High-resistance inspiratory muscle strength training: a promising strategy for improving vascular health in chronic kidney disease

Abstract

Patients with chronic kidney disease (CKD) demonstrate accelerated vascular aging which contributes to an increased risk of cardiovascular disease (CVD). Impaired vascular health in CKD is characterized by both functional and structural alterations to the vasculature including hypertension, arterial stiffness, vascular endothelial dysfunction, and autonomic dysfunction. These detriments persist despite pharmacological intervention. Habitual aerobic exercise can be protective of vascular health; however, the feasibility in patients with CKD is low due to numerous barriers to exercise. In this perspective we emphasize the need for novel and non-pharmacological strategies that can rescue vascular health and reduce the development of CVD in patients with CKD, explain the unique barriers to aerobic exercise in CKD, present a novel physical training intervention-high-resistance inspiratory muscle strength training (IMST) that addresses the barriers to exercise, and provide our opinion on why this lifestyle intervention may be particularly efficacious for patients with CKD.

Keywords: chronic kidney disease; exercise training; inspiratory; lifestyle interventions; vascular health.

FIGURE 1

High blood pressure, arterial stiffness, and impaired endothelial and autonomic function are contributors to cardiovascular disease development in chronic kidney disease. The physiological stressors contributing to each vascular detriment and the current evidence and potential for IMST to improve these stressors are shown. ROS, reactive oxygen species. Created in BioRender. Lapierre-Nguyen, S. (2025) https://BioRender.com/w7vy2r8.

FIGURE 2

The unique barriers to regular exercise in patients with CKD (left) include lack of time and accessibility to exercise (logistical barriers), poor physical function including joint pain, fatigue and shortness of breath (physical barriers), and low motivation, depression, fear of injury, and poor exercise self-efficacy (psychological barriers). High-resistance IMST reduces numerous barriers to exercise in patients with CKD (right). High-resistance IMST can be conducted at home or while traveling due to the device being portable. Additionally, it is low-cost and can be completed safely in only 5 min per day. High-resistance IMST may improve fatigue and enhance patient self-efficacy and motivation to complete exercise. The burden of each type of barrier is indicated by the red bar. Logistical and psychological barriers present the highest burden, and IMST has potential to greatly reduce those barriers. Created in BioRender. Lapierre-Nguyen, S. (2025) https://BioRender.com/15q46cp.