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Cited by 110Cardiovascular and exercise physiologyPhysical Activity and HealthDialysis and Renal Disease Management

Randomized controlled trial to evaluate the impact of aerobic exercise on visceral fat in overweight chronic kidney disease patients

Open access
Baria, F., Kamimura, M. A., Aoike, D. T., Ammirati, A., Leister Rocha, M., de Mello, M. T., Cuppari, L.·2014·Nephrology Dialysis Transplantation
DOI 10.1093/ndt/gft529
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Abstract

BACKGROUND: The prevalence of obesity has markedly increased in patients with chronic kidney disease (CKD). Studies on the impact of exercise focusing on obese CKD patients are scarce. Therefore, we aimed to investigate the effect of aerobic exercise performed either in an exercise centre or at home on visceral fat in overweight non-dialysed CKD patients. METHODS: Twenty-seven sedentary men (52.1 ± 9.5 years, body mass index 30.4 ± 3.8 kg/m(2), estimated glomerular filtration rate (eGFR) 27.5 ± 11.6 mL/min) were randomly assigned to a centre-based exercise group (n = 10), home-based exercise group (n = 8) or control group (n = 9). The aerobic training was prescribed according to ventilatory threshold and performed three times per week during 12 weeks. Body composition was assessed by dual energy X-ray absorptiometry (DEXA) and the distribution of abdominal fat by computed tomography. RESULTS: In the centre-based group, visceral fat and waist circumference decreased 6.4 ± 6.4 mm (P < 0.01) and 2.0 ± 2.3 cm (P = 0.03) and leg lean mass increased 0.5 ± 0.4 kg (P < 0.01). No significant changes were observed in the home-based group. Visceral fat increased 5.0 ± 4.4 mm in the control group (P = 0.01). In relation to the control, a group-by-time interaction was significant for visceral fat and waist circumference for both exercise groups and for leg lean mass for the centre-based group. Mean blood pressure decreased in both exercise groups (centre-based 13%, P < 0.01 and home-based 10%, P = 0.03) and eGFR increased 3.6 ± 4.6 mL/min (P = 0.03) in the centre-based group. These parameters remained unchanged in the control group. CONCLUSIONS: Centre-based aerobic exercise is an effective approach to reduce visceral fat besides promoting relevant clinical benefits in male overweight CKD patients.

AI snapshot

Written from the paper’s full text.

TL;DR

In a 12-week randomized controlled trial of 27 sedentary overweight non-dialysed CKD men, centre-based aerobic exercise reduced visceral fat and waist circumference and increased leg lean mass, whereas the control group gained visceral fat. Home-based exercise did not significantly change body composition within the group but appeared to prevent the visceral fat increase seen in controls.

Key findings

  • Centre-based exercise decreased visceral fat by 6.4 ± 6.4 mm (P < 0.01) and waist circumference by 2.0 ± 2.3 cm (P = 0.03), and increased leg lean mass by 0.5 ± 0.4 kg (P < 0.01).
  • Mean blood pressure decreased in both exercise groups (centre-based 13%, P < 0.01; home-based 10%, P = 0.03), and eGFR increased by 3.6 ± 4.6 mL/min (P = 0.03) in the centre-based group.
  • The control group had a significant increase in visceral fat of 5.0 ± 4.4 mm (P = 0.01), with no significant change in waist circumference.
  • No significant changes in body composition were observed within the home-based group, but the paper reports that home-based exercise prevented the increase in visceral fat seen in controls; physical capacity improved in both exercise groups.

Methods

  • Prospective, randomized, controlled interventional trial of 12 weeks. Twenty-nine sedentary men with CKD stages 3 and 4 were recruited; 27 completed follow-up. Patients were randomized to aerobic exercise (n = 19) or control (n = 10); those in the exercise group chose centre-based (n = 10) or home-based (n = 9, with 8 completing) exercise.
  • Aerobic training was prescribed according to ventilatory threshold and performed three times per week for 12 weeks, starting at 30 min with a 10-min increment every 4 weeks. Centre-based patients trained on a treadmill under supervision; home-based patients trained near home with a heart rate monitor, three initial supervised sessions, weekly telephone calls, and monthly visits.
  • Body composition was assessed by DEXA and abdominal fat distribution by computed tomography; physical/functional capacity, blood pressure, and laboratory parameters were measured at baseline and 12 weeks. Analysis used three-way ANOVA, two-way ANOVA for between-group comparisons and group-by-time interaction, repeated-measures ANOVA within groups, and χ² tests for proportions.

Limitations

  • Stated in the paper: findings are limited to overweight non-dialysed CKD men and may not be extrapolated to the general CKD population.
  • Evident from the text: the sample was small (27 completers; centre-based n = 10, home-based n = 8, control n = 9), and the centre-based versus home-based exercise mode was chosen by participants rather than randomized.
  • Evident from the text: the intervention lasted only 12 weeks, and the authors note that more studies are needed to prove definite effectiveness of supervised home-based exercise.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1093/ndt/gft529

Cites

51 of 51 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 36 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Mean blood pressure decreased in the centre-based exercise group (13%, P < 0.01).

