UK: Researchers have found in a new study that combined exercise (CE), rather than aerobic exercise (AE) alone, promotes beneficial anabolic and muscle-building (myogenic) adaptations in the skeletal muscle of patients with chronic kidney disease (CKD). Integrating both in vivo and in vitro research methods provides deeper mechanistic insights into how exercise drives molecular changes in muscle. These findings highlight the importance of incorporating resistance training along with aerobic exercise to help overcome anabolic resistance in individuals with CKD. The findings were published in BMC Nephrology by Douglas W. Gould and colleagues from the Intensive Care National Audit and Research Centre. The researchers investigated how different exercise approaches affect molecular pathways involved in muscle growth and breakdown in patients with Chronic Kidney Disease.Muscle wasting is a common complication of CKD and contributes to weakness, reduced physical function, and poorer health outcomes. Although exercise is widely recommended for patients with CKD, the molecular mechanisms underlying muscle adaptation to different exercise types remain unclear.To address this gap, researchers analyzed muscle biopsies collected from participants enrolled in the ExTra CKD randomized controlled trial, which evaluated exercise interventions over 12 weeks. Biopsies were obtained at baseline, 24 hours after the first exercise session, and 24 hours after the final training session. The samples were analyzed to measure markers involved in protein synthesis, protein breakdown, and muscle regeneration. The study led to the following findings:The study found clear differences between aerobic exercise alone and combined exercise.Aerobic exercise alone did not significantly change Akt phosphorylation, a key signal involved in muscle protein synthesis.Combined exercise significantly increased Akt phosphorylation after training, indicating improved anabolic signalling.Combined exercise reduced early markers of muscle protein breakdown observed during the untrained state.It also increased expression of the myogenic regulator MyoD, suggesting enhanced muscle regeneration.These findings indicate stronger muscle-building and regenerative responses when resistance training is combined with aerobic exercise.Complementary laboratory experiments were performed using primary skeletal muscle cells from CKD patients and healthy controls.Mechanical stretching of the cells, used to simulate exercise stress, triggered strong activation of anabolic signalling pathways such as Akt and p70S6K.The timing and magnitude of these signalling responses were similar in CKD and healthy cells.This suggests that skeletal muscle in CKD retains the ability to respond to mechanical stimulation.Overall, the study indicates that combining aerobic and resistance exercise can produce beneficial molecular adaptations in skeletal muscle among patients with CKD. The findings also highlight the importance of resistance training as part of exercise programs aimed at counteracting muscle loss and improving physical function in this population.Reference:Gould, D.W., Baker, L.A., Wilkinson, T.J. et al. Anabolic and catabolic responses to different modes of exercise in patients with chronic kidney disease. BMC Nephrol (2026). https://doi.org/10.1186/s12882-026-04891-4