Article

Effects of a Renal Rehabilitation Exercise Program in

Patients with CKD: A Randomized, Controlled Trial
Ana P. Rossi,* Debra D. Burris,† F. Leslie Lucas,‡ Gail A. Crocker,§ and James C. Wasserman*

Abstract
Background and objectives Patients with CKD have a high prevalence of cardiovascular disease associated with
or exacerbated by inactivity. This randomized, controlled study investigated whether a renal rehabilitation
*Department of
exercise program for patients with stages 3 or 4 CKD would improve their physical function and quality of life.
Nephrology and
Transplantation,
Design, setting, participants, & measurements In total, 119 adults with CKD stages 3 and 4 were randomized, and Maine Medical
107 of these patients proceeded to usual care or the renal rehabilitation exercise intervention consisting of usual Center, †Clinical Trial
care plus guided exercise two times per week for 12 weeks (24 sessions). Physical function was determined by three Support Services,
Maine Medical Center
well established performance-based tests: 6-minute walk test, sit-to-stand test, and gait-speed test. Health-related Research Institute,
quality of life was assessed by the RAND 36-Item Short Form Health Survey. ‡
Center for Outcomes
Research and
Results At baseline, no differences in self-reported level of activity, 6-minute walk test, and sit-to-stand test scores Evaluation, Maine
Medical Center
were observed between the usual care (n=48) and renal rehabilitation exercise (n=59) groups, although baseline Research Institute, and
gait-speed test score was higher in the renal rehabilitation exercise group (P,0.001). At follow-up, the renal §
Turning Point Cardiac
rehabilitation exercise group but not the usual care group showed significant improvements in the 6-minute walk Rehabilitation &
test (+210.46266.0 ft [19% improvement] versus 2106219.9 ft; P,0.001), the sit-to-stand test (+26.9627% of age Prevention, Maine
prediction [29% improvement] versus +0.7612.1% of age prediction; P,0.001), and the RAND-36 physical Medical Center,
Portland, Maine
measures of role functioning (P,0.01), physical functioning (P,0.01), energy/fatigue levels (P=0.01), and general
health (P=0.03) and mental measure of pain scale (P=0.04). The renal rehabilitation exercise regimen was generally Correspondence:
well tolerated. Dr. James C.
Wasserman, Division
Conclusions A 12-week/24-session renal rehabilitation exercise program improved physical capacity and quality of Nephrology and
of life in patients with CKD stages 3 and 4. Longer follow-up is needed to determine if these findings will translate Transplantation,
Maine Medical
into decreased mortality rates. Center, 22 Bramhall
Clin J Am Soc Nephrol 9: 2052–2058, 2014. doi: 10.2215/CJN.11791113 Street, Portland, ME
04102-3175. Email:
wassej@mmc.org

Introduction physical performance and all-cause mortality (10).

Cardiovascular disease (CVD) is the major source of
morbidity and mortality in patients with CKD (1). The
overall burden of CVD in the CKD population is nearly
two times as great as that of patients without CKD
(82.1% versus 45.2%) (1). This high prevalence is associ-
ated with and exacerbated by physical inactivity (2–4).
Cardiac rehabilitation in patients with CVD improves
exercise capacity and overall quality of life and exerts
beneficial effects on various CVD risk factors (2,5).
Pooled data from randomized studies and population-
based analyses indicate that cardiac rehabilitation signif-
icantly reduces major coronary events, cardiac mortality,
and all-cause mortality (5,6).
Exercise training in patients with ESRD undergoing
dialysis, studied for over 30 years, has been shown to
improve physical functioning, cardiorespiratory fitness,
cardiovascular risk, and health-related quality of life (7,8).
In addition, patients physically active at the time of
dialysis initiation survive longer compared with their
sedentary counterparts (9). A recent observational study
in patients with CKD found an association between
However, the effects of exercise training on patients
with predialysis CKD are less well described. This
study examined whether a renal rehabilitation exercise
(RRE) program would improve physical function and
health-related quality of life in patients with CKD stages
3 and 4.
Materials and Methods
Study Design
This single-center, randomized, controlled trial ran-
domized 119 participants, of whom 107 participants
received usual CKD clinic care alone (usual care [UC]
group) or usual CKD care plus RRE for 12 weeks (RRE
group). The study was conducted at Maine Nephrology
Associates, a practice comprising 10 board-certified
nephrologists also affiliated with the Maine Medical
Center, in Portland, Maine. The Maine Medical Center
Institutional Review Board approved the study, and it
was conducted with adherence to the Declaration of
Helsinki. The study is registered at ClinicalTrials.gov
(Identifier NCT00792454).

