[Skip to Navigation]
Original Investigation
May 2, 2022

Effect of Structured, Moderate Exercise on Kidney Function Decline in Sedentary Older Adults: An Ancillary Analysis of the LIFE Study Randomized Clinical Trial

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Kidney Health Research Collaborative, University of California, San Francisco
  • 3San Francisco VA Health Care System, San Francisco, California
  • 4Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
  • 5California Pacific Medical Center, San Francisco, California
  • 6Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
  • 7Section of Geriatrics, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
  • 8Section of Geriatric Medicine, Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California
  • 9Geriatric Research Education and Clinical Center, Palo Alto VA Health Care System, Palo Alto, California
  • 10Department of Medicine, University of California, San Diego, La Jolla
  • 11Icahn School of Medicine at Mount Sinai, New York, New York
JAMA Intern Med. 2022;182(6):650-659. doi:10.1001/jamainternmed.2022.1449
Key Points

Question  Can a moderate-intensity physical activity and exercise intervention slow the rate of decline of estimated glomerular filtration rate per cystatin C in sedentary older adults?

Findings  In this ancillary analysis of a randomized clinical trial of 1199 adults aged 70 to 89 years, those randomized to the physical activity and exercise intervention had statistically significantly lower decline in estimated glomerular filtration rate per cystatin C over 2 years compared with those in the health education arm.

Meaning  Clinicians should consider prescribing physical activity and moderate-intensity exercise for older adults to slow the rate of decline of kidney function.

Abstract

Importance  Observational evidence suggests that higher physical activity is associated with slower kidney function decline; however, to our knowledge, no large trial has evaluated whether activity and exercise can ameliorate kidney function decline in older adults.

Objective  To evaluate whether a moderate-intensity exercise intervention can affect the rate of estimated glomerular filtration rate per cystatin C (eGFRCysC) change in older adults.

Design, Setting, and Participants  This ancillary analysis of the Lifestyle Interventions and Independence For Elders randomized clinical trial enrolled 1199 community-dwelling, sedentary adults aged 70 to 89 years with mobility limitations and available blood specimens. The original trial was conducted across 8 academic centers in the US from February 2010 through December 2013. Data for this study were analyzed from March 29, 2021, to February 28, 2022.

Interventions  Structured, 2-year, partially supervised, moderate-intensity physical activity and exercise (strength, flexibility) intervention compared with a health education control intervention with 2-year follow-up. Physical activity was measured by step count and minutes of moderate-intensity activity using accelerometers.

Main Outcomes and Measures  The primary outcome was change in eGFRCysC. Rapid eGFRCysC decline was defined by the high tertile threshold of 6.7%/y.

Results  Among the 1199 participants in the analysis, the mean (SD) age was 78.9 (5.2) years, and 800 (66.7%) were women. At baseline, the 2 groups were well balanced by age, comorbidity, and baseline eGFRCysC. The physical activity and exercise intervention resulted in statistically significantly lower decline in eGFRCysC over 2 years compared with the health education arm (mean difference, 0.96 mL/min/1.73 m2; 95% CI, 0.02-1.91 mL/min/1.73 m2) and lower odds of rapid eGFRCysC decline (odds ratio, 0.79; 95% CI, 0.65-0.97).

Conclusions and Relevance  Results of this ancillary analysis of a randomized clinical trial showed that when compared with health education, a physical activity and exercise intervention slowed the rate of decline in eGFRCysC among community-dwelling sedentary older adults. Clinicians should consider targeted recommendation of physical activity and moderate-intensity exercise for older adults as a treatment to slow decline in eGFRCysC.

Trial Registration  ClinicalTrials.gov Identifier: NCT01072500

Add or change institution
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    1 Comment for this article
    EXPAND ALL
    Creatinine based GFR
    Fatih Tufan, Assoc Prof | Istanbul Aydin University, Medical Park Florya Hospital, Department of Geriatrics
    I read with interest and congratulate the authors for this very important and relavant study.
    Creatinine based GFR estimations remain to be more commonly used in clinical practice. However the use of a cystatin C based equation is most appropriate for such studies. I wonder if the authors have any creatinine based GFR progress data? Creatinine based equations may underestimate GFR in older adults who perform regular exercise and they may overestimate GFR in sarcopenic older adults.
    I think the results of this study imply that cystatin C based equations may provide more accurate estimations especially in sarcopenic older
    adults and also in older adults who perform regular exercise.
    CONFLICT OF INTEREST: None Reported
    READ MORE
    ×