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Bishop et al Exercise_and_chronic_kidney_disease_potential_mechanisms_underlying_physiological_benefits_Nature_Reviews_Nephrology_ACCEPTED_121222.pdf (696.62 kB)

Exercise and chronic kidney disease: potential mechanisms underlying the physiological benefits

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posted on 2022-12-20, 14:44 authored by Nicolette BishopNicolette Bishop, James Burton, Matthew Graham-Brown, David StenselDavid Stensel, Joao Viana, Emma Watson

Increasing evidence indicates that exercise has beneficial effects on chronic inflammation, cardiorespiratory function, muscle and bone strength and metabolic markers in adults with chronic kidney disease (CKD), kidney failure or kidney transplants. However, the mechanisms that underlie these benefits have received little attention, and the available clinical evidence is mainly from small, short-duration (<12 weeks) exercise intervention studies. The available data, mainly from patients with CKD or on dialysis, suggest that exercise-mediated shifts towards a less inflammatory immune cell profile, enhanced activity of the NRF2 pathway and reduced monocyte infiltration into adipose tissue may underlie improvements in inflammatory biomarkers. Exercise-mediated increases in nitric oxide release and bioavailability, reduced angiotensin II accumulation in the heart, left ventricular remodelling and reductions in myocardial fibrosis may contribute to improvements in left ventricular hypertrophy. Exercise stimulates an anabolic response in skeletal muscle in CKD, but increases in mitochondrial mass and satellite cell activation seem to be impaired in this population. Exercise-mediated activation of the canonical wnt pathway may lead to bone formation and improvements in the levels of the bone-derived hormones klotho and fibroblast growth factor 23 (FGF23). Longer duration studies with larger sample sizes are needed to confirm these mechanisms in CKD, kidney failure and kidney transplant populations and provide evidence for targeted exercise interventions.

Funding

National Institute for Health Research (NIHR) Leicester 959 Biomedical Research Centre

Portuguese Foundation of Science and Technology (UID/04045/2020)

Portuguese Society of Nephrology

History

School

  • Sport, Exercise and Health Sciences

Published in

Nature Reviews Nephrology

Volume

19

Issue

4

Pages

244–256

Publisher

Nature Research (part of Springer Nature)

Version

  • AM (Accepted Manuscript)

Rights holder

© Springer Nature Limited

Publisher statement

This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1038/s41581-022-00675-9

Acceptance date

2022-12-14

Publication date

2023-01-17

Copyright date

2023

ISSN

1759-5061

eISSN

1759-507X

Language

  • en

Depositor

Prof Lettie Bishop. Deposit date: 19 December 2022

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