Patients with chronic kidney disease (CKD) have exaggerated increases in blood pressure during exercise that are associated with endothelial dysfunction. We hypothesized that aerobic exercise training would improve endothelial function and attenuate blood pressure reactivity during exercise in CKD. Sedentary individuals with CKD stages III–IV underwent 12 wk of aerobic cycling exercise (n= 26) or nonaerobic exercise (n= 22, control). Both interventions were performed 3 days/wk and matched for duration. Endothelial function was measured via peripheral arterial tonometry and quantified as reactive hyperemia index (RHI). Peak oxygen uptake (V̇ o 2peak) was assessed via maximal treadmill exercise testing with concomitant blood pressure monitoring. All measurements were performed at baseline and after the 12-wk intervention. A linear mixed model was used to compare the rate of increase in blood pressure during the test. RHI improved with exercise (Pre= 1.78±0.10 vs. Post= 2.01±0.13, P= 0.03) with no change following stretching (Pre= 1.73±0.08 vs. Post= 1.67±0.10, P= 0.69). Peak systolic blood pressure during the maximal treadmill exercise test was lower after exercise training (Pre= 186±5 mmHg, Post= 174±4 mmHg, P= 0.003) with no change after stretching (Pre= 190±6 mmHg, Post= 190±4 mmHg, P= 0.12). The rate of increase in systolic blood pressure during the V̇ o 2peak test tended to decrease after training for both groups (− 2 mmHg/stage) with no differences between groups (P= 0.97). There was no change in V̇ o 2peak after either intervention. In conclusion, aerobic exercise training improves endothelial function and attenuates peak blood pressure reactivity during exercise in CKD.

NEW & NOTEWORTHY Patients with chronic kidney disease (CKD) exhibit increased blood pressure reactivity during exercise that is associated with endothelial dysfunction. Twelve weeks of structured, aerobic, exercise training improves endothelial function and attenuates peak blood pressure responses during exercise in CKD stages III–IV.