THE IMPACT OF PHYSICAL ACTIVITY ON FUNCTIONING OF THE CARDIO-RENAL-PULMONARY AXIS IN INDIVIDUALS WITH VISCERAL OBESITY - THE SIGNIFICANCE OF EXERCISE AS A PREVENTIVE AND THERAPEUTIC STRATEGY
Abstract
Introduction: Visceral obesity contributes to dysfunction of the integrated cardio-renal-pulmonary (CORP) axis, promoting insulin resistance, chronic low-grade inflammation, hypertension, and glomerular hyperfiltration. Physical activity (PA) is recognized as an effective therapeutic and preventive strategy; however, its specific impact on all components of the CORP axis requires a comprehensive analysis.
Objective: To evaluate the effects of various forms of physical activity on: cardiovascular fitness and aerobic capacity (VO₂ max, cardiorespiratory fitness - CRF), renal function (glomerular filtration rate - GFR, albuminuria), pulmonary structure and function (lung volumes, tissue compliance), in adults with visceral obesity.
Methods: A systematic review of the literature and selected meta-analyses of randomized controlled trials and cohort studies was conducted using PubMed, PMC, and Embase databases up to June 2025. Interventions included aerobic training, high-intensity interval training (HIIT), resistance training, and combined exercise programs. Changes in CRF, visceral adipose tissue (VAT), GFR, blood pressure, and lung function indicators were analyzed.
Conclusions: Physical activity- particularly aerobic, interval, and combined training- has a beneficial effect on the function of the cardio-renal-pulmonary axis in individuals with visceral obesity. Key mechanisms include enhanced aerobic fitness, VAT reduction, improved metabolic profile, attenuation of inflammation, and nephroprotection. Regular exercise should be an essential component of therapeutic and preventive strategies in this population. Further research is warranted to clarify the dose-response relationship between exercise type/intensity and improvements in each CORP axis system.
References
Nawaz S, Chinnadurai R, Al‐Chalabi S, Evans P, Kalra PA, Syed AA, et al. Obesity and chronic kidney disease: A current review. Obes Sci Pract 2023;9:61–74. https://doi.org/10.1002/osp4.629.
Rabe K, Lehrke M, Parhofer KG, Broedl UC. Adipokines and Insulin Resistance. Molecular Medicine 2008;14:741–51. https://doi.org/10.2119/2008-00058.Rabe.
Salome CM, King GG, Berend N. Physiology of obesity and effects on lung function. J Appl Physiol 2010;108:206–11. https://doi.org/10.1152/japplphysiol.00694.2009.
Kelly JT, Conley M, Hoffmann T, Craig JC, Tong A, Reidlinger DP, et al. A Coaching Program to Improve Dietary Intake of Patients with CKD. Clinical Journal of the American Society of Nephrology 2020;15:330–40. https://doi.org/10.2215/CJN.12341019.
Battaglia Y, Baciga F, Bulighin F, Amicone M, Mosconi G, Storari A, et al. Physical activity and exercise in chronic kidney disease: consensus statements from the Physical Exercise Working Group of the Italian Society of Nephrology. J Nephrol 2024;37:1735–65. https://doi.org/10.1007/s40620-024-02049-9.
Mirabelli M, Misiti R, Sicilia L, Brunetti FS, Chiefari E, Brunetti A, et al. Hypoxia in Human Obesity: New Insights from Inflammation towards Insulin Resistance—A Narrative Review. Int J Mol Sci 2024;25:9802. https://doi.org/10.3390/ijms25189802.
Aparecida Silveira E, Vaseghi G, de Carvalho Santos AS, Kliemann N, Masoudkabir F, Noll M, et al. Visceral Obesity and Its Shared Role in Cancer and Cardiovascular Disease: A Scoping Review of the Pathophysiology and Pharmacological Treatments. Int J Mol Sci 2020;21:9042. https://doi.org/10.3390/ijms21239042.
Rana MN, Neeland IJ. Adipose Tissue Inflammation and Cardiovascular Disease: An Update. Curr Diab Rep 2022;22:27–37. https://doi.org/10.1007/s11892-021-01446-9.
Lopes HF, Corrêa-Giannella ML, Consolim-Colombo FM, Egan BM. Visceral adiposity syndrome. Diabetol Metab Syndr 2016;8:40. https://doi.org/10.1186/s13098-016-0156-2.
