993 
Regular bouts of moderate to vigorous physical activity can protect patients with type 2 diabetes from developing kidney disease, a new study has found.
Overweight and obese people with type 2 diabetes who undertook moderate to vigorous physical activity every week were significantly less likely to progress to chronic kidney disease than those who undertook minimal physical activity.
Increasing cumulative exercise by just over an hour a week is linked to a 33% reduction in risk of renal disease. The researchers showed that the increase in physical activity is just as effective whether the extra exercise is undertaken in short bursts of less than 10 minutes or for long periods of 10 minutes and over.
The findings, published in the British Journal of Sports Medicine, show that being physically active is one of the most effective ways to prevent kidney disease in people with type 2 diabetes and can even help patients unable or unwilling to engage in physical activity for over 10 minutes.
Diabetes accounts for 30-50% of chronic kidney disease cases globally, making it the leading cause of renal disease. Patients who have diabetes and chronic kidney disease have a 10-fold higher risk of death from any cause compared with those who have diabetes alone.
To determine whether there was an association between physical activity and chronic kidney disease risk in patients with type 2 diabetes, the researchers undertook a secondary analysis of an activity tracker study, which was part of the US Look AHEAD trial.
The study involved 1,746 participants, with an average age of 58.
The participants were monitored for moderate to vigorous levels of physical activity and the extent of chronic kidney disease at the start of the study and again at one, four and eight years later.
Chronic kidney disease was defined as a deterioration of at least 30% in the estimated glomerular filtration rate, the rate at which kidneys remove waste and extra water from the blood to make urine (less than 60 ml/min).
On average, participants undertook 329 minutes of moderate to vigorous physical activity every week. Over 80% of this was accumulated in periods of less than 10 minutes, with the remaining 12.5% in periods of more than 10 minutes.
Over the duration of the study, around one in three of the participants developed chronic kidney disease.
The participants who undertook the most moderate to vigorous physical activity, between 329 to 469 mins per week, were significantly less likely to progress to chronic kidney disease than those who did the least physical activity (under 220 mins).
The researchers found that for every 100 minutes of moderate to vigorous activity, there was a 9% lower risk of developing chronic kidney disease. This increased to 19% if the exercise sessions lasted for at least 10 minutes.
Participants who increased their weekly exercise tally by 63 minutes over the first four years of the study had a 33% lower risk of kidney disease than those with the most significant decrease of minutes per week. The improvement was seen whether the physical activity sessions were greater than or less than 10 minutes.
The researchers stated: ‘These findings are consistent with evidence that regular [physical activity] has direct anti-inflammatory effects, and can promote glycaemic control, improve insulin sensitivity, blood pressure, lipid profiles and other metabolic and cardiovascular risk factors, all of which are associated with renal function.’
The researchers suggest that all patients with diabetes should be encouraged to engage in as much exercise intensity as they can tolerate to maximise the benefits.
Just over an hour a day of walking, cycling, jogging or swimming could help overweight and obese adults with type 2 diabetes reduce their risk of progression to chronic kidney disease.
A previous study from 2022 showed that increased coffee consumption lowered rate of kidney function decline in people with type 2 diabetes.
A version of this article was originally published by our sister publication Nursing in Practice.
