- Original article
- Open Access
Effect of intradialytic aerobic exercise on patients with diabetic nephropathy
Bulletin of Faculty of Physical Therapy volume 24, pages 1–7 (2019)
Diabetes is a major health problem in nowadays’ society, as the number of patients with diabetes is growing continuously with their diabetic complications, especially kidney diseases, which is the most feared complication because of its substantial comorbidity, cost, and mortality.
The aim of this study was to determine the effect of intradialytic aerobic exercise on kidney functions tests [serum calcium, serum creatinine, urine creatinine, urine albumin, and estimated glomerular filtration rate (GFR)] in patients with diabetic nephropathy.
Materials and methods
Thirty patients of both sexes (19 male and 11 female) under hemodialysis with a mean age of 54.13±4.32 years were selected from the renal rehabilitation unit of Edfou General Hospital. They were assigned randomly to two groups of equal number. Group A received a moderate-intensity intradialytic aerobic exercise program (12–13 on rate of perceived exertion scale), and group B received their regular dialysis program only. The treatment program continued for 8 weeks (three exercise sessions per week). Laboratory investigations for serum calcium, serum creatinine, urine creatinine, urine albumin, and estimated GFR were carried out at the beginning and after the end of the treatment program in both groups.
The results of this study revealed a significant increase in serum calcium in group A compared with group B, and a significant decrease in serum creatinine and urine creatinine in group A compared with group B (P=0.03 and 0.04, respectively). There was no significant change in urine albumin and estimated GFR between the two groups.
Moderate-intensity intradialytic aerobic exercise (12–13 rate of perceived exertion scale) is beneficial in modulating serum calcium, serum creatinine, and urine creatinine in diabetic nephropathy patients.
NICE Clinical Guideline 73. Chronic kidney disease: early identification and management of chronic kidney disease in adults in primary and secondary care. UK: National Institute for Health and Clinical Excellence; 2008.1.
Stratton IM, Cull CA, Adler AI, Matthews DR, Neil HA, Holman RR. Additive effects of glycaemia and blood pressure exposure on risk of complications in type 2 diabetes: a prospective observational study (UKPDS 75). Diabetologia 2008; 49:1761–1769.
Bloomgarden ZT. American Diabetes Association annual meeting, more on cardiovascular disease. Diabetes Care 2000; 23:845–852.
Zamojska S, Szklarek M, Niewodniczy M, Nowicki M. Correlates of habitual physical activity in chronic hemodialysis patients. Nephrol Dial Transplant 2006; 21:1323–1327.
Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Harrison’s JL. Principles of internal medicine, 18th ed.; 2015. p. 2982.
O’Hare AM, Tawney K, Bacchetti P, Johansen KL. Decreased survival among sedentary patients undergoing dialysis: results from the dialysis morbidity and mortality study wave 2. Am J Kidney Dis 2003; 41:447–454.
Stack AG, Molony DA, Rives T, Tyson J, Murthy BVR. Association of physical activity with mortality in the US dialysis population. Am J Kidney Dis 2005; 45:690–701.
Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med 2010; 170:1566–1575.
Chudyk A, Petrella RJ. Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis. Diabetes Care 2011; 34:1228–1237.
Choi KM, Han KA, Ahn HJ, Hwang SY, Hong HC, Choi HY, et al. Effects of exercise on sRAGE levels and cardiometabolic risk factors in patients with type 2 diabetes: a randomized controlled trial. J Clin Endocrinol Metab 2012; 97:3751–3758.
Nelson M, Rejeski W, Blair S, Duncan P, Judge J, King A. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and Heart Association. Med Sci Sport Med 2007; 39:1435–1445.
Stack AG, Murthy B. Exercise and limitations in physical activity levels among new dialysis patients in the United States: an epidemiologic study. Ann Epidemiol 2008; 18:880–888.
Boor P, Celec P, Behuliak M, Grančič P, Kebis A, Kukan M, et al. Regular moderate exercise reduces advanced glycation and ameliorates early diabetic nephropathy in obese Zucker rats. Metabolism 2009; 58:1669–1677.
Ishikawa Y, Gohda T, Tanimoto M, Omote K, Furukawa M, Yamaguchi S, et al. Effect of exercise on kidney function, oxidative stress, and inflammation in type 2 diabetic KK-A(y) mice. Exp Diabetes Res 2012; 2012:1–10.
Lazarevic G, Antic S, Vlahovic P, Djordjevic V, Zvezdanovic L, Stefanovic V. Effects of aerobic exercise on microalbuminuria and enzymuria in type 2 diabetic patients. Ren Fail 2007; 29:199–205.