Navaneethan SD, Kirwan JP, Remer EM, Schneider E, Addeman B, Arrigain S, et al. Adiposity, Physical Function, and Their Associations With Insulin Resistance, Inflammation, and Adipokines in CKD. American Journal of Kidney Diseases 2021;77:44–55. https://doi.org/10.1053/j.ajkd.2020.05.028.
Palma G, Sorice GP, Genchi VA, Giordano F, Caccioppoli C, D’Oria R, et al. Adipose Tissue Inflammation and Pulmonary Dysfunction in Obesity. Int J Mol Sci 2022;23:7349. https://doi.org/10.3390/ijms23137349.
Feijóo-Bandín S, Aragón-Herrera A, Moraña-Fernández S, Anido-Varela L, Tarazón E, Roselló-Lletí E, et al. Adipokines and Inflammation: Focus on Cardiovascular Diseases. Int J Mol Sci 2020;21:7711. https://doi.org/10.3390/ijms21207711.
Kirichenko T V., Markina Y V., Bogatyreva AI, Tolstik T V., Varaeva YR, Starodubova A V. The Role of Adipokines in Inflammatory Mechanisms of Obesity. Int J Mol Sci 2022;23:14982. https://doi.org/10.3390/ijms232314982.
Hall JE, Mouton AJ, da Silva AA, Omoto ACM, Wang Z, Li X, et al. Obesity, kidney dysfunction, and inflammation: interactions in hypertension. Cardiovasc Res 2021;117:1859–76. https://doi.org/10.1093/cvr/cvaa336.
Uchiyama K, Adachi K, Muraoka K, Nakayama T, Oshida T, Yasuda M, et al. Home‐based aerobic exercise and resistance training for severe chronic kidney disease: a randomized controlled trial. J Cachexia Sarcopenia Muscle 2021;12:1789–802. https://doi.org/10.1002/jcsm.12775.
Chu NM, Hong J, Harasemiw O, Chen X, Fowler KJ, Dasgupta I, et al. Chronic kidney disease, physical activity and cognitive function in older adults—results from the National Health and Nutrition Examination Survey (2011–2014). Nephrology Dialysis Transplantation 2022;37:2180–9. https://doi.org/10.1093/ndt/gfab338.
Seidu S, Abdool M, Almaqhawi A, Wilkinson TJ, Kunutsor SK, Khunti K, et al. Physical activity and risk of chronic kidney disease: systematic review and meta-analysis of 12 cohort studies involving 1,281,727 participants. Eur J Epidemiol 2023;38:267–80. https://doi.org/10.1007/s10654-022-00961-7.
Qin Z, Chen X, Sun J, Jiang L. The association between visceral adiposity index and decreased renal function: A population-based study. Front Nutr 2023;10. https://doi.org/10.3389/fnut.2023.1076301.
Miyasato Y, Oba K, Yasuno S, Matsuyama Y, Masuda I. Associations between visceral obesity and renal impairment in health checkup participants: a retrospective cohort study. Clin Exp Nephrol 2020;24:935–45. https://doi.org/10.1007/s10157-020-01921-9.
Zimmermann S, Mathew A, Schöppe R, Mangova G, Biemann R, Surov A, et al. Fat tissue quantity, waist circumference or waist-to-hip ratio in patients with chronic kidney disease: A systematic review and meta-analysis. Obes Res Clin Pract 2024;18:81–7. https://doi.org/10.1016/j.orcp.2024.03.007.
Rao S, Pandey A, Garg S, Park B, Mayo H, Després J-P, et al. Effect of Exercise and Pharmacological Interventions on Visceral Adiposity: A Systematic Review and Meta-analysis of Long-term Randomized Controlled Trials. Mayo Clin Proc 2019;94:211–24. https://doi.org/10.1016/j.mayocp.2018.09.019.
Gao T, Wang J, Zhao Q, Zhou X, Jiang Y, Ren L, et al. Causality of visceral adipose tissue on chronic kidney disease and renal function measure indicators, and mediation role of hypertension: Mendelian randomization study. Obesity Reviews 2025;26. https://doi.org/10.1111/obr.13845.