2052 Copyright © 2014 by the American Society of Nephrology www.cjasn.org Vol 9 December, 2014
Clin J Am Soc Nephrol 9: 2052–2058, December, 2014 Rehabilitation Exercise in CKD: Randomized, Controlled Trial, Rossi et al. 2053
Participants
The study included men and women 18 years of age or
older with CKD stages 3 or 4 as calculated by the Modification
of Diet in Renal Disease equation (GFR=30–59 or 15–29 ml/min
per 1.73 m2, respectively) (11). This population was identified
through International Classification of Diseases, 9th Edition,
codes and screened consecutively by the principal investi-
gator and study coordinator to determine additional eligi-
bility of potential participants on the basis of predefined
exclusion criteria.
The study excluded patients with angina pectoris, chronic
lung disease resulting in significant shortness of breath or
oxygen desaturation at rest, cerebral vascular disease man-
ifested by transient ischemic attacks, active musculoskeletal
conditions, lower-extremity amputation with no prosthe-
sis, orthopedic disorder severely exacerbated by activity,
metastatic carcinoma, or inability to follow directions be-
cause of language barrier or decreased mental capacity. In
addition, the primary care nephrologist and primary care
physician were required to give permission for their patient
to enter the study after the potential intervention was de-
scribed to them on the basis of their independent assessment
of whether it was safe for their patient to participate in the
event that they were randomized to the exercise intervention.
All patients with CKD stages 3 or 4 who met entry criteria
were invited to participate in the trial. All participants pro-
vided written informed consent, at which time demographic
data and vital signs were obtained. A glucose finger stick was
performed on participants with diabetes as well. Baseline
physical functioning and quality of life outcomes data were
obtained at the next scheduled office visit after random-
ization to the study group but before the intervention was
initiated.
Randomization
Participants were stratified by age (#70 or .70 years of
age) and CKD stage (3 or 4) and randomized to one of two
study arms using computer-generated random numbers.
Given the nature of the intervention, it was not possible to
blind participants or their CKD providers to study group
assignments.
Intervention
All patients received standard CKD clinic care according
to the Kidney Disease Improving Global Outcomes clinical
practice guidelines for management of CKD (12) as provided
by their primary nephrologists within the group practice. In
addition, those randomized to the RRE intervention were
asked to participate in guided exercise two times per week
for 12 weeks at selected physical therapy or cardiac rehabil-
itation facilities in the greater Portland area, where staff had
been trained to implement an established exercise regimen.
Participants with a cardiac history were sent to the cardiac
rehabilitation facility; all others were free to choose among
the facilities offered. Pre- and postassessments were conducted
at the same facility for each patient.
Exercise sessions at these centers were conducted individ-
ually or in a group setting and consisted of cardiovascular,
weight training (resistance), and stretching exercises. An
exercise physiologist or physical therapist assessed car-
diovascular and strength capabilities at the initial session ac-
cording to the perceived level of exertion (PLE) scale (13) to
prescribe the appropriate exercise regimen. The regimen limited
participants to a PLE#11, corresponding to a 60%–65% pre-
dicted maximal heart rate.
Cardiovascular exercises included treadmill walking and/or
stationary cycling. Participants were instructed to increase
the duration of cardiovascular exercises by 2–3 minutes each
session (according to PLE) and enhance the intensity by
increasing bicycle freewheel tension or treadmill speed or
elevation. The goal of cycling or walking was to achieve
60 minutes of continuous exercise. Patients were also en-
couraged to exercise on their own and walk 5000–10,000
steps per day as measured on pedometers provided for
this purpose.
Weight training consisted of upper and lower extremity
extensions and flexions with free weights. Strengthening
and stretching exercises, described in the Dialysis Patients’
Guide to Exercise (14), were started at one set of 10 repe-
titions of each exercise using 1- to 10-lb weights (according
to tolerance) and increased to three sets of 15 repetitions,
after which time weight was further increased.
Some participants experienced difficulties attending all
exercise sessions in a consecutive fashion, and therefore, it
was determined that the exercise period could be extended
as needed to reasonably complete 24 exercise sessions.
Outcomes
Physical function and health-related quality of life were
measured at baseline and on completion of the course of
guided exercise in the RRE group and at comparable time
periods in the UC group.
Physical Function Testing. Three well established
performance-based tests were used to assess changes in
physical function. The 6-minute walk test (6MWT) measured
the distance (in feet) that patients covered in 6 minutes while
traversing a scored hallway (14–17). The sit-to-stand test
(STST) measured lower-extremity muscle strength as a
function of the time that patients needed to stand up from
a seated position and sit back down 10 times from a chair of
standardized height (18). The STST results were standardized
as a percentage of age-predicted value using prediction
formulas developed by Csuka and McCarty (19). Gait speed
was measured as the time needed to travel 20 ft at a comfort-
able pace expressed in centimeters per second for compar-
ison with normative values presented by Bohannon (20).
Self-reported level of activity was measured at baseline
using a scale of 1–4 as described by Painter et al. (7): (1)
activities of daily living only; (2) stretching or strengthening
activity; (3) low cardiovascular exercise (walking or cycling
less than three times weekly and/or ,20 minutes per session);
and (4) recommended cardiovascular exercise (at least three
times per week for $20 minutes per session).
Health-Related Quality of Life. The RAND 36-Item
Short Form Health Survey (RAND-36) questionnaire was
used to evaluate self-reported domains of health status (21).
Questionnaires were self-administered at the study center by
those participants capable of doing so independently. The
research coordinator administered the questionnaire to patients
unable to complete the survey on their own.
Adherence, Tolerability, and Adverse Events
All adverse events were recorded in patient charts. The
number of exercise sessions attended and the total time
2054 Clinical Journal of the American Society of Nephrology
span required to complete the guided exercise program
were noted, and means were tabulated.
Statistical Analyses
Baseline characteristics were compared by chi-squared
tests for categorical variables and t tests for continuous
variables. When data distribution was not normal, a Mann–
Whitney U test was used. The mean change from baseline
was compared between groups using a two-sample t test
if normally distributed or a Mann–Whitney U test if not
normally distributed. Because we were interested in any
change from baseline, we were only able to compare such
changes in those participants who had a follow-up mea-
surement. Because our losses to follow-up were fairly
high and to have a conservative estimate of the effect
size, we performed a secondary analysis of our data using
the last-observation-carried-forward method for those par-
ticipants who did not have a follow-up measurement. The
correlation between the number of sessions attended and
improvement in physical function was evaluated using the
Spearmen correlation coefficient. A P value #0.05 was con-
sidered statistically significant. Calculations were done
with SAS, version 9.2 and STATA 11.1 software.
Statistical Power
Our power calculation was on the basis of the ability to
detect differences between groups in RAND-36 scales. Relying
Figure 1. | Flow chart: distribution of patients from assessment of eligibility to completion of study period. RRE, renal rehabilitation exercise.
on the formulas published by Cohen (22) and variance esti-
mates from studies of the general United States population,
Ware (23) estimated sample size for experimentation com-
parison between two randomly formed groups with com-
parisons between repeated assessments over time. These
estimates assume a nondirectional hypothesis (two tailed)
with a false rejection rate of 5% and a statistical power of
80%. On the basis of these calculations, a sample size of 60
patients per group will detect a 10-point difference between
postintervention scores of the two treatment groups.
Results
Demographics
Among 404 participants screened, 285 participants were
excluded, because they either did not meet eligibility criteria
or lacked interest in study participation (Figure 1). Of 119
participants randomized, six participants per group did not
receive allocated intervention, most commonly for not
showing up in the UC group and lack of medical clearance
in the RRE group. In total, 107 participants entered the
study: 48 (mean age=69612 years) participants in the UC
group and 59 (mean age=68612 years) participants in the
RRE group (Table 1). The mean time between baseline and
follow-up testing was 99619.4 days for the UC group versus
125.5646.9 days for the RRE group (P,0.001). Although
mean ages were similar in the two groups, the RRE group
Clin J Am Soc Nephrol 9: 2052–2058, December, 2014 Rehabilitation Exercise in CKD: Randomized, Controlled Trial, Rossi et al. 2055

