# Exercise as it relates to Disease/Water-based exercise for kidney disease
## What is the background?

Chronic kidney disease (CKD) is increasingly recognized as a global public health problem. CKD is a heterogeneous condition affecting kidney structure and function. CKD is recognized as a worldwide health problem. In 2005 the WHO (World Health Organization) had not recognized CKD as a chronic disease as apart of their report.
The National Kidney Foundation Kidney Disease (KDIGO) proposed the definition and classification for chronic kidney disease in 2004. This created a framework, which promoted increased attention to chronic kidney disease. Then in October 2009 KDIGO initiated a collaborative meta-analysis to examine the relationship of estimated glomerular filtration rate (GFR) and albuminuria which are factors which contribute to chronic kidney disease.

## Where is the research from?

The purpose of this research was to ascertain whether water-based, 12-week, regular, low-intensity aerobic exercise conditioning may provide beneficial effects for individuals with moderate chronic kidney disease and to compare the outcome with data of a sedentary control group.

## What kind of research was this?

The study conducted by Pechter et al was a clinical study. In order to determine if there was a correlation between water-based exercise and patients with chronic kidney disease T tests were used. Each of the measures was tested before and after the study in order to determine these differences within both the control and exercise group. A two-sample paired t-test was used and if a value was P < 0.05 it was accepted as statistically significant. By doing this statistical analysis, conclusions were able to be draw based on the results found.
In order to conduct the twenty- six patients with moderate CKD participated in the water based study. 17 participants were in the exercise group and there was a control group of 9 participants. Participants of both the exercise and control group undertook testing pre and post the study, which analyzed cardiorespiratory, renal functional, body mass and oxidative stress parameters. The study group did aerobic exercise vertically in the pool with total immersion to the shoulder twice a week for 12 weeks, with sessions lasting 30 min at low intensity. The conditioning consisted of a 10min warm-up period with gentle stretching, a 10min period of cardiovascular exercises with gradually increasing intensity and a 10 min cooling down period with a final stretching time.

## What were the basic results?

From the study it was found the exercise group had a decrease in proteinuria and Cys-C values which directly relate to kidney function. Whereas, there was no significant change in the control group. By reducing proteinuria was the most important goal of the rehabilitation. The reduction in proteinuria halts the progression of nephropathy (damage or disease of the kidney). From the study there was a statistically significant improvement in psychological well-being and quality of life in the exercise group from a score of 6.6 before the study to 4.5 after the study.

## How did the researchers interpret the results?

In order to interpret the results, researchers used a statistical analysis in the form of T-tests to identify a correlation between exercise and chronic kidney disease.

## What conclusions should be taken away from this research?

From the research conducted there may be a correlation between low intensity water based exercise and an improvement in a number of aspects, which affects individuals with chronic kidney disease. Although, there are a number of flaws in the research. These include:
* Small sample size
* Not an equal representation of control and experimental participants
* No repetition of study
* Short period of time
A correlation was also found in a study conducted by Pechter et al which was a 10 year follow up study of chronic kidney disease patients who participated in regular exercise. This results showed statistically significant difference of a P-value of 0.037 between the sedentary group and the exercise group in reaching renal replacement therapy or all-cause death in a follow-up time of 10 years. Similarly, in a study by Peng et al which, analyzed two different groups of rats. One group did a 30 min session 3 times per week while the other group did the same but for a 60 min session. The results showed the greatest benefit in the group that took part in the 60 min session in alleviating the effects of chronic kidney disease. Similarly to both of the Pechter et al studies the benefits of water-based exercise depend on depend on the duration and intensity but what must be considered is the individual and their specific physiological condition.

## What are the implications of this research?

The studies which have been conducted have concluded that there may be a relationship between water based exercise and an improvement in patients with chronic kidney disease. The implications of this research is that water based exercise can be incorporated into rehabilitation programs to decrease the effect of chronic kidney disease. However as shown in the literature there is no clear direction in relation to intensity and duration. There would need to be further research specifically surrounding water based exercise and its effect as there is clear statistical evidence that there may be a correlation.

## References

* ↑ Levey et al (2012), Chronic Kidney Disease, Lancet, 379, 165
* ↑ Jong et al,(2011), "The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report" International Kidney, 80,17-28
* ↑ Pechter et al,(2003),Beneficial effects of water-based exercise in patients with chronic kidney disease, International Journal of Rehabilitation Research, 26,1-4
* ↑ Peng et al,(2012),Swimming Exercise Prevents Fibrogenesis in Chronic Kidney Disease by Inhibiting the Myofibroblast Transdifferentiation,PLoS One, 7,
Fact Sheet based on: 1. Beneficial effects of water-based exercise in patients with chronic kidney disease. International Journal of Rehabilitation Research. 2003;26(1)