Exercise therapy for kidney transplant recipients: a systematic review and meta-analysis with a focus on exercise type.

Abstract

Background: Exercise therapy is important for exercise tolerance, for the prevention of frailty or sarcopenia, and to improve quality of life (QOL). Previous studies, including systematic reviews, have shown the efficacy of exercise therapy for kidney transplant recipients (KTRs), but the optimal types of exercise remain unclear. Therefore, we aimed to synthesize the published evidence and compare the efficacy of types of exercise.

Methods: We systematically searched for randomized controlled trials of the efficacy of exercise therapy in KTRs on PubMed and Ichushi, then performed a meta-analysis. Exercise was categorized as aerobic training (AT), resistance training (RT), or AT + RT. The risk of bias was assessed using ROB2 and the certainty of the evidence was evaluated using the GRADE approach.

Results: Twenty-five studies were included in the study and 18 in the meta-analysis. Exercise was associated with significant improvements in QOL (SF-36 physical functioning score), cardiorespiratory function (VO₂peak), physical function (performance in the 6-min walk test (6MWT) and sit/stand test (STS)), and a metabolic index (triglyceride concentration). Kidney function tended to be superior in the exercise group, but the difference was not significant. Other indices of glucose and lipid metabolism and the incidence of hospitalization did not differ between the Exercise and Control groups. AT + RT significantly improved VO₂peak, 6MWT performance, and the triglyceride concentration, whereas AT alone did not improve VO₂peak and RT alone did not improve 6MWT performance or the triglyceride concentration. The certainty of the evidence was generally "low" or "very low".

Conclusion: Exercise therapy improved the QOL, cardiorespiratory function, physical function, and triglyceride concentration of KTRs. The AT + RT combination may be the most effective exercise therapy for such patients.