Exercise and CKD: Skeletal Muscle Dysfunction and Practical Application of Exercise to Prevent and Treat Physical Impairments in CKD

Abstract

Patients with chronic kidney disease (CKD) experience substantial loss of muscle mass, weakness and poor physical performance. As kidney disease progresses, skeletal muscle dysfunction forms a common pathway for mobility limitation, loss of functional independence, and vulnerability to disease complications. Screening for those at high-risk of mobility disability by self-reported and objective measures of function is an essential first step in developing an interdisciplinary approach to treatment which includes rehabilitative therapies and counseling on physical activity. Exercise has beneficial effects on systemic inflammation, muscle and physical performance in CKD. Kidney health providers need to identify patient- and care delivery barriers to exercise in order to effectively counsel patients on physical activity. A thorough medical evaluation and assessment of baseline function using self-reported and objective function assessment is essential to guide an effective, individualized exercise prescription to prevent function decline in persons with kidney disease. This review focuses on the impact of kidney disease on skeletal muscle dysfunction in the context of the disablement process and reviews screening and treatment strategies that kidney health professionals can employ in clinical practice to prevent functional decline and disability.