Effect of a multimodal exercise program combined with inspiratory muscle training on cardiovascular recovery, functional capacity, and quality of life in CKD patients with Type 4 cardiorenal syndrome

Background: Chronic Kidney Disease (CKD)-associated Type 4 cardiorenal syndrome is marked by progressive cardiac dysfunction, reduced functional capacity, and impaired Quality of Life (QOL).

Objective: To determine whether a multimodal exercise programme combining flexibility, aerobic, and resistance training with Inspiratory Muscle Training (IMT) produces greater improvement in cardiovascular recovery, functional capacity, and QOL than IMT alone in patients with CKD-associated Type 4 cardiorenal syndrome.

Methods: Fifty-two participants were randomly allocated to an experimental group (multimodal exercise plus IMT, n=26) or a control group (IMT alone, n=26). Left Ventricular Ejection Fraction (LVEF), Heart Rate Recovery (HRR), Six-Minute Walk Distance (6MWD), Kidney Disease Quality of Life (KDQOL), and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores were assessed pre- and post intervention.

Results: Both groups improved significantly from baseline (p<0.001), but improvement was consistently and substantially greater in the experimental group across all five outcomes, with large-to very-large effect sizes that remained significant after Bonferroni correction and ANCOVA adjustment for baseline scores.

Conclusion: Adding multimodal exercise training to IMT yields superior cardiovascular, functional and quality-of-life outcomes than respiratory training alone in Type 4 cardiorenal syndrome.