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  • Review Article
  • Published:

Physical inactivity: a risk factor and target for intervention in renal care

Nature Reviews Nephrology volume 13, pages 152–168 (2017)Cite this article

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An Erratum to this article was published on 13 April 2017

This article has been updated

Key Points

  • Physical inactivity is a major modifiable risk factor for poor health-related quality of life, morbidity and mortality in patients with renal disease

  • An urgent need exists for the better assessment and management of physical inactivity in patients with renal disease

  • The level of physical activity in patients with chronic kidney disease (CKD) commonly decreases with disease progression, and does not fully recover after transplantation

  • Regular physical activity is beneficial across all stages of CKD, improving cardiometabolic, neuromuscular, and cognitive function, and can reduce the comorbidity burden in patients with renal disease

  • Physical activity, together with nutrition, is now recognized as an important component in the management of patients with CKD; a behavioural approach is crucial to help patients successfully adopt and maintain improved physical activity habits

Abstract

Regular physical activity is associated with an increased quality of life and reduced morbidity and mortality in the general population and in patients with chronic kidney disease (CKD). Physical activity, cardiorespiratory fitness, and muscle mass decrease even in the early stages of CKD, and continue to decrease with disease progression; notably, full recovery is generally not achieved with transplantation. The combined effects of uraemia and physical inactivity drive the loss of muscle mass. Regular physical activity benefits cardiometabolic, neuromuscular and cognitive function across all stages of CKD, and therefore provides an approach to address the multimorbidity of the CKD population. Interestingly, maintenance of muscle health is associated with renoprotective effects. Despite evidence of its benefits, physical activity and exercise management are not routinely addressed in the care of these patients. Although studies defining the optimum frequency, duration and intensity of physical activity are lacking, evidence from related fields can guide practical approaches to the care of patients with renal disease. Optimization of metabolic and nutritional status alongside promotion of physical activity is recommended. Behavioural approaches are now recognized as crucial in helping patients to adopt lifestyle changes and might prove valuable in integrating physical activity into renal care.

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Figure 1: The cycle of decreased physical functioning and reduced physical activity.
Figure 2: Change in physical activity level according to severity of chronic kidney disease (CKD) and transplantation status.
Figure 3: Association between physical activity, muscle mass and mortality in renal transplant recipients.
Figure 4: The contribution of chronic kidney disease (CKD) and related comorbidities on physical functioning and risk of mortality.

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Change history

  • 21 March 2017

    In the original pdf and online versions of this article, the y-axes of FIGS 3b–c and components of Supplementary information S1 (table) were incorrect, and the permissions line for FIGS 3a–b was not included. These errors have now been corrected in the online pdf and html versions of the manuscript.

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Acknowledgements

All authors researched data for the article, provided substantial contribution to discussions of the content and contributed to writing and to review/editing of the manuscript before submission.

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Author notes

  1. Dorien M. Zelle and Gerald Klaassen: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Nephrology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700RB, Groningen, Netherlands

    Dorien M. Zelle, Gerald Klaassen, Stephan J.L. Bakker & Gerjan Navis

  2. Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700RB, Groningen, Netherlands

    Edwin van Adrichem

  3. Research group Healthy Ageing, Hanze University of Applied Sciences, Allied Health Care and Nursing, Groningen, Eyssoniusplein 18, 9701 DC, Groningen, Netherlands

    Edwin van Adrichem

  4. Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700RB, Groningen, Netherlands

    Eva Corpeleijn

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Supplementary information

Supplementary information S1 (table)

Cochrane Risk of Bias Assessment pertaining to table 3. (PDF 53 kb)

Supplementary information S2 (table)

Evidence-based benefits of physical activity in patients with renal disease (PDF 95 kb)

PowerPoint slides

Glossary

Physical functioning

The ability to perform locomotor tasks, such as activities of daily living, in a normal manner.

VO2peak

The peak amount of oxygen that the body is able to utilize during sustained physical exertion.

Sarcopenia

The age-related loss of skeletal muscle mass and function that affects millions of older adults. This loss of muscle mass and function can lead to limitations in physical functioning and decreased quality of life.

Physical deconditioning

The deterioration of the cardiovascular and musculoskeletal system, primarily induced by physical inactivity, debilitating disease, prolonged bed rest, or sarcopenia.

Vigorous intensity physical activity

Exercise that requires a large amount of effort, causing rapid breathing and a substantial increase in heart rate, such as jogging, swimming laps, and hiking uphill.

Moderate intensity

Exercise that requires a moderate amount of effort that noticeably accelerates the heart rate and breathing, such as brisk walking, easy cycling and general gardening.

Pulse wave velocity

The velocity at which the arterial pulse propagates through the circulatory system. It is a widely used, simple, non-invasive method to determine arterial distensibility and endothelial function.

High sensitivity (hs)-CRP

C-reactive protein (CRP) is an acute phase protein that is raised in many different infections. High-sensitivity CRP (hs-CRP) is a sensitive test, used more commonly in apparently healthy people.

Glycated haemoglobin

Glucose-bound haemoglobin.

Postprandial glucose levels

Refers to the blood glucose level measured 2 h after a meal, a time period in which postprandial glucose level is normalized in people with normal glucose tolerance. Postprandial glucose abnormality is the first indicator of impaired glucose metabolism, as it is the result of reduced first-phase insulin secretion.

Muscle secretome

A complex set of several hundred peptides secreted from muscle cells; secretion of many of these peptides is dependent upon muscle contraction.

Bioimpedance

A commonly used method for estimating body composition (lean body mass and body fat) by calculating the opposition to the flow (impedance) of an electric current through body tissues.

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Zelle, D., Klaassen, G., van Adrichem, E. et al. Physical inactivity: a risk factor and target for intervention in renal care. Nat Rev Nephrol 13, 152–168 (2017). https://doi.org/10.1038/nrneph.2016.187

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