In VA Study, Moderate Physical Activity Lowered Risk Of Chronic Kidney Disease

Peter Kokkinos, PhD, FAHA, FACSM Veterans Affairs Medical Center Professor, Georgetown University School of Medicine George Washington University School of Medicine and Health Sciences Director, LIVe ProgramMedicalResearch.com Interview with:
Peter Kokkinos, PhD, FAHA, FACSM
Veterans Affairs Medical Center
Professor, Georgetown University School of Medicine
George Washington University School of Medicine and Health Sciences
Director, LIVe Program

Medical Research: What is the background for this study?

Dr. Kokkinos: This is a prospective study and part of a larger cohort, the Veterans Exercise Testing Study (VETS) designed to assess the association between aerobic fitness and the risk of developing Chronic Kidney Disease or CKD. Our cohort included 5,812 middle-aged male Veterans from the Washington, DC Veterans Affairs Medical Center. All participants were CKD-Free prior to entering the study.

Exercise capacity was assessed by a graded exercise test and peak Metabolic Equivalents or METs were determined. Accordingly, we established the following four age-adjusted fitness categories based on Quartiles of peak METs achieved: Least-fit (≤25%; 4.8±0.90 METs; n=1258); Low-fit (25.1%-50%; 6.5±0.96 METs; n=1614); Moderate-fit (50.1%-75%; 7.7±0.91 METs; n=1958), and High-fit (>75%; 9.5±1.0 METs; n=1436).

Multivariable Cox proportional hazard models were used to assess the exercise capacity-CKD association. The models were adjusted for age, BMI, blood pressure, medications, CVD, Risk factors, race, and history of alcoholism.

Medical Research: What are the main findings?

Dr. Kokkinos: During a median follow-up period of 7.9 years, 1,000 individuals developed CKD. The CKD-fitness association was independent, inverse and graded. The CKD risk was 22% lower for every 1-MET increase in exercise capacity.

When considering fitness categories, CKD risk decreased progressively as fitness status increased. Specifically, when compared to the Least-Fit individuals the risk of developing CKD was 13% 45% and 58% lower for individuals in the Low-Fit; Moderate and High-Fit categories, respectively.

These findings support that higher aerobic fitness lowers the risk of developing CKD. The average exercise capacity necessary to realize these health benefits was just over 6.5 METs (Low-fit). This level of fitness is achievable by many middle-aged and older individuals by daily exercises such as brisk walking. Moderate intensity exercises are effective in improving aerobic fitness regardless of age or comorbidities. Thus, exercise interventions for individuals at risk for CKD and those with preclinical CKD may be implemented to prevent or at least attenuate the rate of developing CKD.

Medical Research: What should clinicians and patients take away from your report?

Dr. Kokkinos: Health care providers should advise their patients to engage regularly in moderate intensity physical activities or structured exercise programs designed to improve aerobic fitness.

Brisk walking is the safest, most effective and inexpensive way to increase fitness and improve health. Individuals should start slowly, even as low as 10 minutes each day and add 1-2 minutes to their sessions each week. The goal is to accumulate a total of 150-200 minutes of aerobic activity each week. This can be achieved by walking briskly 4-6 times per week, 30-40 minutes per session.

It is important to emphasize that physical activity is associated with some risk of injury and even death, especially in sedentary individuals. However, the risk of physical INACTIVITY is far greater than that of physical ACTIVITY. To reduce this risk even more, all individuals MUST consult their physician prior to engaging in any exercise.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Kokkinos: Our next project is a randomized-controlled trial to assess if an exercise program designed to increase cardiorespiratory fitness and muscular strength can reverse or at least attenuate the deterioration of kidney function in patients with CKD stages 3 & 4).

Citation:

Exercise Capacity and Risk of Chronic Kidney Disease in US Veterans: A Cohort Study

Peter Kokkinos, PhD, Charles Faselis, MD, Jonathan Myers, PhD, Xuemei Sui, MD, PhD, MPH, Jiajia Zhang, PhD, Apostolos Tsimploulis, MD Lakhmir Chawla, MD Carlos Palant, MD

Mayo Clinic Proceedings Published Online: March 16, 2015

 

MedicalResearch.com Interview with: Peter Kokkinos, PhD, FAHA, FACSM (2015). In VA Study, Moderate Physical Activity Lowered Risk Of Chronic Kidney Disease MedicalResearch.com