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The effect of exercise training interventions in adult kidney transplant recipients: a systematic review and meta-analysis of randomised control trials

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journal contribution
posted on 14.01.2022, 17:14 by Thomas J Wilkinson, Nicolette C Bishop, Roseanne E Billany, Courtney J Lightfoot, Ellen M Castle, Alice C Smith, Sharlene A Greenwood
BACKGROUND
Kidney transplant recipients (KTRs) are characterised by adverse changes in physical fitness and body composition. Post-transplant management involves being physically active, although evidence for the effect of exercise is limited.

OBJECTIVE
To assess the effects of exercise training interventions in KTRs.

METHODS
NCBI PubMed (MEDLINE) and CENTRAL (EMBASE, WHO ICTRP) databases were searched up to March 2021 to identify eligible randomized controlled trials (RCTs) that studied exercise training in adult KTRs. Outcomes included exercise capacity, strength, blood pressure, body composition, heart rate, markers of dyslipidaemia and renal function, and health-related quality of life (QoL).

RESULTS
Sixteen RCTs, containing 827 KTRs, were included. The median intervention length was 14-weeks with participants exercising between 2–7x/week. Most studies used a mixture of aerobic and resistance exercise. Significant improvements were observed in cardiorespiratory function (VO2peak) (3.21 ml/kg/min, p = 0.003), 6MWT (76.3 meters, p = 0.009), physical function (STS-60, 4.8 repetitions, p = 0.04), and high-density lipoprotein (HDL) (0.13 mg/dL, p = 0.03). A moderate increase in maximum heart rate was seen (p = 0.06). A moderate reduction in creatinine was also observed (0.14 mg/dl, p = 0.05). Isolated studies reported improvements in strength, bone health, lean mass, and QoL. Overall, studies had high risk of bias suggestive of publication bias.

CONCLUSIONS
Exercise training may confer several benefits in adult KTRs, particularly by increasing cardiorespiratory function and exercise capacity, strength, HDL levels, maximum heart rate, and improving QoL. Additional long-term large sampled RCTs, incorporating complex interventions requiring both exercise and dietary behaviour change, are needed to fully understand the effects of exercise in KTRs.

Funding

TJW, CJL, ACS are part-funded by the Stoneygate Trust and supported by the National Institute for Health Research Leicester Biomedical Research Centre (BRC). TJW is funded by the Applied Research Collaboration East Midlands. NCB is supported by the National Institute for Health Research Leicester Biomedical Research Centre (BRC). REB and NCB were part-funded by a Heart Research UK project grant. EMC was supported by a Kidney Research UK PhD Fellowship. SAG is supported by an NIHR Post-doctoral Fellowship.

History

Citation

Thomas J. Wilkinson, Nicolette C. Bishop, Roseanne E. Billany, Courtney J. Lightfoot, Ellen M. Castle, Alice C. Smith & Sharlene A. Greenwood (2021). 'The effect of exercise training interventions in adult kidney transplant recipients: a systematic review and meta-analysis of randomised control trials', Physical Therapy Reviews, DOI: 10.1080/10833196.2021.2002641

Author affiliation

Leicester Diabetes Centre; Department of Health Sciences; Department of Cardiovascular Sciences; Leicester NIHR Biomedical Research Centre

Version

VoR (Version of Record)

Published in

Physical Therapy Reviews

Pagination

1 - 21

Publisher

Informa UK Limited

issn

1083-3196

eissn

1743-288X

Acceptance date

10/12/2021

Copyright date

2021

Available date

14/01/2022

Language

en

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