Clinical outcomes of exercise in people with pre-dialysis stages of chronic kidney disease: A systematic review with meta-analyses.

Background: Chronic kidney disease (CKD) is a leading cause of death and premature morbidity. Exercise may potentially delay or prevent disease progression. We conducted a systematic review and meta-analysis of the effect of exercise in people with pre-dialysis CKD on functional ability, quality of life, renal parameters, cardiovascular risk factors and inflammatory markers. Methods: We searched 7 major databases from January 2000 to November 2021, using key terms related to pre-dialysis CKD and exercise. Trials comparing the effects of exercise with a control group were pooled. Meta-analyses used a random effects inverse variance model. Results: Twenty-six trials (860 participants) met the inclusion criteria. Significant improvements were identified in peak VO 2 (2.85mL/kg/min, 95%CI:1.31,4.40; p=0.0003); the 6 Minute Walk (54.25m, 95%CI:29.65,78.85; p<0.0001), Timed Up and Go (-0.34, 95%CI:-0.57,-0.12; p=0.003), 2 Minute Step (57.48 steps, 95%CI:27.80,87.16; p=0.0001), and Sit To Stand tests (6.45 repetitions, 95%CI:1.18,11.72; p=0.02)]; Short Form [SF]-36 General Health (5.27, 95%CI:0.25,10.28; p=0.04); SF-36 Physical Component Summary (1.91, 95%CI:0.25,3.57; p=0.02); SF-36 Mental Component Summary (2.40, 95%CI:0.37,4.42; p=0.02)]; and waist circumference (-3.17, 95%CI:-4.44,-1.89; p<0.00001). Conclusions: Exercise improved aerobic capacity, functional ability and quality of life in people with early CKD. Additional evidence is needed to determine if progression towards dialysis can be delayed.