    “Mean blood pressure decreased in both exercise groups (centre-based 13%, P < 0.01 and homebased 10%, P = 0.03)”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the centre-based exercise group, leg lean mass increased significantly after 12 weeks (0.5 ± 0.4 kg; P < 0.01).

    “In the centre-based group, visceral fat and waist circumference decreased 6.4 ± 6.4 mm (P < 0.01) and 2.0 ± 2.3 cm (P = 0.03) and leg lean mass increased 0.5 ± 0.4 kg (P < 0.01).”
    • Also stated in: § R E S U LT S · plain
      “LBM increased in the centre-based group due to the increase in the leg lean mass.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In relation to the control group, a significant group-by-time interaction was found for leg lean mass for the centre-based exercise group.

    “In relation to the control, a group-by-time interaction was significant for visceral fat and waist circumference for both exercise groups and for leg lean mass for the centre-based group.”
    Quote in the paperNot a substantial claim
  • Findingown data

    eGFR increased in the centre-based exercise group (3.6 ± 4.6 mL/min; P = 0.03).

    “eGFR increased 3.6 ± 4.6 mL/min (P = 0.03) in the centre-based group.”
    Quote in the paperSubstantial claim
  • Findingnone given

    Energy intake did not change during the study.

    “Since in the present study, the intensity of the exercise was mild to moderate and there was no change in the energy intake, the changes in energy balance were probably not sufficient to promote significant reductions in the total fat mass but enough to reduce visceral fat.”
    Quote in the paperSubstantial claim
  • May combine two claims. 11
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 12

  • May combine two claims.

    Findingown data

    In the home-based exercise group, no significant changes were observed in body weight, BMI, visceral fat, waist circumference, or total body fat after 12 weeks.

    “No significant changes were observed in the homebased group.”
    • Also stated in: § R E S U LT S · plain
      “no significant changes in body weight, BMI, visceral fat, waist circumference and total body fat were found in the home-based group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Total body fat did not change within the groups, but the group-by-time interaction was significant.

    “Total body fat did not change within the groups but, since the pattern of changes was different between the two groups, the interaction group by time was significant.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    In the centre-based exercise group, visceral fat decreased significantly after 12 weeks (6.4 ± 6.4 mm; P < 0.01; average 6%, range 3-10%).

    “In the centre-based group, visceral fat and waist circumference decreased 6.4 ± 6.4 mm (P < 0.01) and 2.0 ± 2.3 cm (P = 0.03) and leg lean mass increased 0.5 ± 0.4 kg (P < 0.01).”
    • Also stated in: § D I S C U S S I O N · plain
      “We found that visceral fat decreased on average 6% among patients in the centre-based exercise group, ranging from 3 to 10%.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Mean blood pressure and eGFR remained unchanged in the control group.

    “These parameters remained unchanged in the control group.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    In the present study, aerobic exercise resulted in a significant reduction in blood pressure in overweight non-dialysed CKD patients.

    “The aerobic exercise in our study also resulted in a significant reduction of blood pressure of the patients.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Aerobic exercise induces a negative energy balance and consequently reduces fat mass, as long as there is no compensation in other components of energy expenditure or energy intake.

    “Aerobic exercise induces a negative energy balance and consequently reduces fat mass, as long as there is no compensation in other components of energy expenditure or energy intake [21].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    Centre-based aerobic exercise is an effective approach to reduce visceral fat and promotes relevant clinical benefits in male overweight CKD patients.

    “Centre-based aerobic exercise is an effective approach to reduce visceral fat besides promoting relevant clinical benefits in male overweight CKD patients.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The impact of exercise on body composition in non-dialysed CKD patients is still unclear and deserves further investigation.

    “The impact of exercise on body composition is still unclear and deserves further investigation.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [9]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [10]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    In the present study, the intensity of exercise was mild to moderate and there was no change in energy intake; therefore, changes in energy balance were probably not sufficient to promote significant reductions in total fat mass but enough to reduce visceral fat.

    “Since in the present study, the intensity of the exercise was mild to moderate and there was no change in the energy intake, the changes in energy balance were probably not sufficient to promote significant reductions in the total fat mass but enough to reduce visceral fat.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The training programme was conducted in accordance with the recommendations of the American College of Sports Medicine.

    “The training programme was conducted in accordance with the recommendations of the American College of Sports Medicine [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The study was approved by the Human Investigation Review Committee of Federal University of São Paulo, and informed consent was obtained from each subject.

    “The Human Investigation Review Committee of Federal University of São Paulo approved the study, and informed consent was obtained from each subject.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Patients were randomized to aerobic exercise group or control group.

    “Patients were randomized to aerobic exercise group (n = 19) or control group (n = 10).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The same blinded skilled technician performed all abdominal CT measurements during the study.

