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Exercise training in kidney transplant recipients: a systematic review

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Abstract

Background and aims

Evidences on the benefits of physical exercise in kidney transplant patients (KTx) are not conclusive and concerns on safety remain. We here gather and interpret current evidence on the benefits/harms of exercise training intervention in KTx.

Methods

Systematic review of exercise training programs in KTx.

Results

A total of 24 studies including 654 KTx patients on intervention and 536 controls were evaluated. The median age was 46 years; the transplant vintage was 2 days to 10 years. The intervention was an aerobic or resistance exercise program or a combination of both; interventions consisted of 20–60 min’ sessions, 2–3 times per week repetitions and 5.5 months’ median duration. Most studies improved cardiorespiratory fitness (expressed as VO2peak) as well as maximum heart rate, which was associated with a significant increase in muscle performances and strength. No significant changes in body weight or composition were observed, but a trend towards weight reduction in overweight or obese patients on stable KTx was noted. The arterial blood pressure reduced a little after exercise when it was high at start. Exercise intervention had no clinically relevant impact on anaemia, glycaemia or lipidaemia. In contrast, exercise training improved several aspects of quality of life. No data on long-term hard outcomes or on high-risk subpopulations such comorbid or elderly patients were available.

Conclusions

In adult kidney transplant patients, a structured physical exercise program improved the aerobic capacity and ameliorated muscle performance and quality of life. No harms were observed in the short-term, but long-term RCTs are required. Overall, in mid-age kidney transplant patients without major comorbidities, an aerobic or resistance supervised exercise lasting 3–6 months could be suggested within the comprehensive treatment of kidney transplant.

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Acknowledgements

The European Renal Nutrition (ERN) Working Group is an initiative of and supported by the European Renal Association-European Dialysis Transplant Association (ERA-EDTA). The Physical exercise in chronic kidney disease Working Group is supported by the Italian Society of Nephrology (SIN).

Author information

Authors and Affiliations

  1. Department of Movement Sciences and Wellbeing, Parthenope University, Naples, Italy

    Patrizia Calella

  2. PROFITH “PROmoting FITness and Health through Physical Activity” Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain

    Sonsoles Hernández-Sánchez & Jonatan R. Ruiz

  3. Division of Nephrology, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Carlo Garofalo

  4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Juan J. Carrero

  5. Division of Nephrology, Dialysis and Transplantation, Nephrology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy

    Vincenzo Bellizzi

  6. European Renal Nutrition (ERN) Working Group at the European Renal Association-European Dialysis Transplant Association (ERA-EDTA), London, UK

    Juan J. Carrero & Vincenzo Bellizzi

  7. Physical Exercise in Chronic Kidney Disease Working Group at the Italian Society of Nephrology (SIN), Rome, Italy

    Vincenzo Bellizzi

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  1. Patrizia Calella
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Correspondence to Vincenzo Bellizzi.

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Calella, P., Hernández-Sánchez, S., Garofalo, C. et al. Exercise training in kidney transplant recipients: a systematic review. J Nephrol 32, 567–579 (2019). https://doi.org/10.1007/s40620-019-00583-5

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  • DOI: https://doi.org/10.1007/s40620-019-00583-5

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