Xiong B, Yu W, Guan X, Tian Z, Zhu M, Yang H, et al. The association between weekend warrior physical activity pattern and albuminuria in hypertensive patients. BMC Public Health 2024;24:3431. https://doi.org/10.1186/s12889-024-20899-7.
Martens RJH, van der Berg JD, Stehouwer CDA, Henry RMA, Bosma H, Dagnelie PC, et al. Amount and pattern of physical activity and sedentary behavior are associated with kidney function and kidney damage: The Maastricht Study. PLoS One 2018;13:e0195306. https://doi.org/10.1371/journal.pone.0195306.
Hellberg M, Höglund P, Svensson P, Clyne N. Randomized Controlled Trial of Exercise in CKD—The RENEXC Study. Kidney Int Rep 2019;4:963–76. https://doi.org/10.1016/j.ekir.2019.04.001.
Ma Q, Gao Y, Lu J, Liu X, Wang R, Shi Y, et al. The effect of regular aerobic exercise on renal function in patients with CKD: A systematic review and meta-analysis. Front Physiol 2022;13. https://doi.org/10.3389/fphys.2022.901164.
Kuo H-Y, Huang Y-H, Wu S-W, Chang F-H, Tsuei Y-W, Fan H-C, et al. The Effects of Exercise Habit on Albuminuria and Metabolic Indices in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. Medicina (B Aires) 2022;58:577. https://doi.org/10.3390/medicina58050577.
Li M, Chi X, Wang Y, Setrerrahmane S, Xie W, Xu H. Trends in insulin resistance: insights into mechanisms and therapeutic strategy. Signal Transduct Target Ther 2022;7:216. https://doi.org/10.1038/s41392-022-01073-0.
Calcaterra V, Vandoni M, Rossi V, Berardo C, Grazi R, Cordaro E, et al. Use of Physical Activity and Exercise to Reduce Inflammation in Children and Adolescents with Obesity. Int J Environ Res Public Health 2022;19:6908. https://doi.org/10.3390/ijerph19116908.
Siddiqui R, Obi Y, Dossabhoy NR, Shafi T. Is There a Role for SGLT2 Inhibitors in Patients with End-Stage Kidney Disease? Curr Hypertens Rep 2024;26:463–74. https://doi.org/10.1007/s11906-024-01314-3.
Bao Y, Hu Y, Shi M, Zhao Z. SGLT2 inhibitors reduce epicardial adipose tissue more than GLP ‐1 agonists or exercise interventions in patients with type 2 diabetes mellitus and/or obesity: A systematic review and network meta‐analysis. Diabetes Obes Metab 2025;27:1096–112. https://doi.org/10.1111/dom.16107.
Wang X, Wu N, Sun C, Jin D, Lu H. Effects of SGLT-2 inhibitors on adipose tissue distribution in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Diabetol Metab Syndr 2023;15:113. https://doi.org/10.1186/s13098-023-01085-y.
Martínez-Camacho MÁ, Jones-Baro RA, Gómez-González A, Morales-Hernández D, Lugo-García DS, Melo-Villalobos A, et al. Physical and respiratory therapy in the critically ill patient with obesity: a narrative review. Front Med (Lausanne) 2024;11. https://doi.org/10.3389/fmed.2024.1321692.
Alqarni AA, Aldhahir AM, Alqahtani JS, Siraj RA, Aldhahri JH, Madkhli SA, et al. Spirometry profiles of overweight and obese individuals with unexplained dyspnea in Saudi Arabia. Heliyon 2024;10:e24935. https://doi.org/10.1016/j.heliyon.2024.e24935.
Wang S, Sun X, Hsia T-C, Lin X, Li M. The effects of body mass index on spirometry tests among adults in Xi’an, China. Medicine 2017;96:e6596. https://doi.org/10.1097/MD.0000000000006596.
Bordoni B, Escher AR. Obesity and the Importance of Breathing. Cureus 2025. https://doi.org/10.7759/cureus.77431.
Ross R, Neeland IJ, Yamashita S, Shai I, Seidell J, Magni P, et al. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol 2020;16:177–89. https://doi.org/10.1038/s41574-019-0310-7.
