Pilot Randomized Trial of Home-Based, Video-Supervised Exercise on Muscle Metabolism and Physical Endurance in Chronic Kidney Disease

BackgroundMuscle impairment in chronic kidney disease (CKD) contributes to decreased physical performance, frailty, and higher mortality risk. Regular exercise improves muscle function in CKD. This pilot randomized controlled study evaluated the efficacy of a home-based, video-supervised exercise program on muscle function and physical endurance in CKD. MethodsSedentary adults (n=32) with moderate-to-severe nondialysis CKD (eGFR <60 mL/min/1.73m2) were randomized to 12 weeks of moderately intense home-based, video-supervised exercise or usual care. Co-primary outcomes included in-vivo muscle mitochondrial bioenergetics (rate of phosphocreatine [PCr] recovery, kPCr) using phosphorus-31 (31P) magnetic resonance spectroscopy and work efficiency using graded cycle exercise testing. Secondary outcomes included 6-minute walk distance test (6MWD), total work, and peak oxygen consumption (VO2peak). Other outcomes were body composition measures and plasma cytokines. Linear mixed models estimated between-group differences. ResultsParticipants included 23 exercisers (EX) and nine in usual care (UC), with mean (SD) ages of 62.6 (10.8) and 67.2 (8.2) years, and eGFRs of 35.0 (12.6) and 32.3 (12) mL/min/1.73m2, respectively. No serious adverse events occurred; 90.5% of EX completed [&ge;]75% of sessions. Compared to UC, EX resulted significantly increased in-vivo muscle mitochondrial bioenergetics (0.20min-1, 95%CI [0.05,0.35], P=0.01), total work (5.03kJ, 95%CI [1.25,8.80], P=0.007), and 6MWD (39.1m, 95%CI [7.1,71.1], P=0.014). EX preserved fat-free mass (2.23kg, 95%CI [0.46, 4.0], P=0.011) and marginally decreased fat mass (-2.05kg, 95%CI [-4.5, 0.37], P=0.087) compared to UC. IL-8 concentration differed most between EX vs. UC (effect size -1.23, 95%CI [-0.67, -0.02], P=0.016). Differences in IL-6, TNF-, IL-1{beta}, IL-10, VO2peak and work efficiency were non-significant between groups. ConclusionsAmong adults with stage 3-5 CKD, 12-weeks of moderately intense home-based video-supervised, personalized exercise is feasible and improves muscle oxidative capacity and physical endurance. By addressing common barriers to exercise, such exercise protocols could help mitigate the functional decline and frailty associated with CKD. Key PointsO_LIA home-based video-supervised exercise program was feasible with a high level of adherence in nondialysis chronic kidney disease (CKD). C_LIO_LIA 12-week moderately intense home-based exercise program improved muscle mitochondria oxidative capacity and physical endurance in nondialysis CKD. C_LIO_LIAddressing common barriers to exercise could help mitigate the functional decline and frailty associated with CKD. C_LI