Aerobic Training and Arterial Stiffness in Chronic Kidney Disease (CKD) Patients

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.

Inclusion Criteria:

- Stage 3 Chronic Kidney Disease (CKD)

- Primary diagnosis hypertension or diabetes

Exclusion Criteria:

- Smokers

- Individuals < 35 or > 70 years of age

- Any contraindicators to exercise training as defined by the ACSM guidelines (GETP8)