Exercise Study Testing Enhanced Energetics of Mitochondria Video Integrated Delivery of Activity Training in CKD

Prior treatment

• Current or previous transplantation
• Drugs that alter mitochondrial function:
  • muscle relaxants (methocarbamol, baclofen, tizanidine, carisoprodol, cyclobenzaprine)
  • oral steroids (Equivalent of 10mg or more of prednisone daily)
  • anti-viral medications (tenofovir, zalcitabine, didanosine, stavudine, lamivudine, zidovudine, abacavir, adefovir, interferon, ribavirin, efavirenz, dasabuvir, ombitasvir)
  • oral calcineurin inhibitors (Tacrolimus, Cyclosporine)
  • Antiepileptic drugs (Phenytoin, phenobarbital, carbamazepine, valproic acid, oxcarbazepine, ethosuximide, zonisamide, topiramate, and vigabatrin)
  • Antipsychotics (haloperidol, thioridazine, risperidone, quetiapine, clozapine, olanzapine and aripiprazole)
• Drugs- anticoagulants or antiplatelets
  • Anticoagulants, any 1 (coumadin, rivaroxaban, apixaban, dabigatran, edoxaban)
  • Antiplatelets, any 2 (aspirin, cilostazol, clopidogrel, dipyridamole, prasugrel, ticagrelor, ticlopidine, vorapaxar)
• Implants that prohibit MRI measurements or trauma involving metal fragments

Other illness

• Oxygen dependent Chronic obstructive pulmonary disease (COPD)
• HIV infection or hepatitis viral infection
• Active malignant cancer other than non-melanomatous skin cancer
• History of clotting disorder (Deep venous thrombosis, pulmonary embolism) or bleeding disorder.
• History of sever heart disease/disorders: coronary artery bypass graft (CABG) surgery, atrial fibrillation
• Any condition which in the judgement of the clinical investigator places the participant at risk from participation in the study.
  • Additional Criteria:
• Uncontrolled diabetes with a HgbA1c \>8.5
• Active uncontrolled thyroid disease

Lab values

• Anemia (Hgb \<9 g/dL)

Other

• Current pregnancy (all females of child-bearing potential will have a pregnancy test)
• Wheelchair dependence or other disability that precludes physical exercise
• Shortness of breath after walking \<100 steps on flat surface
• Weight \>300 pounds
• Decompensated cirrhosis
• Pacemaker
• Vascular stent: bare metal or any recently placed (within 6 months)
• Current substance abuse
• Institutionalization
• Current participation in an interventional trial
• Inability to provide informed consent without a proxy respondent
• Non-English speaking
• On chronic dialysis
• Expectation to start dialysis within 6 months.
• High dose antioxidants (Vitamine C, Vitamin E)
• Baseline systolic blood pressure \>170 or diastolic blood pressure \>100
• Current substance abuse (i.e. amphetamine abuse)
• Chronic opioid use (i.e. for chronic pain)
• Chronic use of immunosuppressants
• Active coronary ischemia detected by ECG on cycle ergometry VO2max testing. These individuals will be promptly referred to their primary care provider by the PI.

• Moderate-severe CKD determined by estimated glomerular filtration rate (eGFR) \<60ml/min per 1.73m2
• No history chronic treatment with dialysis.
• Age 30 years old to 75 years
• Sedentary defined as self-reporting no more than 1 day per week of regular (structured) endurance exercise (EE) \[e.g., brisk walking, jogging/running, cycling, elliptical, or swimming activity that results in feelings of increased heart rate or rapid breathing (EE), and/or sweating\] or resistance exercise (RE) (resulting in muscular fatigue) lasting no more than 60 minutes in the past year.
  • Persons bicycling as a mode of transportation to/from work \> 1 day/week etc. are not considered sedentary
  • Leisure walkers are included unless they meet the heart rate, breathing and sweating criteria noted above
  • Persons adherent to both 1 day/week of RE and 1 day/week of EE are excluded