Aerobic and Resistant Physical Exercise on Chronic Kidney Disease (CKD) Patients: are there any Benefits?

Abstract

Chronic kidney disease (CKD) has become an epidemic condition, with increasing incidence worldwide, generating high mortality rates and high health care costs. Several studies have demonstrated that inflammation is common in patients with CKD and it is associated with a high mortality rate in this population. Regular exercise has been described as a therapeutic strategy for reducing the risk of chronic and metabolic diseases, in part because of exercise training seems to exert anti-inflammatory effects. Therefore, the aim of the present review was to analyze the effects of aerobic and resistance exercise on inflammatory biomarkers in patients with CKD. CKD results in serum accumulation of toxic substances, the uremic toxins. These activate immune and inflammatory response in experimental models and in patients with CKD. Several studies involving non-pharmacological interventions have focused on CKD patients, aiming at reducing the inflammatory state, improving quality of life and extending the survival of these patients. It has been found that using treadmill for walking in patients undergoing pre-dialysis treatment was effective in reducing CRP and IL-6, showing that this type of aerobic exercise may also promote an anti-inflammatory effect. In contrast, some studies have not been able to show any beneficial effect on inflammation; e.g., a study using an intradialytic cycling protocol for HD patients 3x / week for 6 months found no decrease in IL-6, CRP and TNF-α. There are a number studies reporting favorable effects of exercise training on the inflammatory response triggered by hypertension, diabetes, obesity, dyslipidemia and cardiovascular events in the general population; however, this review showed that the role of the anti-inflammatory effect of aerobic and resistance exercise remains controversial in CKD patients, particularly in those undergoing dialysis. Conversely, data from the literature found that high intensity aerobic exercise training for a sustained period of time seems to have anti-inflammatory effects when compared to resistance exercise, in particular when PCR is used as a marker of inflammation.