High Levels of Weekly Physical Activity have been Associated with Lower Renal Disease Risk in Diabetes and Overweight or Obese People

High weekly levels of moderate-to-vigorous intensity physical exercise are associated with a lower risk of developing chronic kidney disease in overweight or obese people with type 2 diabetes, according to a study published online in the British Journal of Sports Medicine.

However, increasing the weekly tally by a little over an hour is associated with a 33% reduction in risk, with effects evident for bouts lasting more than or less than 10 minutes at a time, according to the study.

Diabetes is the major cause of chronic kidney disease, accounting for 30–50 percent of all cases. According to the study, diabetes combined with chronic renal disease increases the chance of death from any cause by a factor of ten or more when compared to diabetes alone.

The evidence suggests that exercise improves kidney function in people with type 2 diabetes in the short term, but it is unclear what the long-term effects are or whether they are cumulative and/or depending on session length, according to the researchers.

To investigate, they conducted a secondary analysis of data from the US Look AHEAD experiment. This multicenter, randomized controlled trial compared the cardiovascular results of an intensive lifestyle intervention to standard diabetes assistance and education in 5,145 overweight or obese people with type 2 diabetes.

The current analysis focused on an activity tracker study conducted at eight of the sixteen trial sites, with 1,746 Look AHEAD participants with an average age of 58. More than half (59%; 1,025) were female.

Moderate to vigorous physical activity levels were measured at the beginning of the trial, as well as 1, 4, and 8 years later, using an activity tracker to examine the possible impact on progression to chronic renal disease, or end-stage disease.

Chronic kidney disease was defined as a decrease of at least 30% in the estimated glomerular filtration rate (eGFR)—the rate at which kidneys eliminate waste and excess water from blood to produce urine—to less than 60 mL/min.

The average weekly total for moderate to intense physical activity was 329 minutes; the amount accumulated in bouts of less than 10 minutes was 267; and the amount accumulated in bouts of 10 or more was 41.

During an average 12-year monitoring period, approximately one-third (567) of individuals developed chronic renal disease.

Those who engaged in the most moderate to vigorous physical activity (329 to 469 minutes per week) were considerably less likely to develop chronic renal disease than those who engaged in the least amount (less than 220 minutes).

Overall, a greater cumulative weekly average was associated with a 9% lower risk for every 100 minutes and a 19% lower risk if achieved in bouts of at least 10 minutes each.

Increasing the weekly tally by at least an hour (63 minutes or more) over the first four years of the study was associated with a 33% decreased risk, compared to the biggest documented decline of 198 minutes per week.

And among the weekly “improvers,” physical activity bouts lasting both more than and less than 10 minutes were associated with a lower risk of advancement, the research revealed.

As an observational study, we cannot determine the cause. The researchers, however, recognize that the study participants were highly motivated and may not be representative of all overweight or obese patients with diabetes.

More information: Association of accelerometer-measured physical activity and its change with progression to chronic kidney disease in adults with type 2 diabetes and overweight/obesity, British Journal of Sports Medicine (2024). DOI: 10.1136/bjsports-2023-107564