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The effect of exercise on blood pressure in chronic kidney disease: A systematic review and meta-analysis of randomized controlled trials

Author

Listed:
  • Stephanie Thompson
  • Natasha Wiebe
  • Raj S Padwal
  • Gabor Gyenes
  • Samuel A E Headley
  • Jeyasundar Radhakrishnan
  • Michelle Graham

Abstract

Background and objectives: Management of hypertension in chronic kidney disease (CKD) remains a major challenge. We conducted a systematic review to assess whether exercise is an effective strategy for lowering blood pressure in this population. Design, setting, participants, and measurements: We searched MEDLINE, EMBASE, the Cochrane Library, CINAHL and Web of Science for randomized controlled trials (RCTs) that examined the effect of exercise on blood pressure in adults with non-dialysis CKD, stages 3–5. Outcomes were non-ambulatory systolic blood pressure (primary), other blood pressure parameters, 24-hour ambulatory blood pressure, pulse-wave velocity, and flow-mediated dilatation. Results were summarized using random effects models. Results: Twelve studies with 505 participants were included. Ten trials (335 participants) reporting non-ambulatory systolic blood pressure were meta-analysed. All included studies were a high risk of bias. Using the last available time point, exercise was not associated with an effect on systolic blood pressure (mean difference, MD -4.33 mmHg, 95% confidence interval, CI -9.04, 0.38). The MD after 12–16 and 24–26 weeks of exercise was significant (-4.93 mmHg, 95% CI -8.83, -1.03 and -10.94 mmHg, 95% CI -15.83, -6.05, respectively) but not at 48–52 weeks (1.07 mmHg, 95% CI -6.62, 8.77). Overall, exercise did not have an effect on 24-hour ambulatory blood pressure (-5.40 mmHg, 95% CI -12.67, 1.87) or after 48–52 weeks (-7.50 mmHg 95% CI -20.21, 5.21) while an effect was seen at 24 weeks (-18.00 mmHg, 95% CI -29.92, -6.08). Exercise did not have a significant effect on measures of arterial stiffness or endothelial function. Conclusion: Limited evidence from shorter term studies suggests that exercise is a potential strategy to lower blood pressure in CKD. However, to recommend exercise for blood pressure control in this population, high quality, longer term studies specifically designed to evaluate hypertension are needed.

Suggested Citation

  • Stephanie Thompson & Natasha Wiebe & Raj S Padwal & Gabor Gyenes & Samuel A E Headley & Jeyasundar Radhakrishnan & Michelle Graham, 2019. "The effect of exercise on blood pressure in chronic kidney disease: A systematic review and meta-analysis of randomized controlled trials," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-18, February.
    • Handle: RePEc:plo:pone00:0211032
    DOI: 10.1371/journal.pone.0211032
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    References listed on IDEAS

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    1. Tom M. Palmer & Jaime L. Peters & Alex J. Sutton & Santiago G. Moreno, 2008. "Contour-enhanced funnel plots for meta-analysis," Stata Journal, StataCorp LLC, vol. 8(2), pages 242-254, June.
    2. Alessandro Liberati & Douglas G Altman & Jennifer Tetzlaff & Cynthia Mulrow & Peter C Gøtzsche & John P A Ioannidis & Mike Clarke & P J Devereaux & Jos Kleijnen & David Moher, 2009. "The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-28, July.
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    1. Jena Lee & Yujin Suh, 2025. "Physical activity and its associated factors among adults with chronic kidney disease in a community setting: A secondary data analysis," PLOS ONE, Public Library of Science, vol. 20(9), pages 1-14, September.

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