Exercise and diseased kidneys journal of physiology

David G. Edwards Department of Kinesiology and Applied Physiology, University of D 2011

Endothelial function is impaired in chronic kidney disease and declines with sedentary ageing. In
addition to the risk of progressing to renal failure, chronic kidney disease is also associated with an
increased prevalence of cardiovascular disease. Exercise training would appear to be particularly
beneficial in chronic kidney disease to improve endothelial function and reduce cardiovascular risk;
however, data are lacking in both animal models and humans with reduced renal function. As a result
exercise training is not recommended to the same extent in chronic kidney disease as it is for those with
cardiovascular disease or traditional cardiovascular risk factors (Johansen, 2005). There may be unique
considerations for exercise training in kidney disease . The acute increase in cardiac output during
exercise impacts many vascular beds. Exercise training elicits endothelial improvements in the
vasculature supplying the heart and active skeletal muscle beds but also non-exercised limbs, all of
which appear to be shear dependent, suggesting endothelial adaptations are systemic. However, it is
well known that renal blood flow declines to levels that are well below resting values during exercise as
a result of a redistribution of blood flow to meet the needs of exercising muscle reduction in renal blood
flow during exercise may reduce shear stress and exacerbate high oxidative stress and low endothelial
nitric oxide synthase (eNOS) levels in the ageing kidney glance these results may be interpreted as a
failure of exercise to improve renal function in ageing. However, their findings that exercise training did
not worsen renal injury or function in ageing is also significant. A worsening of kidney disease with
training could ultimately have a significant impact on exercise recommendations for older adults or
those with kidney disease of any age.

Physical exercise and renal function Masato Suzuki Received: December 20, 2014 / Accepted: February
2, 2015

The kidneys play an important role in maintaining physiological factors within the body such as pH,
osmotic pressure, and electrolyte balance by excreting metabolic waste and noxious products, as well as
excreting and reabsorbing water and electrolytes including Na+ , K+ , and Cl- . These functions are
performed by excretion and reabsorption in the renal tubules and quantified as renal plasma flow (RPF)
and glomerular filtration rate (GFR). Even if the amounts of excretable noxious products were to
increase with an increase in metabolic rate, the RPF would be reduced during exercise. Therefore,
physical exercise has a negative effect on the kidneys in terms of maintaining renal function. However,
in sports medicine, research on renal function in athletes has been given less importance compared to
other areas of study such as the respiratory, circulatory, and neuromuscular systems, as well as glucose
and fat metabolism, since it has no direct influence on the performance of exercise. On the other hand,
renal function is important in the maintenance of fluid-electrolyte balance even in healthy persons and
athletes during exercise in warm conditions or in water. The purposes of this study are to review the
previous literature, present some of our observations on renal function, and discuss the mechanisms
underlying the changes in renal function and the roles of the kidneys during and/or after exercise.
Strategies to improve physical activity by exercise training in patients with chronic kidney disease

International Journal of Nephrology and Renovascular Disease

Yoshiyuki Morishita Daisuke Nagata Division of Nephrology, Department of Internal Medicine, Jichi
Medical University, Tochigi, Japan

Decreased physical activity resulting in muscle loss is often observed in CKD patients and is one of the
main predictors of mortality in these patients. Appropriate exercise training is important in improving
physical activity by preventing muscle loss in CKD patients, improving their quality of life and reducing
their mortality rate. Total management, including testing, programming, and counseling for exercise
training by medical staff, may encourage exercise training by CKD patients.