Objective To examine the long-term association of objectively measured moderate-to-vigorous physical activity (MVPA) and its longitudinal changes with progression to chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) and overweight/obesity.
Methods This study included 1746 participants in the Look AHEAD trial with baseline estimated glomerular filtration rate (eGFR)≥60 mL/min/1.73 m2. MVPA was measured at baseline, year 1, year 4 and year 8 using an RT3 accelerometer. The outcome was progression to CKD, defined as eGFR<60 mL/min per 1.73 m2 with a drop of ≥30% or end-stage kidney disease. Cox hazards models were fitted to examine the association between MVPA and outcomes.
Results Over a median follow-up of 12.0 years, 567 participants experienced progression to CKD. Overall, there was a linear inverse association of cumulative average total MVPA (per 100 min/week higher amount, HR: 0.91; 95% CI: 0.86 to 0.96) and MVPA accumulated in bouts of ≥10 min (per 100 minutes/week higher amount, HR: 0.81; 95% CI: 0.72 to 0.91) with progression to CKD. Moreover, an increase in total MVPA from baseline to year 4 (the fourth quartile, ≥63.2 min/week) was associated with a 33% lower risk of progression to CKD compared with the largest MVPA reduction (the first quartile, <−198.3 min/week). A lower risk of progression to CKD was also observed for increases in MVPA accumulated in bouts of both <10 min and ≥10 min.
Conclusions Longer MVPA time and increases in MVPA was associated with a reduced risk of progression to CKD in adults with overweight/obesity and T2D.
- Physical activity
Data availability statement
Data may be obtained from a third party and are not publicly available. The data sets analysed in the current study are available on application at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Repository.
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Contributors ML, FFH and XQ designed and conducted the research. ML and YanjunZhang performed the data management and statistical analyses. ML and XQ wrote the manuscript. All authors reviewed/edited the manuscript for important intellectual content. All authors read and approved the final manuscript. XQ is the guarantor of the project and accepts full responsibility for the work and/or the conduct of the study, had access to the data and controlled the decision to publish.
Funding The study was supported by the National Key Research and Development Program (2022YFC2009600, 2022YFC2009605 to XQ); the National Natural Science Foundation of China (81973133 to XQ); the National Natural Science Foundation of China (Key Program) (82030022 to FFH); the Program of Introducing Talents of Discipline to Universities, 111 Plan (D18005 to FFH); Guangdong Provincial Clinical Research Center for Kidney Disease (2020B1111170013 to FFH); Key Technologies R&D Program of Guangdong Province (2023B1111030004 to FFH).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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