Effects of additional physical exercise on the nutritional status and disease progression during the low-protein diet in Chronic Kidney Disease Patients: a systematic review and meta-analysis

Low-protein diet (LPD) is the core of dietary and nutritional therapy for non-dialysis chronic kidney disease (CKD) patients. In addition, physical exercise could prevent and treat various illnesses and chronic diseases. The objective of the study was to search for and appraise evidence on the effect of additional physical exercise on patients'' nutritional status and indicators of disease progression when compared with the LPD alone. PubMed Central, Embase, Cochrane, and Web of Knowledge for randomized controlled trials (published between January 1, 1956 and May 17, 2023) were searched. A total of 8698 identified studies, 9 were eligible and were included in our analysis (N = 250 participants). Compared with the LPD alone, additional physical exercise reduced serum creatinine by a mean of –0.21 mg/dL (95% CI –0.39 to –0.03) in CKD patients. Similarly, blood pressure decreased after physical exercise, with systolic blood pressure decreasing by –7.05 mm Hg (95% CI –13.13 to –0.96) and diastolic blood pressure decreasing by –5.31 mm Hg (95% CI –7.99 to –2.62). Subgroup analyses revealed that resistance exercise (RE) was effective in decreasing estimated glomerular filtration rate (eGFR) of –1.71 mL/min per 1.73 m² (95% CI –3.29 to –0.14). In addition, the VO2peak increasing by 2.41 mL/kg/min (95% CI 0.13 to 4.70) when physical exercise was continued for 24 weeks. The above results suggest that the LPD with additional physical exercise care is more beneficial for patients with CKD.