Efficacy of Exercises in Improving the Quality of Life for Chronic Kidney Disease Patients Without Dialysis
Chronic kidney disease (CKD) has emerged as a significant public health concern, affecting approximately 11% to 13% of the general population. The disease imposes a substantial burden on patients, impacting their physical, psychological, and social well-being. The restrictions on daily activities due to CKD and its treatments further exacerbate the challenges faced by patients. Among the various interventions explored to mitigate these effects, exercise has garnered attention for its potential to improve the quality of life (QoL) in CKD patients. However, the evidence regarding the efficacy of exercise in enhancing QoL remains inconsistent, necessitating a comprehensive meta-analysis to evaluate its impact on pre-dialysis CKD patients.
This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was performed across PubMed, CINAHL, and the CENTRAL databases up to April 2020, with the search limited to English-language publications. The search terms included combinations of keywords related to CKD, exercise, and QoL. Only randomized controlled trials (RCTs) that assessed the efficacy of exercise in improving QoL for CKD patients were included. Studies involving patients undergoing renal replacement therapy or those from which data could not be extracted were excluded. Two independent researchers conducted the study selection, assessment, and data extraction processes, with discrepancies resolved by a third researcher. The quality of the included studies was evaluated using the Cochrane risk-of-bias tool.
The initial search identified 921 studies, which were narrowed down to 32 studies after the first screening. Following a full-text review, 25 studies were excluded, leaving seven RCTs for the final analysis. These studies collectively included 393 patients and utilized various QoL assessment tools, including the SF-36 questionnaire, the Kidney Disease Quality of Life questionnaire (KDQOL-SF), the RAND 36-item Health Survey (RAND-36), and the Kidney Disease Quality of Life-36 Questionnaire (KDQOL-36). The QoL scores were evaluated 12 weeks after the initiation of the exercise interventions.
The meta-analysis revealed that exercise significantly improved several QoL components in pre-dialysis CKD patients. Specifically, improvements were observed in the effect of kidney disease, burden of kidney disease, cognitive function, sleep, role-physical, pain, general health perception, and energy/fatigue. For instance, the burden of kidney disease showed a weighted mean difference (WMD) of 12.91 (95% CI: 7.25, 18.57), while cognitive function demonstrated a WMD of 7.03 (95% CI: 1.01, 13.05). Sleep quality also improved significantly, with a WMD of 8.60 (95% CI: 2.45, 14.75). These findings underscore the multifaceted benefits of exercise in enhancing the well-being of CKD patients.
However, the analysis did not detect significant improvements in other QoL components, such as work status, social support, and role-emotional. This lack of significant change may be attributed to the complex interplay of factors influencing QoL, including CKD-associated complications and comorbidities. Additionally, the heterogeneity in exercise protocols, patient selection, and methodological limitations across the included studies may have contributed to the inconsistent findings.
The improvements in QoL observed in this meta-analysis can be attributed to several mechanisms. First, exercise enhances physical capabilities and alleviates symptoms such as fatigue, thereby improving patients’ tolerance for daily activities. Second, exercise has been shown to improve sleep quality, which positively impacts overall QoL. Third, exercise may reduce cardiovascular complications and other comorbidities associated with CKD, thereby alleviating psychological anxiety and perceptions of disease burden. These factors collectively contribute to a more energetic and fulfilling daily life for CKD patients.
Despite the promising findings, the results of this meta-analysis should be interpreted with caution due to the heterogeneity and potential biases in the included studies. The variability in exercise protocols, such as the type, intensity, and duration of exercise, may have influenced the outcomes. Furthermore, the use of different QoL assessment tools across studies could have introduced measurement biases. To address these limitations, future research should aim to standardize exercise protocols and QoL assessment methods to facilitate more robust comparisons.
In conclusion, this meta-analysis provides evidence supporting the efficacy of exercise in improving the QoL of pre-dialysis CKD patients. The findings highlight the potential of exercise as a non-pharmacological intervention to enhance physical, psychological, and social well-being in this patient population. However, the inconsistent results across studies and the limitations inherent in the included research underscore the need for further investigation. Future studies should explore the optimal exercise regimens for CKD patients and investigate the long-term effects of exercise on QoL and disease progression. By addressing these gaps, healthcare providers can better integrate exercise into the comprehensive management of CKD, ultimately improving patient outcomes and quality of life.
doi.org/10.1097/CM9.0000000000000941
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