The physiology behind the effect of exercise on hypertension and the kidney

Session: Linking Lifestyle, BP, and Kidney Diseases: What Is the Evidence

Presenter: Danielle L. Kirkman, PhD

Dr. Danielle KirkmanIn this standing room only session, Danielle L. Kirkman, PhD, from the Virginia Commonwealth University, led the discussion surrounding the links between lifestyle, blood pressure, and kidney diseases with her presentation entitled, “The Physiology Behind the Effect of Exercise on Hypertension and Kidney.”

First, the pathophysiology of hypertension was discussed. Dr. Kirkman dove into six factors, back by studies and they were: (1) activation of sympathy nervous system, (2) total body autoregulation: increased TPR, (3) structural changes: resistance vessels kidney, (4) endothelial dysfunction and oxidative BLANK, (5) genetic contributions, and (6) renal mechanisms and salt balance: salt sensitivity perturbed RAAS.

Increased physical activity and exercise training alters salt sensitivity. In fact, according to one study presented by Dr. Kirkman, physical activity reduces salt sensitivity. Furthermore, aerobic exercise training reduces salt sensitivity among older individuals with hypertension.

According to studies that incorporate data on PRA, Angil, and aldosterone, the practice of exercise triggered changes in blood pressure, and therefore, enhanced the renin-angiotensin-aldosterone system’s (RAAS) role in regulating blood pressure.

Exercise Training and CKD

When looking at the effects of endurance training for reduced sympathetic nerve activity in CKA, observed was an increase in renal sympathetic nerve activation, and upregulation of RAAS, impaired baroreflex control, and inflammation and oxidative stress.

Aerobic exercise improves microvascular function in CKD.

The take away for the HCP

Dr. Kirkman concluded her presentation with suggestions for the HCP. According to Dr. Kirkman, “[HCPs] can and should integrate exercise into routine care for their patients with kidney disease:

• Aerobic exercise is good for cardiorespiratory fitness, strength, and cardiovascular benefits 3 days each week for at least 3-7 months.
• While benefits of higher intensity exercise have been seen, lower exercise programs are showing their benefits and may even be more realistic for the patient to perform.
• “Intradialytic” exercise is not only a safe and convenient option for patients, it also has a high compliance rate.