Exercise as it relates to Disease/Benefit of exercise for chronic kidney disease

Prevalence
Chronic Kidney Disease (CKD) was the 10th leading cause of death in Australia in 2011. Approximately 1.7 million Australian (1 in 10) aged 18 years and over have indicators of CKD such as reduced kidney function and/or the presence of albumin in the urine.

What is Chronic Kidney Disease?
CKD is a syndrome that is associated with low glomerular filtration rate. It is now widely accepted as risk factor for cardiovascular disease (CVD), kidney failure and mortality. CKD is often associated with non-conventional risk factors such as anemia and serum calcium and phosphate disturbances, which are proportional to CKD stages. There are five CKD stages:

Causes of Chronic Kidney Disease
It is normally characterized by slowly worsening albuminuria, hypertension and progressive decline in glomerular filtration rate (GFR), sometimes with nephrotic syndrome. Common causes of CKD are glomerular and tubulointerstitial diseases resulting from infections and exposure to drugs and toxins

These comorbidities significantly increase the chance of CKD, and stem from risk factors such as:

Treatment

 * Lifestyle modifications, such as weight reduction, exercise and dietary are essential for patients with CKD. Weight reduction is effective for proteinuria reduction in obese patients
 * In term of pharmacological approaches, there is a wide range of options that offer the possibility of slowing progression. However, control of hypertension is the most effect effective intervention. Control of proteinuria and the inhibition of the renin-angiotensin system are important factors in slowing the progression of diabetic and non-diabetic CKD
 * Dialysis and transplantation are effective but the high cost restrict its availability worldwide hence leaving many patients with kidney failure die without treatment

==Exercise As An Intervention: Aerobic Exercise vs. Resistance Training ==

Limitations and Considerations
Once a patient pregresses to ESRD, as renal placement therapy has a paradoxical effect on survival, weight reduction may no longer be indicated. Therefore, a higher BMI has a beneficial effect on survival in ESRD

Exercise Recommendation
Patients should visit the care team prior to exercise for exercise and physical functioning consideration. Patients should be regularly assessed to determine their level of cardiac risk factors, physical functioning so that a training program can be appropriately prescribed.

Aerobic Exercise

 * Low to moderate intensity aerobic exercise 3 or more times per week.
 * Exercise should begin at low intensity (50-60% of peak heart rate) and short duration (10–20 minutes per session)

Resistance Training

 * Should be initiated at low intensity and progressed gradually as tolerated
 * Base on 3RM or higher to avoid tendon injuries
 * All major muscle groups should be trained in 3 sessions per week

Warm-up and cool-down sessions of 5 to 10 minutes should proceed and follow each aerobic or resistance in each session. Stretching or yoga could assist in flexibility, balance, coordination and improving gait.