Flywheel Exercise for CKD

Among Veterans, the prevalence of chronic kidney disease (CKD) is reported to be as high as
47.3% and a third higher than the general population. Muscle wasting and dysfunction have
been identified as primary consequences of CKD. Disease-induced reductions in lean tissue
adversely affect muscle fatigability. Consequently, muscle fatigability may serve as a
potential limiting factor that contributes to activity limitations. However, there is a lack
of evidence informing our understanding of muscle fatigability in patients with CKD. Dialysis
treatment is a major factor contributing to the high financial costs of CKD care. Thus, in
addition to potential health and quality of life benefits, treatments capable of maintaining
kidney function or delaying the onset of dialysis treatment would provide substantial
socio-economic benefit. Both lean body mass and muscle fatigability may be improved through
strength training. Eccentric-overload (i.e. muscle lengthening) progressive resistance
exercise (PRE) has been shown to be safe and effective for a variety of chronic conditions.
Eccentric PRE using portable flywheel technology may provide a clinically viable treatment
option to combat muscle impairments in CKD given the cost effectiveness and minimal space
requirements for this mode of exercise.

The purpose of this study is to assess feasibility of the eccentric-overload PRE regimen for
Veterans with CKD stage 3 & 4 predialysis using a prospective single-arm pre-test post-test
intervention design. The primary aim of the project is to determine the effects of
eccentric-overload PRE on muscle fatigability in Veterans with CKD Stages 3 & 4 predialysis.
Feasibility of the regimen will be determined by the time needed to complete the 4-exercise
regimen and the perceived exertion levels reported by the study participants.