had a lower proportion of men (39% versus 69%), was more
likely to be taking oral hypoglycemic agents (27% versus 6%),
and was less likely to have arrhythmias (5% versus 17%).
The UC group had higher systolic BP (140.5620.2 versus
126.3618.7 mmHg). Approximately 74% of patients had
stage 3 CKD, and 26% of patients had stage 4 CKD; there
were no meaningful differences in CKD stage by treatment
group assignment. The length of time between allocation
and start of RRE was a median of 25 days (interquartile
range [IQR]=16.5–46 days).
Physical Function
Baseline physical function was generally similar be-
tween the groups (Table 1). The UC and RRE groups
had comparable self-reported levels of activity (1.6561.1 ver-
sus 1.7661.1; P=0.59), 6MWT scores (10806296 versus
10916340 ft; P=0.86), and STST scores (62.5619.2% versus
67.8621.4% of age predicted; P=0.19) at baseline. However,
patients assigned to the RRE group had significantly higher
gait-speed test (GST) at baseline than those in the UC group
(median=130 versus 102.5 cm/s; P,0.001).
Patients in the RRE group realized significant improvements
from baseline in physical function according to 6MWT and
STST measures (Figure 2). A 12-week/24-session course of
guided exercise produced a 19% increase in 6MWT scores in
patients with CKD stages 3 or 4 (+2106266 versus 2106220 ft
for the UC group; P,0.001) and a 29% improvement in the
STST scores (+27627% of age predicted for the RRE group
versus +0.7612% of age predicted for the UC group;
P,0.001). No significant differences between groups were ob-
served for GST (median change=0; IQR=29 to +13 cm/s in the
UC group versus median change=+9.5; IQR=236.4 to +34 cm/s
in the RRE group; P=0.76) (Figure 2). The effect size was
slightly smaller but remained statistically significant accord-
ing to the last observation carried forward analysis as well
(Supplemental Table A).

