Key result
12 weeks of aerobic exercise training safely prevented the progressive increase in resting muscle sympathetic nerve activity and augmentation index observed in the stretching control group among patients with CKD.
Why the study?
Chronic kidney disease is characterized by chronic sympathetic nervous system overactivation increasing cardiovascular risk, motivating whether aerobic exercise training reduces resting sympathetic activity and vascular stiffness.
Does 12 weeks of aerobic exercise training reduce resting muscle sympathetic nerve activity and vascular stiffness in sedentary older adults with chronic kidney disease?
RCT (n=58)
Open-label with blinded analysis
Computer-generated sequence stratified by stage of CKD
Yes
Does 12 weeks of aerobic exercise training reduce resting muscle sympathetic nerve activity and vascular stiffness in sedentary older adults with chronic kidney disease?
Absolute Event Rate: 28.1% vs 36%
p-value: p=0.022
Aerobic exercise training safely prevents the progressive increase in resting muscle sympathetic nerve activity and aortic wave reflection observed over 12 weeks in sedentary older adults with chronic kidney disease.
Supports aerobic exercise to prevent sympathetic and stiffness progression in CKD; extends RCT evidence to sedentary older adults.
BACKGROUNDChronic kidney disease (CKD) is characterized by chronic overactivation of the sympathetic nervous system (SNS), which increases the risk of cardiovascular (CV) disease and mortality. SNS overactivity increases CV risk by multiple mechanisms, including vascular stiffness. We tested the hypothesis that aerobic exercise training would reduce resting SNS activity and vascular stiffness in patients with CKD.METHODSIn this randomized controlled trial, sedentary older adults with CKD underwent 12 weeks of exercise (cycling, n = 32) or stretching (an active control group, n = 26). Exercise and stretching interventions were performed 20-45 minutes/session at 3 days/week and were matched for duration. Primary endpoints include resting muscle sympathetic nerve activity (MSNA) via microneurography, arterial stiffness by central pulse wave velocity (PWV), and aortic wave reflection by augmentation index (AIx).RESULTSThere was a significant group × time interaction in MSNA and AIx with no change in the exercise group but with an increase in the stretching group after 12 weeks. The magnitude of change in MSNA was inversely associated with baseline MSNA in the exercise group. There was no change in PWV in either group over the study period.CONCLUSIONOur data demonstrate that 12 weeks of cycling exercise has beneficial neurovascular effects in patients with CKD. Specifically, exercise training safely and effectively ameliorated the increase in MSNA and AIx observed over time in the control group. This sympathoinhibitory effect of exercise training showed greater magnitude in patients with CKD with higher resting MSNA.TRIAL REGISTRATIONClinicalTrials.gov, NCT02947750.FUNDINGNIH R01HL135183; NIH R61AT10457; NIH NCATS KL2TR002381; and NIH T32 DK00756; NIH F32HL147547; and VA Merit I01CX001065.
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Jeong et al. (2023) conducted an RCT in Chronic kidney disease (CKD) stages III-IV (n=58). Aerobic exercise training (cycling) vs. Stretching (active control) was evaluated on Muscle sympathetic nerve activity (MSNA) burst frequency (bursts/min) (p=0.022). 12 weeks of aerobic exercise training safely prevented the progressive increase in resting muscle sympathetic nerve activity and augmentation index observed in the stretching control group among patients with CKD.
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