The effect of exercise training interventions in adult kidney transplant recipients: a systematic review and meta-analysis of randomised control trials

Abstract

Background

Kidney transplant recipients (KTRs) are characterised by adverse changes in physical fitness and body composition. Post-transplant management involves being physically active, although evidence for the effect of exercise is limited.

Objective

To assess the effects of exercise training interventions in KTRs.

Methods

NCBI PubMed (MEDLINE) and CENTRAL (EMBASE, WHO ICTRP) databases were searched up to March 2021 to identify eligible randomized controlled trials (RCTs) that studied exercise training in adult KTRs. Outcomes included exercise capacity, strength, blood pressure, body composition, heart rate, markers of dyslipidaemia and renal function, and health-related quality of life (QoL).

Results

Sixteen RCTs, containing 827 KTRs, were included. The median intervention length was 14-weeks with participants exercising between 2–7x/week. Most studies used a mixture of aerobic and resistance exercise. Significant improvements were observed in cardiorespiratory function (VO₂peak) (3.21 ml/kg/min, p = 0.003), 6MWT (76.3 meters, p = 0.009), physical function (STS-60, 4.8 repetitions, p = 0.04), and high-density lipoprotein (HDL) (0.13 mg/dL, p = 0.03). A moderate increase in maximum heart rate was seen (p = 0.06). A moderate reduction in creatinine was also observed (0.14 mg/dl, p = 0.05). Isolated studies reported improvements in strength, bone health, lean mass, and QoL. Overall, studies had high risk of bias suggestive of publication bias.

Conclusions

Exercise training may confer several benefits in adult KTRs, particularly by increasing cardiorespiratory function and exercise capacity, strength, HDL levels, maximum heart rate, and improving QoL. Additional long-term large sampled RCTs, incorporating complex interventions requiring both exercise and dietary behaviour change, are needed to fully understand the effects of exercise in KTRs.

Keywords:

• Exercise
• rehabilitation
• kidney transplant
• training
• renal

Acknowledgments

The views expressed are those of the author(s) and not necessarily those of the UK Kidney Association (UKKA), NHS, the Applied Research Collaboration East Midlands, the National Institute for Health Research Leicester BRC or the Department of Health. We thank Professor James Burton for leading the UKKA guideline development group of which this data has contributed to.

Disclosure statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The views expressed are those of the authors and not necessarily those of the UK Kidney Association (UKKA), National Health Service (NHS), the Applied Research Collaboration East Midlands, the National Institute for Health Research (NIHR), or the Department of Health. Data and conclusions from this work contributed to recommendations in the first ‘Exercise and Lifestyle in CKD’ clinical practice guidelines as commissioned by the UK Kidney Association (UKKA) and is being undertaken in association the Exercise and Lifestyle Clinical Study Group (CSG).

Authors’ contribution

TJW contributed to the original conception and design of the study. All authors either contributed to the review of included papers (TJW, NCB, SAG, REB, CJL), analysis (TJW) or interpretation (EMC, ACS) of data. TJW drafted the manuscript. All authors critically revised the manuscript. All authors gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

Funding

No specific funding was granted for the production of this work. TJW, CJL, ACS are part-funded by the Stoneygate Trust and supported by the National Institute for Health Research Leicester Biomedical Research Centre (BRC). TJW is funded by the Applied Research Collaboration East Midlands. NCB is supported by the National Institute for Health Research Leicester Biomedical Research Centre (BRC). REB and NCB were part-funded by a Heart Research UK project grant. EMC was supported by a Kidney Research UK PhD Fellowship. SAG is supported by an NIHR Post-doctoral Fellowship.

Additional information

Notes on contributors

Thomas J. Wilkinson

Thomas J. Wilkinson, PhD - Applied Research Collaboration East Midlands, Leicester, UK. Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK. Research Fellow at the Leicester Diabetes Centre. His research interests include lifestyle interventions in people living with multiple long-term conditions (multimorbidity), in particular those with kidney disease.

Nicolette C. Bishop

Nicolette C. Bishop, PhD - School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK. Professor of Exercise Immunology at Loughborough University. Her research interests span the effects of exercise on immunity, inflammation and infection in the general population and those with specific long-term conditions to the impacts of exercise on immune cell function and infection risk in elite athletes.

Roseanne E. Billany

Roseanne E. Billany, MPhil - Department of Cardiovascular Sciences, University of Leicester, Leicester, UK. Clinical Trials Facilitator and PhD student exploring exercise/lifestyle in kidney transplant recipients. She is interested in the link between lifestyle and cardiometabolic disease.

Courtney J. Lightfoot

Courtney J. Lightfoot, PhD - Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK. Leicester NIHR Biomedical Research Centre, Leicester, UK. Research Associate at the University of Leicester. Her research interests include development of complex interventions, patient activation and self-management, patient experiences of living with a chronic condition including symptom burden and quality of life.

Ellen M. Castle

Ellen M. Castle, PhD - Therapies Department King’s College Hospital NHS Trust, London, UK. Renal Medicine, School of Life Course Sciences, King’s College London, UK. Specialist Renal Physiotherapist at King’s College London. She has an interest in exercise following kidney transplantation and completed her PhD investigating the use of an online-resource to prevent weight gain in new kidney transplant recipients.

Alice C. Smith

Alice C. Smith, PhD - Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK. Leicester NIHR Biomedical Research Centre, Leicester, UK. Professor of Lifestyle Medicine at the University of Leicester. Her primary research interest is the role of physical activity, exercise and lifestyle management in kidney disease. Her translational research programme spans lab-based exploratory and mechanistic work to implementation and service evaluation.

Sharlene A. Greenwood

Sharlene A. Greenwood, PhD - Therapies Department King’s College Hospital NHS Trust, London, UK. Renal Medicine, School of Life Course Sciences, King’s College London, UK. NIHR Advanced Research Fellow, President of the UKKA, and consultant physiotherapist at King’s College Hospital. She leads a clinical and research team of therapists, leading on various research and clinical innovation projects in renal, cardiac and physical activity.