Table 1. Baseline characteristics by study group

Characteristics UC Group (n=48)a RRE Group (n=59)a

Sex, n (% men) 33 (68.8) 23 (39)

Age (yr), mean 6 SD 69.2612.4 67.7612.4
CKD stage, n (%)
3 35 (74.5) 42 (72.4)
4 12 (25.5) 16 (27.6)
Comorbidities, n (%)
Diabetes mellitus 17 (35.4) 27 (47.4)
Coronary artery disease 10 (22) 17 (30)
Congestive heart failure 1 (2) 3 (5)
Peripheral artery disease 4 (9) 4 (7)
Arrhythmia 8 (17) 3 (5)
BP (mmHg), mean6SD
Systolic 140.5620.2 126.3618.7
Diastolic 71.8610.5 69.169.7
Body mass index (kg/m2) 30.768.7 32.267.3
Medications, n (%)
ACE inhibitor 22 (48) 24 (44)
ARB 10 (22) 17 (31)
b-Blocker 27 (59) 31 (55)
Epoetin therapy 12 (25) 11 (19.3)
Insulin 8 (17) 11 (20)
Oral hypoglycemic agents 3 (6) 15 (27)
Vitamin D supplementation 23 (47.9) 23 (40.3)
Tobacco use, n (%) 2 (4.9) 2 (4.3)
Self-reported health, n (%)
Excellent 3 (6.4) 4 (6.9)
Very good 5 (10.6) 9 (15.5)
Good 27 (57.5) 33 (56.9)
Fair 11 (23.4) 10 (17.2)
Poor 1 (2.1) 2 (3.5)
Self-reported level of activity (scale of 1–4), mean6SD 1.6561.1 1.7661.1
6-min walk test (ft), mean6SD 10806296 10916340
Prediction for healthy individual, %b 61.5 62.2
Sit-to-stand test (% age predicted), mean6SD 62.5619.2 67.8621.4
Gait-speed test (cm/s), median (interquartile range) 102.5 (81–123) 130 (102.5–180)
Prediction for healthy individual, %b 90.5 131.6

UC, usual care; RRE, renal rehabilitation exercise; ACE, angiotensin-converting enzyme; ARB, angiotensin II receptor blocker.
a
Not all patients have values for all measures.
b
Percentage of the prediction for healthy individuals reference equation for 6-minute walk (17) and gait-speed test (20).
2056 Clinical Journal of the American Society of Nephrology

The addition of RRE to the usual CKD care produced

significant beneficial effects, regardless of CKD stage (P values
for the interaction terms=0.65 for 6MWT; P=0.59 for STST),
sex (P=0.43 for 6MWT; P=0.19 for STST), and age #70 versus
.70 years (P=0.64 for 6MWT; P=0.19 for STST).

