Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 11;36(7):1352-1362.
doi: 10.1681/ASN.0000000636.

Long-Term Physical Exercise for Preventing CKD in Older Adults: A Randomized Clinical Trial

Stein I Hallan  1   2 , Marius A Øvrehus  1   2 , Michael G Shlipak  3 , O Alison Potok  4   5 , Solfrid Romundstad  6 , Nils P Aspvik  7 , Ulrik Wisløff  8   9 , Joachim H Ix  4   5 , Dorthe Stensvold  8   10 , Knut A Langlo  1   2
Affiliations

Long-Term Physical Exercise for Preventing CKD in Older Adults: A Randomized Clinical Trial

Stein I Hallan et al. J Am Soc Nephrol. .

Abstract

Key Points:

  1. Physical exercise mitigates several kidney-related pathophysiological pathways, yet its effect on kidney function remains underexplored.

  2. This randomized clinical trial found that high-intensity interval training significantly reduced the risk of rapid eGFR decline in older adults.

  3. Physical exercise can preserve kidney function, benefiting public health and individual patient outcomes similar to other cardiovascular diseases.

Background: CKD is a growing global public health issue. Physical exercise mitigates several kidney-related pathophysiological pathways, yet its effect on kidney function remains underexplored. We investigated the dose-response effect of physical exercise on kidney function preservation in older adults.

Methods: We conducted a post hoc analysis of the Generation 100 Study, a 5-year open-label, randomized, parallel-arm clinical trial conducted from 2012 to 2018 in Trondheim, Norway. All inhabitants aged 70–77 years were invited (n=6966). Main exclusion criteria were dementia; severe, uncontrolled cardiovascular disease or hypertension; or conditions precluding exercise. The control group (n=385) received information on national physical activity recommendations. Intervention groups underwent supervised moderate-intensity continuous training (70% of peak heart rate) for 50 minutes (n=380) twice weekly for 5 years or high-intensity interval training (90% of peak heart rate) for 4 minutes ×4 (n=391) twice weekly for 5 years. The primary outcome was cystatin C–based rapid eGFR decline (>5 ml/min per 1.73 m2 per year).

Results: A total of 1156 participants were randomized, with median (interquartile range) age 72 (3) years and eGFR 95 (20) ml/min per 1.73 m2. Oxygen uptake increased by 1.8, 2.3, and 3.3 ml/kg per minutes in the control, moderate-intensity, and high-intensity groups, respectively. Rapid eGFR decline occurred in 117 (30%), 108 (28%), and 92 (23%) participants, respectively. Compared with controls, relative risk (RR) was 0.93 (95% confidence interval [CI], 0.75 to 1.16) for the moderate-intensity and 0.75 (95% CI, 0.59 to 0.95) for high-intensity groups, demonstrating a significant dose-response relationship (P for trend 0.02). In observational analyses, participants with decreasing moderate-to-vigorous intensity activity (>−20 min/wk) had RR 1.30 (95% CI, 0.93 to 1.83) for rapid eGFR decline, while those with increasing activity (>+20 min/wk) had RR 0.73 (95% CI, 0.53 to 0.99) compared with stable activity after adjusting for baseline age, sex, peak oxygen uptake, and eGFR.

Conclusions: High-intensity interval training significantly reduced the risk of rapid eGFR decline in older adults.

Clinical Trial registry name and registration number:: ClinicalTrials.gov: NCT01666340.

Keywords: CKD; community engagement and health; geriatric nephrology; health policy; randomized controlled trials; renal function decline.

PubMed Disclaimer

Conflict of interest statement

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/JSN/F66.

References

    1. Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. Lancet. 2017;389(10075):1238–1252. doi: 10.1016/S0140-6736(16)32064-5 - DOI - PubMed
    1. Taal MW, Brenner BM. Predicting initiation and progression of chronic kidney disease: developing renal risk scores. Kidney Int. 2006;70(10):1694–1705. doi: 10.1038/sj.ki.5001794 - DOI - PubMed
    1. Levin A Tonelli M Bonventre J, et al. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet. 2017;390(10105):1888–1917. doi: 10.1016/S0140-6736(17)30788-2 - DOI - PubMed
    1. Querfeld U, Mak RH, Pries AR. Microvascular disease in chronic kidney disease: the base of the iceberg in cardiovascular comorbidity. Clin Sci (Lond). 2020;134(12):1333–1356. doi: 10.1042/CS20200279 - DOI - PMC - PubMed
    1. Gao J, Pan X, Li G, Chatterjee E, Xiao J. Physical exercise protects against endothelial dysfunction in cardiovascular and metabolic diseases. J Cardiovasc Transl Res. 2022;15(3):604–620. doi: 10.1007/s12265-021-10171-3 - DOI - PMC - PubMed

Associated data

LinkOut - more resources