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Randomized Controlled Trial
. 2022 Jun 1;182(6):650-659.
doi: 10.1001/jamainternmed.2022.1449.

Effect of Structured, Moderate Exercise on Kidney Function Decline in Sedentary Older Adults: An Ancillary Analysis of the LIFE Study Randomized Clinical Trial

Michael G Shlipak  1   2   3 , Anoop Sheshadri  1   2   3 , Fang-Chi Hsu  4 , Shyh-Huei Chen  4 , Vasantha Jotwani  1   2 , Gregory Tranah  5 , Roger A Fielding  6 , Christine K Liu  6   7   8   9 , Joachim Ix  10 , Steven G Coca  11 ; LIFE Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Effect of Structured, Moderate Exercise on Kidney Function Decline in Sedentary Older Adults: An Ancillary Analysis of the LIFE Study Randomized Clinical Trial

Michael G Shlipak et al. JAMA Intern Med. .

Abstract

Importance: Observational evidence suggests that higher physical activity is associated with slower kidney function decline; however, to our knowledge, no large trial has evaluated whether activity and exercise can ameliorate kidney function decline in older adults.

Objective: To evaluate whether a moderate-intensity exercise intervention can affect the rate of estimated glomerular filtration rate per cystatin C (eGFRCysC) change in older adults.

Design, setting, and participants: This ancillary analysis of the Lifestyle Interventions and Independence For Elders randomized clinical trial enrolled 1199 community-dwelling, sedentary adults aged 70 to 89 years with mobility limitations and available blood specimens. The original trial was conducted across 8 academic centers in the US from February 2010 through December 2013. Data for this study were analyzed from March 29, 2021, to February 28, 2022.

Interventions: Structured, 2-year, partially supervised, moderate-intensity physical activity and exercise (strength, flexibility) intervention compared with a health education control intervention with 2-year follow-up. Physical activity was measured by step count and minutes of moderate-intensity activity using accelerometers.

Main outcomes and measures: The primary outcome was change in eGFRCysC. Rapid eGFRCysC decline was defined by the high tertile threshold of 6.7%/y.

Results: Among the 1199 participants in the analysis, the mean (SD) age was 78.9 (5.2) years, and 800 (66.7%) were women. At baseline, the 2 groups were well balanced by age, comorbidity, and baseline eGFRCysC. The physical activity and exercise intervention resulted in statistically significantly lower decline in eGFRCysC over 2 years compared with the health education arm (mean difference, 0.96 mL/min/1.73 m2; 95% CI, 0.02-1.91 mL/min/1.73 m2) and lower odds of rapid eGFRCysC decline (odds ratio, 0.79; 95% CI, 0.65-0.97).

Conclusions and relevance: Results of this ancillary analysis of a randomized clinical trial showed that when compared with health education, a physical activity and exercise intervention slowed the rate of decline in eGFRCysC among community-dwelling sedentary older adults. Clinicians should consider targeted recommendation of physical activity and moderate-intensity exercise for older adults as a treatment to slow decline in eGFRCysC.

Trial registration: ClinicalTrials.gov Identifier: NCT01072500.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Shlipak reported grants from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Disease during the conduct of the study, grants from Bayer Pharmaceuticals outside the submitted work, and personal fees from AstraZeneca, Boehringer Ingelheim, Intercept Pharmaceuticals, Cricket Health, and Bayer Pharmaceuticals outside the submitted work. Dr Fielding reported grants from the National Institute on Aging and US Department of Agriculture Agricultural Research Service during the conduct of the study, as well as stock options from Axcella Health and InsideTracker, grants from Lonza, and personal fees from Juvicell, Chugai, Pfizer, Biophytis, Amazentis, and Nestlé outside the submitted work. Dr Ix reported grants from the National Institutes of Health and Baxter International during the conduct of the study, as well as travel support from the American Society of Nephrology and Kidney Disease Improving Global Outcomes, serving on the data safety board for Sanifit, and serving on the advisory boards for Ardelyx, Jnana, and AstraZeneca. Dr Coca reported personal fees from Renalytix, Bayer, Boehringer Ingelheim, Reprieve Cardiovascular, Axon Therapies, Nuwellis, 3ive, and Renalytix outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. CONSORT Diagram
eGFRCysC indicates estimated glomerular filtration rate by cystatin C; SPPB, Short Physical Performance Battery.
Figure 2.
Figure 2.. Effect of Randomization to Physical Activity and Exercise vs Health Education on Rapidly Declining Kidney Function, Overall and Stratified by Subgroups
eGFRCysC indicates estimated glomerular filtration rate by cystatin C. aThe Other category is excluded because there were too few participants to make a meaningful analysis by subgroup.
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