Health-Related Quality of Life

Patients in the RRE group reported significant improve-
ments in the physical measures of the RAND-36 compared
with patients in the UC group (Table 2), including role
functioning/physical (mean change=28.9 in the UC group
versus mean change=19.0 in the RRE group; P,0.001), phys-
ical functioning (mean change=20.7 in the UC group versus
mean change=11.1 in the RRE group; P=0.004), energy/fatigue
levels (mean change=0.5 in the UC group versus mean
change=9.8 in the RRE group; P=0.01), and general health
(mean change=21.2 in the UC group versus mean change=4.9
in the RRE group; P=0.03). The RRE group also reported sig-
nificant improvement in the pain scale compared with the UC
group (mean change=23.8 in the UC group versus mean
change=5.7 in the RRE group; P=0.04). Neither study group
experienced significant changes in other mental measures
of the RAND-36 (Table 2).

Adherence, Tolerability, and Adverse Events

Figure 2. | Physical function: baseline and follow-up measures by
group. (Top) Six-minute walk test; (middle) sit-to-stand test; (bottom)
gait-speed test. Values are means6SDs for the 6-minute walk and sit-
to-stand tests and medians with 25%–75% interquartile ranges for
gait-speed test. UC, usual care.
This guided exercise program in patients with CKD stages
3 or 4 was generally well tolerated. No exercise-related
adverse events were observed. Not all participants in the
RRE group followed the protocol of exercising two times
per week for 12 consecutive weeks. Of 48 participants in-
cluded in the analysis, 35 (72.9%) participants attended all
24 sessions, completing the exercise program in a mean of
15.1 weeks; the remaining 13 participants attended a mean
of 13 sessions in 14.5 weeks.
Eleven patients allocated to the RRE group (18.6%) did
not complete the RRE program: four patients were lost to
follow-up, six patients withdrew from the study early, and
one patient suddenly died, which was not related to exercise
(Table 3). These 11 patients attended an average of 9.5 exer-
cise sessions. Chronic pain and time conflict were among the
reasons why patients withdrew from the study (Table 3).
Only two (4.2%) patients in the UC group did not complete
the study; one patient withdrew early citing a lack of interest,
and one patient was lost to follow-up.

Table 2. Health-related quality of life: mean change from baseline (SD) by group

Measure UC Group (n=46)a RRE Group (n=48)a P

Physical measures
Role functioning/physical 28.9 (38.4) 19.0 (31.7) ,0.001
Physical functioning 20.7 (18.7) 11.1 (19.3) 0.004
Energy/fatigue 0.5 (18.0) 9.8 (17.6) 0.01
General health 21.2 (11.5) 4.9 (15.3) 0.03
Mental measures
Pain 23.8 (24.4) 5.7 (20.0) 0.04
Emotional wellbeing 20.4 (17.1) 4.2 (16.9) 0.20
Social functioning 1.6 (22.6) 4.2 (20.8) 0.57
Role functioning/emotional 1.9 (29.2) 6.9 (24.5) 0.38

