Long-Term Physical Exercise for Preventing CKD in Older Adults: A Randomized Controlled Trial.

IF 10.3 1区医学 Q1 UROLOGY & NEPHROLOGY Journal of The American Society of Nephrology Pub Date : 2025-02-04 DOI:10.1681/ASN.0000000636

Stein I Hallan, Marius A Øvrehus, Michael G Shlipak, O Alison Potok, Solfrid Romundstad, Nils P Aspvik, Ulrik Wisløff, Joachim H Ix, Dorthe Stensvold, Knut A Langlo

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Abstract

Background: Chronic kidney disease (CKD) is a growing global public health issue. Physical exercise mitigates several kidney-related pathophysiological pathways, yet its impact on kidney function remains underexplored. We investigated the dose-response effect of physical exercise on kidney function preservation in older adults.

Methods: Post-hoc analysis of the Generation 100 Study, a 5-year open-label, randomized, parallel-arm clinical trial conducted from 2012 to 2018 in Trondheim, Norway. All inhabitants aged 70-77 years were invited (n=6,966). Main exclusion criteria were dementia; severe, uncontrolled cardiovascular disease or hypertension; or conditions precluding exercise. The control group (n=385) received information on national physical activity recommendations. Intervention groups underwent supervised moderate-intensity continuous training (70% of peak heart rate) for 50 minutes (n=380) twice weekly for five years or high-intensity interval training (90% of peak heart rate) for 4 minutes x4 (n=391) twice weekly for five years. The primary outcome was cystatin C-based rapid eGFR decline (>5mL/min/1.73m2 per year).

Results: A total of 1,156 participants were randomized with median (interquartile range) age 72 (3) years and eGFR 95 (20) mL/min/1.73 m2. Oxygen uptake increased by 1.8, 2.3, and 3.3 mL/kg/min in the control, moderate-intensity, and high-intensity groups. Rapid eGFR decline occurred in 117 (30%), 108 (28%), and 92 (23%) participants, respectively. Compared to controls, relative risk (RR) was 0.93 (0.75-1.16) for moderate-intensity and 0.75 (95% CI 0.59-0.95) for high-intensity, demonstrating a significant dose-response relationship (P for trend 0.02). In observational analyses, participants with decreasing moderate-vigorous activity (> -20 minute/week) had RR 1.30 (95% CI 0.93-1.83) for rapid eGFR decline, while those with increasing activity (> +20 minutes/week) had RR 0.73 (0.53-0.99) compared to stable activity after adjusting for baseline age, sex, VO2peak and eGFR.

Conclusions: High-intensity interval training significantly reduced the risk of rapid eGFR decline in older adults.

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来源期刊

Journal of The American Society of Nephrology 医学-泌尿学与肾脏学

CiteScore

22.40

自引率

2.90%

发文量

492

审稿时长

3-8 weeks

期刊介绍： The Journal of the American Society of Nephrology (JASN) stands as the preeminent kidney journal globally, offering an exceptional synthesis of cutting-edge basic research, clinical epidemiology, meta-analysis, and relevant editorial content. Representing a comprehensive resource, JASN encompasses clinical research, editorials distilling key findings, perspectives, and timely reviews. Editorials are skillfully crafted to elucidate the essential insights of the parent article, while JASN actively encourages the submission of Letters to the Editor discussing recently published articles. The reviews featured in JASN are consistently erudite and comprehensive, providing thorough coverage of respective fields. Since its inception in July 1990, JASN has been a monthly publication. JASN publishes original research reports and editorial content across a spectrum of basic and clinical science relevant to the broad discipline of nephrology. Topics covered include renal cell biology, developmental biology of the kidney, genetics of kidney disease, cell and transport physiology, hemodynamics and vascular regulation, mechanisms of blood pressure regulation, renal immunology, kidney pathology, pathophysiology of kidney diseases, nephrolithiasis, clinical nephrology (including dialysis and transplantation), and hypertension. Furthermore, articles addressing healthcare policy and care delivery issues relevant to nephrology are warmly welcomed.

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