care group showed significant improvements in the 6-minute walk test (+210.4±266.0 ft [19% improvement] versus -10±219.9 ft; P<0.001), the sit-to-stand test (+26.9±27% of age prediction [29% improvement] versus +0.7±12.1% of age prediction; P<0.001), and the RAND-36 physical measures of role functioning (P<0.01), physical functioning (P<0.01), energy/fatigue levels (P=0.01), and general health (P=0.03) and mental measure of pain scale (P=0.04). The renal rehabilitation exercise regimen was generally well tolerated.
  
  
  CONCLUSIONS
  A 12-week/24-session renal rehabilitation exercise program improved physical capacity and quality of life in patients with CKD stages 3 and 4. Longer follow-up is needed to determine if these findings will translate into decreased mortality rates.
authors.affiliation: Department of Nephrology and Transplantation, Maine Medical Center.
authors.forename: Ana P
authors.initials: AP
authors.lastname: Rossi
authors.affiliation: Clinical Trial Support Services, Maine Medical Center Research Institute.
authors.forename: Debra D
authors.initials: DD
authors.lastname: Burris
authors.affiliation: Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, and.
authors.forename: F Leslie
authors.initials: FL
authors.lastname: Lucas
authors.affiliation: Turning Point Cardiac Rehabilitation & Prevention, Maine Medical Center, Portland, Maine.
authors.forename: Gail A
authors.initials: GA
authors.lastname: Crocker
authors.affiliation: Department of Nephrology and Transplantation, Maine Medical Center, wassej@mmc.org.
authors.forename: James C
authors.initials: JC
authors.lastname: Wasserman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005081:Exercise Therapy; D017079:Exercise Tolerance / Q000502:physiology; D005221:Fatigue / Q000209:etiology / Q000534:rehabilitation; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000534:rehabilitation; D010349:Patient Compliance; D011446:Prospective Studies; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D016138:Walking / Q000502:physiology
keywords: CKD; exercise training; physical function; quality of life; renal rehabilitation exercise