a
Patients with missing data on either measure are not included; not all patients have values for all measures.
Clin J Am Soc Nephrol 9: 2052–2058, December, 2014
Discussion
Guided RRE can improve the physical function of pa-
tients with stages 3 or 4 CKD. This study shows that a 12-
week/24-session program of guided exercise, conducted at
a physical therapy or cardiac rehabilitation center and
accompanied by distribution of a pedometer and encourage-
ment to use it, affords measureable significant improvements
in physical function testing, like the 6MWT and the STST,
and enhances health-related quality of life, including per-
ception of energy, physical functioning, general health, and
pain in patients with substantially compromised renal func-
tion. Our findings corroborate results from smaller exercise
studies that included 8–30 participants with predialysis
CKD (24) as well as the recently published randomized
Australian LANDMARK III trial that examined the effects
of lifestyle intervention, including aerobic and resistance
exercise training, for 12 months on cardiorespiratory fitness
in a subset of 83 patients with stages 3 or 4 CKD (25). An
observational study by Roshanravan et al. (10) found that
impaired physical performance of the lower extremities in
patients with CKD was strongly associated with all-cause
mortality, with timed-up-and-go and gait speed more
strongly predictive of 3-year mortality than kidney func-
tion or commonly measured serum biomarkers and 6MWT
having the greatest receiver-operating characteristic curve
for 3-year mortality. However, to our knowledge, this is the
first randomized, controlled trial that reported a substantial
improvement in the physical measures of the RAND-36 in
this patient population undergoing RRE, and it is the largest
prospective, randomized study to date to show a significant
improvement in physical function in patients with stages 3
or 4 CKD receiving an exercise intervention.
This study proves that RRE programs can be integrated into
standard CKD clinic care. Given the multiple comorbidities
of the CKD population, the implementation of a successful
exercise program requires a multidisciplinary approach, in-
cluding clearance from a primary care provider, cardiologist,
or surgeon before beginning RRE and collaboration with the
exercise or cardiac rehabilitation facility staff. We found that,
from time to time, exercise staff were uncomfortable with the
burden of comorbidities of some of the patients with stages 3
or 4 CKD. The exercise trainers required significant teaching
and reassurance to allow them to confidently coach this pa-
tient population at increased risk for cardiovascular morbidity
Table 3. Reasons for study discontinuation
Reasons for Study UC Group RRE Group
Discontinuation (n=48) (n=59)
Early withdrawal
Time conflict 0 2
Chronic joint pain 0 2
Lack of interest 1 0
Bell’s palsy 0 1
No explanation 0 1
Lost to follow-up 1 4
Death 0 1
Total 2 (4.2%) 11 (18.6%)a
a if these findings will translate into decreased mortality rates
P=0.03.
Rehabilitation Exercise in CKD: Randomized, Controlled Trial, Rossi et al. 2057
and mortality. Additionally, 18.6% of participants in the
exercise arm did not complete the program, and not all
participants in the RRE group followed the protocol of
exercising two times per week for 12 consecutive weeks,
revealing the difficulty inherent in motivating sustained
health-related behavioral change. For 48 participants in-
cluded in the analysis of the number of sessions attended,
the mean number attended was 19.3 sessions, with 35 par-
ticipants attending all 24 sessions. Although this incomple-
tion rate may seem to be high, it should be considered in the
context of other studies of lifestyle intervention in patients
with CKD (25) and other patients with multiple comorbidities
(26,27). In the LANDMARK III substudy, in which 12% of
patients with CKD in the intervention group dropped out,
those remaining attended 70% of supervised gym-based
sessions (25). In more general studies not restricted to pa-
tients with CKD, such as the Lifestyle Interventions and
Independence for Elders Pilot, in which Fielding et al. (26)
assessed activity adherence in 424 sedentary older adults
with functional limitations, and the Diabetes Prevention
Program analysis by Crandall et al. (27), which looked at
the influence of age on the effects of lifestyle modifications
and metformin to prevent diabetes, adherence rates ranged
from 34% to 76%.
Our study has several limitations. Given the nature of the
intervention, neither participants nor investigators were
blinded to the intervention arm. In addition, randomiza-
tion at the baseline assessment might have been prefer-
able; it may have avoided that our intent to treat analysis
does not include those patients who were randomized but
withdrew from the study before the period when baseline
data were collected. Despite randomization, the sex distri-
bution was not balanced at baseline, with more women in
the RRE arm and more men in the UC arm. Therefore, we
also analyzed the main outcomes by sex. No sex differences
were found in the results for the UC group. In the RRE
group, although men had a greater qualitative improve-
ment in the 6MWT and the STST, this effect was not sta-
tistically significant when the interaction between sex and
treatment group was analyzed. It is also important to note
that patients had to be able to travel to an exercise facility.
This might have introduced an overall selection bias in
both groups, because people who consented to be in the
study might have been more physically active than those
who declined to participate. Finally, baseline GST scores
were higher in the RRE group, despite randomization,
raising the possibility that, by chance, this group was more
physically fit than the UC group. However, we believe that
this result is unlikely, because all other measures of
physical capacity were similar in both groups at baseline,
including the self-reported level of activity. Because our
hypothesis test was of improvement, using change from
baseline as its measure accounted somewhat for baseline
imbalances.
In summary, a 12-week RRE program was effective at im-
proving the physical capacity and quality of life of patients
with CKD stages 3 and 4. Overall, exercise training in this
particular study setting and patient population was well
tolerated, with no exercise-related adverse events observed.
Larger studies and longer follow-up are needed to determine
and slow the progression of CKD.
2058 Clinical Journal of the American Society of Nephrology
Acknowledgments
This research was funded by a Maine Medical Center Research
Institute Grant.
Disclosures
None.
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Received: November 21, 2013 Accepted: August 25, 2014
Published online ahead of print. Publication date available at www.
cjasn.org.
This article contains supplemental material online at http://cjasn.
asnjournals.org/lookup/suppl/doi:10.2215/CJN.11791113/-/
DCSupplemental.
See related editorial, “Exercise to Improve Physical Function and
Quality of Life in CKD,” on pages 2023–2024.