    “The same blinded skilled technician performed all measurements during the study.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    No medication modification was done during follow-up.

    “No medication modification was done during the follow-up.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    A renal-specific diet was prescribed to all patients and no modification was performed during the study.

    “As part of the nutritional routine care in our centre, a renal-specific diet containing 25-30 kcal/adjusted body weight/day and 0.6-0.8g/ adjusted body weight/day of protein was prescribed to all patients, and no modification was performed during the study.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The study was a prospective, randomized, controlled interventional trial of 12 weeks.

    “This was a prospective, randomized, controlled interventional trial of 12 weeks.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The control group was advised not to perform any type of physical exercise during follow-up.

    “The patients from the control group were advised not to perform any type of physical exercise during follow-up.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Study design and conductnone given

    The use of an objective end point assessment of visceral fat and an exercise prescription using gold standard methodologies strengthened the significance of the results.

    “Nevertheless, the use of an objective end point assessment of visceral fat and the exercise prescription using gold standard methodologies strengthened the significance of the results.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The findings are limited to overweight non-dialysed CKD men and may not be extrapolated to the general CKD population.

    “A limitation of this study is that the findings are limited to overweight non-dialysed CKD men, so that the results may not be extrapolated for the general CKD population.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The home-based patients were initially submitted to three supervised exercise sessions and then monitored weekly by telephone calls and monthly visits to assess progress, adherence and provide support.

    “In order to correctly perform the exercise, the home-based patients were initially submitted to three supervised exercise sessions and then were monitored weekly by telephone calls and in monthly visits to assess progress, adherence and to provide support.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The exercise intensity was prescribed according to ventilatory threshold obtained in the cardiopulmonary exercise test.

    “The exercise intensity was prescribed according to ventilatory threshold (VT) obtained in the cardiopulmonary exercise test.”
    Quote in the paperNot a substantial claim
21 of 21

  • The paper relies on this without support.

    The present study is the first to show the impact of aerobic exercise as a single intervention on visceral fat reduction in obese CKD patients.

    “To the best of our knowledge, the present study is the first to show the impact of aerobic exercise as a single intervention on visceral fat reduction in obese CKD patients.”

  • The paper relies on this without support.

    Clinical studies of aerobic exercise on kidney function in CKD patients are scarce.

    “clinical studies with CKD patients are scarce”

  • The paper relies on this without support.

    In-centre closely supervised exercise may not be an option for most patients.

    “Considering that in-centre closely supervised exercise may not be an option for most patients”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Exercise mode was chosen, not randomly assigned

    Major

    The abstract says patients were randomly assigned to three groups, but the methods say randomization was between exercise and control, after which exercise patients chose the centre-based or home-based mode.

  • Urinary sodium changed despite being described as unchanged

    Minor

    The results say the other laboratory parameters remained unchanged in the centre-based and control groups, but Table 1 reports a significant increase in urinary sodium in the centre-based group.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. 2000, American journal of kidney diseases : the official journal of the National Kidney Foundation, 35, S1

Cited by

Sorted by citations

Related

Authors
Baria, F., Kamimura, M. A., Aoike, D. T., Ammirati, A., Leister Rocha, M., de Mello, M. T., & Cuppari, L.
Affiliations
Universidade Federal de São Paulo (BR)
Corresponding author
Cuppari, L.
ORCID
Venue
Nephrology Dialysis Transplantation
Publisher
Oxford University Press (OUP)
Published
2014-01-20
Volume
29
Issue
4
Pages
857-864
ISSN
  • 0931-0509 (ISSN-L)
  • 1460-2385
DOI
10.1093/ndt/gft529
OpenAlex
W2163076045
Semantic Scholar
b211463291c72e06cea9c5f3af4da825aaad76a9
Cited by
110
References
48
Citations by year
2026: 5 · 2025: 5 · 2024: 9 · 2023: 10 · 2022: 10 · 2021: 11 · 2020: 12 · 2019: 14 · 2018: 9 · 2017: 7 · 2016: 6 · 2015: 6 · 2014: 5
FWCI
15.70
Type
journal article
Language
en
Open access
Locations
  • Nephrology Dialysis Transplantation (publishedVersion)
  • PubMed (publishedVersion)
  • Americanae (AECID Library) (publishedVersion)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
Funders
Fundação de Amparo à Pesquisa do Estado de São Paulo (09/14786-0)
Topics
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
Keywords
aerobic exercise, visceral fat, chronic kidney disease, overweight, obesity, home-based exercise, waist circumference, leg lean mass, blood pressure, estimated glomerular filtration rate, ventilatory threshold, sedentary men
MeSH terms
Adolescent, Adult, Aged, Body Composition, Exercise Therapy, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Exercise, Absorptiometry, Photon, Body Mass Index, Treatment Outcome, Intra-Abdominal Fat, Overweight, Renal Insufficiency, Chronic, Young Adult, Sedentary Behavior

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