Aerobic exercise training attenuates the peak blood pressure response to exercise in chronic kidney disease

Abstract

Chronic kidney disease (CKD) is an expanding public health problem. Patients with CKD have reduced exercise tolerance and are at a high risk for cardiovascular disease and events. Previous work has demonstrated that an exaggerated blood pressure response to exercise occurs in these patients which may contribute to their poor exercise capacity and increased cardiovascular risk. The purpose of this study was to test the hypothesis that 12 weeks of aerobic exercise training would attenuate the peak blood pressure response to exercise in patients with CKD. METHODS: Twenty-eight patients with stage 3 and 4 CKD (mean±SD: estimated glomerular filtration rate 43 ± 12 ml/min/1.73 m2) were randomly allocated to an exercise training (EX) or control (CON) group. EX consisted of 12 weeks of supervised aerobic exercise 3 times per week. Exercise duration and intensity progressively increased to 45 minutes at 65% to 85% heart rate reserve. CON received routine care. Cardiopulmonary exercise testing was performed on a cycle ergometer at baseline and following 12 weeks. Exercise intensity increased by 15W every minute and automated breath-by-breath gas analysis averaged over 10 seconds intervals was acquired throughout the protocol. Blood pressure (Tango M2, SunTech, NC) was recorded at rest and every 2 min throughout exercise and recovery. RESULTS: Twelve weeks of EX increased both VO2peak (p<0.01) and exercise duration (p<0.01). At 12 weeks, peak systolic blood pressure was not different from baseline in the EX (207 ± 32 vs 206 ± 35 mmHg; p=0.86) or CON groups (192 ± 39 vs 194 ± 39 mmHg; p=0.85). Exercise training significantly reduced peak diastolic blood pressure (91 ± 14 vs 81 ± 14; p = 0.002) whereas this was unchanged in the CON group (82 ± 15 vs 84 ± 15 mmHg; p=0.66). CONCLUSION: Twelve weeks of aerobic exercise training improved exercise capacity and attenuated peak diastolic blood pressure during exercise in patients with stage 3 & 4 CKD. The reduced blood pressure reactivity observed following exercise training in CKD may reduce cardiovascular risk and requires further investigation. Funding source: National Institutes of Health, National Heart Lung and Blood Institute grant R01HL113514 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.