Aerobic Training and Arterial Stiffness in Chronic Kidney Disease (CKD) Patients
Condition: Chronic Kidney Disease; Hypertension; Diabetes
MeSH terms: Kidney Diseases; Renal Insufficiency, Chronic
Study type: Interventional

Summary: 
      The current study is designed to examine the impact of 16 weeks of moderate intensity aerobic
      training on arterial stiffness and blood pressure in stage 3 chronic kidney disease (CKD)
      patients. The investigators hypothesize that short term aerobic training will improve the
      stiffness of arteries in CKD patients.
    

Detailed description: 
      The focus of the current research group is to examine the impact of lifestyle interventions
      on the development of cardiovascular disease (CV) in chronic kidney disease (CKD) patients.
      The study being proposed is to determine the effect of short-term aerobic training on
      arterial stiffness and blood pressure (BP) in CKD patients. Arterial stiffness has been
      chosen as a dependent variable since it is one of the most important predictors of CV
      complications while hypertension is known to play a critical role both in the development of
      CV and in the progression of CKD (6, 41). The specific aims of the study are: (a) to
      determine the effect of short-term aerobic training on arterial stiffness in CKD patients,
      (b) to determine the effect of short-term aerobic training on resting and ambulatory blood
      pressures (ABP) in CKD patients and (c) to determine the effect of short-term aerobic
      training on the acute post-exercise blood pressure response in CKD patients since acute
      responses may be related to changes following a period of chronic training. Fifty, 35-70 yr
      old, stage 3 CKD patients, with either diabetes or hypertension as the primary cause of their
      CKD will be recruited for this study. Subjects will be randomly assigned to either the
      exercise group (ExG = 25) or to the control group (CG = 25). At the start of the study each
      subject will attend 4 research sessions. During the first session, resting and 24 hr ABP
      readings will be recorded. In the second session, anthropometric measures, peak oxygen uptake
      (VO2peak), and ABP values will be measured. Sessions 3 & 4 will be performed in random order.
      During these sessions, pulse wave velocity (PWV), augmentation index (AIx) and BP will be
      measured at baseline after a rest period. Subjects will then either walk for 30 min at 50-60%
      of VO2 peak, or sit quietly for an equal period of time. BP will be monitored for 60 min in
      recovery following exercise and ABP will be taken during the subsequent 24 hrs. ExG will
      perform supervised aerobic training for 45-50 min, 3 times per week, at a moderate intensity,
      for 16 weeks. CG will continue their activities of daily living but will not be given an
      exercise program. All subjects will be retested at week 8 for BP, ABP, and arterial stiffness
      and at week 16 for all variables. After 16 weeks of the study both groups will be retested
      using identical procedures as at baseline. A series of 2 X 2 analyses of covariance with age,
      baseline PWV, AIx and BP as the covariates, will be used to determine the effect of the 16
      week intervention period on the primary outcome variables. A 2 X 7 X 2, mixed factorial
      repeated measures ANOVA will be used to analyze the post-exercise data while a Pearson Moment
      Correlation Coefficient will be computed to examine the relationship between post-exercise
      acute responses and BP changes following chronic training. An alpha level of 0.05 will be
      used for all analyses.
    

Intervention name(s): Exercise training
Intervention type(s): Behavioral
Intervention description(s): Participants receive 16 weeks of moderate intensity aerobic training under the supervision of personal trainers. Each session lasts from 15 to 55 minutes depending upon patient tolerance
Other intervention name(s): Non-pharmacologic; Lifestyle
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Aerobic exercise; Moderate intensity; Ambulatory blood pressure; Post exercise hypotension