Effect of Structured, Moderate Exercise on Kidney Function Decline in Sedentary Older Adults An Ancillary Analysis of the LIFE Study Randomized Clinical Trial

IMPORTANCE Observational evidence suggests that higher physical activity is associated with slower kidney function decline; however, to our knowledge, no large trial has evaluated whether activity and exercise can ameliorate kidney function decline in older adults. OBJECTIVE To evaluate whether a moderate-intensity exercise intervention can affect the rate of estimated glomerular filtration rate per cystatin C (eGFR (CysC)) change in older adults. DESIGN, SETTING, AND PARTICIPANTS This ancillary analysis of the Lifestyle Interventions and Independence For Elders randomized clinical trial enrolled 1199 community-dwelling, sedentary adults aged 70 to 89 years with mobility limitations and available blood specimens. The original trial was conducted across 8 academic centers in the US from February 2010 through December 2013. Data for this study were analyzed from March 29, 2021. to February 28, 2022. INTERVENTIONS Structured, 2-year, partially supervised, moderate-intensity physical activity and exercise (strength, flexibility) intervention compared with a health education control intervention with 2-year follow-up. Physical activity was measured by step count and minutes of moderate-intensity activity using accelerometers. MAIN OUTCOMES AND MEASURES The primary outcome was change in eGFR(CysC). Rapid eGFR(cysC) decline was defined by the high tertile threshold of 6.7%/y. RESULTS Among the 1199 participants in the analysis, the mean (SD) age was 78.9 (5.2) years, and 800 (66.7%) were women. At baseline, the 2 groups were well balanced by age, comorbidity, and baseline eGFR(CysC). The physical activity and exercise intervention resulted in statistically significantly lower decline in eGFR(CysC) over 2 years compared with the health education arm (mean difference, 0.96 mL/min/1.73 m(2); 95% CI, 0.02-1.91mL/min/1.73 m(2)) and lower odds of rapid eGFR cysc decline (odds ratio, 0.79; 95% Cl. 0.65-0.97). CONCLUSIONS AND RELEVANCE Results of this ancillary analysis of a randomized clinical trial showed that when compared with health education, a physical activity and exercise intervention slowed the rate of dedine in eGFR (CysC) among community-dwelling sedentary older adults. Clinicians should consider targeted recommendation of physical activity and moderate-intensity exercise for older adults as a treatment to slow decline in eGFR(CysC).