{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T06:03:48Z","timestamp":1784527428344,"version":"3.55.0"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013070","name":"Longhua Hospital Shanghai University of Traditional Chinese Medicine","doi-asserted-by":"publisher","award":["SATCM Document on Personnel and Education No. 256 (2025)"],"award-info":[{"award-number":["SATCM Document on Personnel and Education No. 256 (2025)"]}],"id":[{"id":"10.13039\/501100013070","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013070","name":"Longhua Hospital Shanghai University of Traditional Chinese Medicine","doi-asserted-by":"publisher","award":["SHDC12025121"],"award-info":[{"award-number":["SHDC12025121"]}],"id":[{"id":"10.13039\/501100013070","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013070","name":"Longhua Hospital Shanghai University of Traditional Chinese Medicine","doi-asserted-by":"publisher","award":["(2025-2027) (1-2-1)"],"award-info":[{"award-number":["(2025-2027) (1-2-1)"]}],"id":[{"id":"10.13039\/501100013070","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013070","name":"Longhua Hospital Shanghai University of Traditional Chinese Medicine","doi-asserted-by":"publisher","award":["2025YFC3512802"],"award-info":[{"award-number":["2025YFC3512802"]}],"id":[{"id":"10.13039\/501100013070","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013070","name":"Longhua Hospital Shanghai University of Traditional Chinese Medicine","doi-asserted-by":"publisher","award":["2026ZD0557104"],"award-info":[{"award-number":["2026ZD0557104"]}],"id":[{"id":"10.13039\/501100013070","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013070","name":"Longhua Hospital Shanghai University of Traditional Chinese Medicine","doi-asserted-by":"publisher","award":["SCWLKY-007-002"],"award-info":[{"award-number":["SCWLKY-007-002"]}],"id":[{"id":"10.13039\/501100013070","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Physical frailty, impaired cardiorespiratory fitness (CRF), and diminished lower limb function are prevalent in non-dialysis chronic kidney disease (NDD-CKD) and strongly associated with adverse clinical outcomes. This systematic review and meta-analysis aimed to evaluate the efficacy of exercise training interventions on the core dimensions of the frailty phenotype, CRF, and lower limb function in the NDD-CKD population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Seven electronic databases were systematically searched from inception to March 1, 2026, for randomized controlled trials (RCTs) comparing structured exercise interventions with usual care or sham exercise in adult NDD-CKD patients. Primary outcomes included the five core frailty phenotypes (absolute body weight, handgrip strength, walking speed, physical activity, and fatigue), CRF, and lower limb function. Data were synthesized using a random-effects model, reporting standardized mean differences (SMDs) with 95% confidence intervals (CIs). This study is registered with PROSPERO (CRD420261363651).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighteen RCTs encompassing 938 participants were included. Compared with the control group, exercise interventions significantly improved specific frailty dimensions, notably increasing walking speed (SMD = 0.36, 95% CI 0.03\u20130.69;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.03) and alleviating fatigue (SMD = 0.34, 95% CI 0.04\u20130.64;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.03). Furthermore, exercise significantly enhanced overall CRF (SMD = 0.46, 95% CI 0.29\u20130.63;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001) and lower limb function (SMD = 0.55, 95% CI 0.32\u20130.79;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). Outcomes for absolute body weight, handgrip strength, and general physical activity levels did not reach statistical significance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Exercise training is an effective and safe intervention method that can alleviate specific frailty characteristics (walking speed and fatigue), and enhance the cardiovascular and lower extremity functions of NDD-CKD patients. It is advocated to promote exercise as an early \u201cpre-rehabilitation\u201d strategy to enhance the physical functional reserve of patients before dialysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>\n                      , identifier CRD420261363651.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1868774","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T05:36:03Z","timestamp":1784525763000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of exercise training on frailty, cardiorespiratory fitness, and lower limb function in non-dialysis chronic kidney disease: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Sujie","family":"Yang","sequence":"first","affiliation":[{"name":"Longhua Hospital, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Longhua Hospital, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueling","family":"Li","sequence":"additional","affiliation":[{"name":"Longhua Hospital, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Zhu","sequence":"additional","affiliation":[{"name":"Longhua Hospital, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuye","family":"Chen","sequence":"additional","affiliation":[{"name":"Longhua Hospital, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifei","family":"Zhong","sequence":"additional","affiliation":[{"name":"Longhua Hospital, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianwen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Longhua Hospital, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.kisu.2021.11.003","article-title":"Epidemiology of chronic kidney disease: an 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