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TOPLINE:

Higher weekly levels of moderate physical activity are associated with a lower risk for chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) and obesity or overweight.

METHODOLOGY:

• The long-term effect of moderate or vigorous physical activity on progression to CKD among patients with T2D has been unclear; the US and World Health Organization guidelines recently recognized health benefits of short bouts of activity lasting < 10 minutes.
• An exploratory post hoc analysis of the Look AHEAD trial assessed the long-term effects of moderate to vigorous physical activity on the risk for CKD progression in 1746 patients with T2D (mean age, 58.7 years; 58.7% women) and overweight or obesity and a baseline estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m².
• Moderate to vigorous physical activity was assessed using a triaxial accelerometer at baseline and at 1, 4, and 8/9 years, with health outcomes followed up for a mean of 12 years.
• Sedentary, light, moderate, and vigorous physical activity intensity was measured in bouts of < 10 minutes or bouts ≥ 10 minutes, with moderate to vigorous physical activity defined as the sum of all minutes at moderate or higher levels.
• The primary outcome was progression to CKD, defined as eGFR < 60 mL/min/1.73 m² with ≥ 30% drop at a follow-up visit from baseline, end-stage renal disease, self-reported kidney failure, or death.

TAKEAWAY:

• Patients whose weekly moderate to vigorous physical activity was in the highest quartile (≥ 469.2 min/wk) had a 31% lower risk (hazard ratio [HR], 0.69; P = .004) of CKD progression than those whose activity was in the lowest quartile (< 220.3 min/wk).
• Higher cumulative weekly moderate to vigorous physical activity in bouts lasting ≥ 10 minutes reduced the risk for CKD progression by 19% (HR, 0.81; P = .001).
• In the first 4 years from baseline, patients who increased moderate to vigorous physical activity by 63.2 minutes a week had a 33% lower risk for CKD progression than those whose physical activity declined by 198.3 min/wk (P = .033).
• An increase in weekly moderate to vigorous physical activity in bouts < 10 minutes or ≥ 10 minutes reduced the risk for CKD progression by 33% (P = .028) and 29% (P = .036), respectively.

IN PRACTICE:

"Maintaining a high level of [moderate to vigorous physical activity], regardless of length of the bout, may have renal benefit for adults with overweight/obesity and T2D, especially for individuals who are unwilling or unable to engage in [physical activity] bouts that are ≥ 10 min in duration," wrote the authors.

SOURCE:

This study was led by Mengyi Liu, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China, and was recently published online in the British Journal of Sports Medicine.

LIMITATIONS:

The use of secondary data analyses may have introduced selection bias and unmeasured confounding. Trial participants were motivated for an intensive lifestyle intervention study and had to pass a maximal exercise test at baseline, so the population may not represent most people with diabetes and obesity. Accelerometers may not accurately assess upper body movement and activities and may have underestimated physical activity. Reverse causation is possible due to the observational nature of the study.

DISCLOSURES:

The study was supported by the National Key Research and Development Program, National Natural Science Foundation of China, Program of Introducing Talents of Discipline to Universities, and other sources. The authors declared no conflicts of interest.