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Author Interview: Kirsten Johansen, MD

Pedometer-Assessed Physical Activity in Children and Young Adults with CKD

Professor of Medicine
University of California, San Francisco
San Francisco VA Medical Center
Nephrology Section, 111J


Pedometer-Assessed Physical Activity in Children and Young Adults with CKD

Aalia Akber, Anthony A. Portale, and Kirsten L. Johansen
Pedometer-Assessed Physical Activity in Children and Young Adults with CKDCJASN CJN.06330611; published ahead of print March 15, 2012,doi:10.2215/CJN.06330611


What are the main findings of the study?

We enrolled children and adolescents with chronic kidney disease — either nondialysis-dependent CKD, dialysis-dependent ESRD or transplanted — and asked them to wear pedometers, or step counters, for a week to measure their physical activity in the form of average daily steps.

We also had them perform a six-minute walk test and asked about their physical functioning using a standardized pediatric health-related quality of life instrument, the PedsQL. The main findings were that children and adolescents with chronic kidney disease were extremely inactive.

Very few even came close to meeting recommended steps per day for their age range, and they were also much less active than a representative sample of youths from the NHANES study.

We also found that lower physical activity was associated with worse physical performance (i.e., a shorter distance walked in six minutes) and with worse self-reported physical function.

Were any of the findings unexpected?

Yes. We suspected that children with CKD would be less active than their peers, but I was surprised by the magnitude of the difference, in other words I was surprised at just how sedentary they were. We know that adults with ESRD are extremely inactive, but they typically have many comorbid conditions that might be contributing, so these data in children were particularly interesting because they suggest that possibly CKD itself or its treatment may contribute to inactivity. The other finding that was somewhat unexpected was that children who were less active did less well on our six minute walk test and reported worse physical functioning.

Again, this finding would be typical for older adults who would be expected to lose function if they do not maintain some degree of activity, but we thought that children might be "high functioning" enough to do well on these measures even if they were sedentary. After all, it was a six-minute walk test, not a shuttle run or maximal treadmill test. Yet, children who were less active did not perform as well and were substantially below norms generated for healthy children.

What should clinicians and patients take away from this study?

Well, our data do not prove that increasing physical activity will improve any of these things, but what if it could?

What would be the downside? I recommend that nephrologists focus on physical activity with their patients.

Physical activity is a potentially modifiable behavior. Ask your pediatric (and adult) patients if they are active.

Tell them to walk more. We focus heavily on disease management, but we should not forget the basics. Most children with CKD see nephrologists more than any other type of doctor. If they don't hear it from us, they might not hear it at all.

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