Exercise Training in Chronic Kidney Disease

INTERVENTION: Randomised study of supervised cardiovascular exercise versus supervised cardiovascular plus resistance exercise, with a 6 week usual activity run‐in period for all participants. 12 week course of supervised exercise classes, duration approximately 1 hour, 3 times a week, consisting of either cardiovascular exercises alone or a combination of cardiovascular and lower body resistance exercises. Exercise intensity will be tailored to the individual and progressed through the 12 week course as individually appropriate. CONDITION: Chronic kidney disease ; Urological and Genital Diseases ; Chronic kidney disease PRIMARY OUTCOME: Muscle strength (total weight lifted during training sessions and estimated 1 repetition maximum of quadriceps extension) measured at 6 weeks, 12 weeks, 18 weeks SECONDARY OUTCOME: 1. Quadriceps Muscle size: Magnetic Resonance Imaging & 3D Ultrasonography. Measured at baseline, 6 weeks, 18 weeks; 2. Exercise Capacity: VO2peak. Measured at baseline, 6 weeks, 18 weeks; 3. Physical Function: Shuttle walk tests; sit to stand tests. Measured at baseline, 6 weeks, 12 weeks, 18 weeks; 4. Daily Physical Activity: 7 day Accelerometry. Measured at baseline, 6 weeks, 18 weeks; 5. Body composition: Weight, height, waist circumference. Measured at baseline, 6 weeks, 12 weeks, 18 weeks; 6. Arterial Stiffness: Pulse Wave Velocity. Measured at baseline, 6 weeks, 18 weeks; 7. Clinical parameters: Extracted from medical records. Measured at baseline, 6 weeks, 18 weeks; 8. Muscle metabolism: Muscle biopsy. Measured at 6 weeks, 18 weeks; 9. Plasma markers of inflammation and oxidative stress, Venous blood sample. Measured at baseline, 6 weeks, 18 weeks; 10. Quality of Life: SF36 and EQ5D questionnaires. Measured at baseline, 6 weeks, 12 weeks, 18 weeks; 11. Symptom perception: Chronic Kidney Disease Symptom Score. Measured at baseline, 6 weeks, 12 weeks, 18 weeks; 12. Physical Activity habits and attitudes: Leicester Kidney Patient Physical Activity Questionnaire (comprising Duke Activity Status Index; GP Physical Activity Questionnaire; Leisure Time Exercise Questionnaire; Stage of Change Questionnaire; Self Efficacy Questionnaire). Measured at baseline, 6 weeks, 12 weeks, 18 weeks; 13. Fatigue: FACIT‐Fatigue Questionniare & Visual Analogue Scale. Measured at baseline, 6 weeks, 12 weeks, 18 weeks; 14. Appetite: Visual Analogue Scale. Measured at baseline, 6 weeks, 12 weeks, 18 weeks INCLUSION CRITERIA: 1. Male and female aged between 18 and 100 years 2. Established Chronic kidney disease (Stages 3b‐5) 3. Attending Nephrology outpatient clinics in the Leicester region