Abstract
BackgroundChronic Kidney Disease (CKD) patients frequently develop life-impairing bone mineral disorders. Despite the reported impact of exercise on bone health, systematic reviews of the evidence are lacking. This review examines the association of both physical activity (PA) and the effects of different exercise interventions with bone outcomes in CKD.MethodsEnglish-language publications in EBSCO, Web of Science and Scopus were searched up to May 2019, from which observational and experimental studies examining the relation between PA and the effect of regular exercise on bone-imaging or -outcomes in CKD stage 3–5 adults were included. All data were extracted and recorded using a spreadsheet by two review authors. The evidence quality was rated using the Cochrane risk of bias tool and a modified Newcastle-Ottawa scale.ResultsSix observational (4 cross-sectional, 2 longitudinal) and seven experimental (2 aerobic-, 5 resistance-exercise trials) studies were included, with an overall sample size of 367 and 215 patients, respectively. Judged risk of bias was low and unclear in most observational and experimental studies, respectively. PA was positively associated with bone mineral density at lumbar spine, femoral neck and total body, but not with bone biomarkers. Resistance exercise seems to improve bone mass at femoral neck and proximal femur, with improved bone formation and inhibited bone resorption observed, despite the inconsistency of results amongst different studies.ConclusionsThere is partial evidence supporting (i) a positive relation of PA and bone outcomes, and (ii) positive effects of resistance exercise on bone health in CKD. Prospective population studies and long-term RCT trials exploring different exercise modalities measuring bone-related parameters as endpoint are currently lacking.
Highlights
Chronic Kidney Disease (CKD) patients frequently develop life-impairing bone mineral disorders
Bone parameters were defined as areal bone mineral density (BMD) or bone mineral content (BMC) or Tscore measured with dual X-ray absorptiometry (DXA), bone macro- and micro-structure measured by 3D imaging techniques [quantitative computerized tomography (QCT) and magnetic resonance imaging (MRI)], and quantitative ultrasound (QUS) measurements of bone density that included broadband ultrasound attenuation (BUA) and the speed of sound (SOS)
Intradialytic resistance exercise training revealed to be effective in improving BMD at femoral neck and total. Implications for practice This is the first systematic review on observational and experimental studies to analyse the association of physical activity (PA) and exercise with bone outcomes and health in CKD patients
Summary
Chronic Kidney Disease (CKD) patients frequently develop life-impairing bone mineral disorders. Patients suffering from CKD frequently develop mineral and bone disorders (MBD) due to systemic alterations induced by the disease [4]. This syndrome has been associated with the spectrum of renal osteodystrophy [4], vascular calcifications, abnormalities in bone mineralisation and turnover [5], increased bone fractures [4], as well as increased morbidity and mortality, resulting in a diminished quality of life [6]. CKD-MBD encompasses a wide spectrum of clinical disorders such as alterations in mineral and bone metabolism [6], which are in turn associated with abnormalities in calcium, parathyroid hormone (PTH), phosphate or vitamin D metabolism [7]. PTH and FGF-23 are the main regulating hormones of bone integrity and mineral homeostasis [2]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
