Exercise training and reduction of cardiovascular disease risk factors in patients with chronic kidney disease.

Observational studies have reported a significant inverse association between physical function/aerobic capacity and mortality in patients with CKD. Several randomized controlled trials have provided evidence of a cardioprotective effect of exercise training via multiple mechanisms, which may result in a reduction of cardiovascular disease risk factors in patients with CKD. This review focuses on the available evidence for the role of exercise training in the reduction of cardiovascular disease risk factors as classified into antiatherosclerotic, anti-ischemic, antiarrhythmic, and antithrombotic protective effects. Preliminary evidence, primarily from studies in patients requiring hemodialysis, suggests that exercise training improves arterial compliance, cardiac autonomic control, and left ventricular systolic function while decreasing inflammation, oxidative stress, and blood pressure levels. It is concluded that these studies have provided preliminary evidence that exercise training may result in a reduction of cardiovascular disease risk factors. The available evidence supports the use of therapeutic exercise training as an adjunct component of a comprehensive treatment program for patients with CKD. However, it is clear that much additional research is required to confirm the apparent, multiple, cardioprotective effects of exercise training and to identify additional mechanisms, especially in patients with predialysis CKD.