Leehey DJ, Moinuddin I, Bast JP, Qureshi S, Jelinek CS, Cooper C, et al. Aerobic exercise in obese diabetic patients with chronic kidney disease: a randomized and controlled pilot study. Cardiovasc Diabetol 2009;8:62.
Kouidi E. Central and peripheral adaptations to physical training in patients with end-stage renal disease. Sports Med 2001; 31:651–665.
Neil A, Smart A, Andrew D, Williams B, Itamar Levinger C, Steve Selig D et al. Exercise & Sports Science Australia (ESSA) position statement on exercise and chronic kidney disease. J Sci Med Sport 2013; 16: 406–411.
Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials. BMJ 2010; 340:c869.
Moher D, Schulz KF, Altman DG. The CONSORT statement: revised 52 recommendations for improving the quality of reports of parallel-group randomized trials. Ann Intern Med 2001; 134:657–662.
Moher D, Schulz KF, Altman D. The CONSORT statement: revised 53 recommendations for improving the quality of reports of parallel-group randomized trials. JAMA 2001; 285:1987–1991.
Moher D, Schulz KF, Altman DG. The CONSORT statement: revised 54 recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 2001; 357:1191–1194.
Martínez-Castelao A, Górriz JL, Bover J, et al. Consensus document for the detection and management of chronic kidney disease. Nefrologia 2014; 34:24362–24362.
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16:31–41.
Gault MH, Longerich LL, Harnett JD, Wesolowski C. Predicting glomerular function from adjusted serum creatinine. Nephron 1992; 62:249–256.
American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 6th ed. Indianapolis: Lippincott Williams & Wilkins; 2000.
Yu H-I, Chiu S-T, Hua S-C, Tai T-S, Chen H-C. The effect of physical activity on diabetic nephropathy. Life Sci J 2014; 11:3.
Tanaka K, Hara S, Kushiyama A, Ubara Y, Yoshida Y, Mizuiri S, et al. Risk of macrovascular disease stratified by stage of chronic kidney disease in type 2 diabetic patients: critical level of the estimated glomerular filtration rate and the significance of hyperuricemia. Clin Exp Nephrol 2011; 15:391–397.
Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. J Am Med Assoc 2001; 286:1218–1227.
Nicolucci A. Improvement of quality of life with supervised exercise training in subjects with. Arch Intern Med 2011; 171:1951–1953.
Kurdak H, Sandıkçı S, Ergen N, Dogan A, Kurdak SS. The effects of regular aerobic exercise on renal functions in streptozotocin induced diabetic rats. J Sports Sci Med 2010; 9:294–299.
Yuji I, Tomohito G, Mitsuo T, Keisuke O, Masako F, Saori Y. Effect of exercise on kidney function, oxidative stress, and inflammation in type 2 diabetic KK-A mice. Exp Diabetes Res 2012; 2012:702948.
El-Nahas N, Bahey H, Aboelazm SH. Moderate versus low intensity aerobic exercise on bone mineral density in patients on hemodialysis. Glob J Med Res 2013; 13:11–17.
Zaher S, El-Nahas N, Serry Z. Effect of aerobic exercise on serum calcium and phosphorus in patients under renal haemodialysis. Faculty of Physical Therapy [master thesis]. Cairo: Cairo University; 2012.
Vaithilingham I, Polkinghorne KR, Atkins RC, Kerr PG. Time and exercise improve phosphate removal in hemodialysis patients. Am J Kidney Dis 2004; 43:85–89.
Makhlough A, Ilali E, Mohseni R, Shahmohammadi S. Effect of intradialytic aerobic exercise on serum electrolytes levels in hemodialysis patients. Iran J Kidney Dis 2012; 6:119–123.
Azra SM, Soleimani A, Alavi NM, Baseri AM, Savari M. Comparing the effects of active and passive intradialytic pedaling exercises on dialysis efficacy, electrolytes, hemoglobin, hematocrit, blood pressure and health-related quality of life. Nurs Midwifery Stud 2015; 4:e25922.
Afshar R, Shegarfy L, Shavandi N, Sanavi S. Effects of aerobic exercise and resistance training on lipid profiles and inflammation status in patients on maintenance hemodialysis. Indian J Nephrol 2010; 20:185–189.
Parsons TL, Toffelmire EB, King-VanVlack CE. The effect of an exercise program during hemodialysis on dialysis efficacy, blood pressure and quality of life in end-stage renal disease (ESRD) patients. Clin Nephrol 2004; 61:261–274.
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
About this article
Cite this article
Neveen, A., Nesreen, E., Nadia, M. et al. Effect of intradialytic aerobic exercise on patients with diabetic nephropathy. Bull Fac Phys Ther 24, 1–7 (2019). https://doi.org/10.4103/1110-6611.254615
- aerobic exercise
- chronic kidney disease
- diabetic nephropathy