The association of physical activity and physical function with clinical outcomes in adults with chronic kidney disease

Abstract

Despite guidelines supporting the regular assessment of physical functioning and encouragement of physical activity in management of the patient with chronic kidney disease (CKD), implementation has been undermined by a lack of understanding of the evidence for this recommendation. The purpose of this review is to present a summary of emerging data from larger epidemiologic cohorts that report associations between low levels of physical functioning and/or low physical activity and clinical outcomes in patients with CKD. Low levels of physical activity and poor physical functioning are strongly associated with mortality and poor clinical outcomes in adult patients with CKD, regardless of treatment modality. Low physical performance and activity limitations are more prevalent in patients with CKD, regardless of age, compared to older community-dwelling adults. The strength of the evidence presented should strongly motivate a focus of treatment on assessing and improving physical activity and physical function as part of routine patient-centered management of persons with CKD. Physical activity interventions are warranted because patients with CKD, regardless of age, have a high prevalence of low physical functioning and frailty that is similar to or higher than the general population of elderly adults; physical activity, physical function, and performance are strongly associated with all-cause mortality; and exercise training and exercise counseling have been shown to improve measures of physical functioning.