Verheggen RJHM, Maessen MFH, Green DJ, Hermus ARMM, Hopman MTE, Thijssen DHT. A systematic review and meta‐analysis on the effects of exercise training versus hypocaloric diet: distinct effects on body weight and visceral adipose tissue. Obesity Reviews 2016;17:664–90. https://doi.org/10.1111/obr.12406.
Strasser B, Spreitzer A, Haber P. Fat Loss Depends on Energy Deficit Only, Independently of the Method for Weight Loss. Ann Nutr Metab 2007;51:428–32. https://doi.org/10.1159/000111162.
Laforgia J, Withers RT, Gore CJ. Effects of exercise intensity and duration on the excess post-exercise oxygen consumption. J Sports Sci 2006;24:1247–64. https://doi.org/10.1080/02640410600552064.
Boutcher SH. High-Intensity Intermittent Exercise and Fat Loss. J Obes 2011;2011:1–10. https://doi.org/10.1155/2011/868305.
IRVING BA, DAVIS CK, BROCK DW, WELTMAN JY, SWIFT D, BARRETT EJ, et al. Effect of Exercise Training Intensity on Abdominal Visceral Fat and Body Composition. Med Sci Sports Exerc 2008;40:1863–72. https://doi.org/10.1249/MSS.0b013e3181801d40.
Heydari M, Freund J, Boutcher SH. The Effect of High-Intensity Intermittent Exercise on Body Composition of Overweight Young Males. J Obes 2012;2012:1–8. https://doi.org/10.1155/2012/480467.
Willis LH, Slentz CA, Bateman LA, Shields AT, Piner LW, Bales CW, et al. Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults. J Appl Physiol 2012;113:1831–7. https://doi.org/10.1152/japplphysiol.01370.2011.
Cadore EL, Pinto RS, Lhullier FLR, Correa CS, Alberton CL, Pinto SS, et al. Physiological Effects of Concurrent Training in Elderly Men. Int J Sports Med 2010;31:689–97. https://doi.org/10.1055/s-0030-1261895.
Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The Physical Activity Guidelines for Americans. JAMA 2018;320:2020. https://doi.org/10.1001/jama.2018.14854.
DONNELLY JE, BLAIR SN, JAKICIC JM, MANORE MM, RANKIN JW, SMITH BK. Appropriate Physical Activity Intervention Strategies for Weight Loss and Prevention of Weight Regain for Adults. Med Sci Sports Exerc 2009;41:459–71. https://doi.org/10.1249/MSS.0b013e3181949333.
Schlotz W, Hellhammer J, Schulz P, Stone AA. Perceived Work Overload and Chronic Worrying Predict Weekend–Weekday Differences in the Cortisol Awakening Response. Psychosom Med 2004;66:207–14. https://doi.org/10.1097/01.psy.0000116715.78238.56.
Hill EE, Zack E, Battaglini C, Viru M, Viru A, Hackney AC. Exercise and circulating Cortisol levels: The intensity threshold effect. J Endocrinol Invest 2008;31:587–91. https://doi.org/10.1007/BF03345606.
Hallsworth K, Fattakhova G, Hollingsworth KG, Thoma C, Moore S, Taylor R, et al. Resistance exercise reduces liver fat and its mediators in non-alcoholic fatty liver disease independent of weight loss. Gut 2011;60:1278–83. https://doi.org/10.1136/gut.2011.242073.
Borghouts LB, Keizer HA. Exercise and Insulin Sensitivity: A Review. Int J Sports Med 2000;21:1–12. https://doi.org/10.1055/s-2000-8847.
Green DJ, Hopman MTE, Padilla J, Laughlin MH, Thijssen DHJ. Vascular Adaptation to Exercise in Humans: Role of Hemodynamic Stimuli. Physiol Rev 2017;97:495–528. https://doi.org/10.1152/physrev.00014.2016.
NELSON ME, REJESKI WJ, BLAIR SN, DUNCAN PW, JUDGE JO, KING AC, et al. Physical Activity and Public Health in Older Adults. Med Sci Sports Exerc 2007;39:1435–45. https://doi.org/10.1249/mss.0b013e3180616aa2.
Yamaoka K, Tango T. Effects of lifestyle modification on metabolic syndrome: a systematic review and meta-analysis. BMC Med 2012;10:138. https://doi.org/10.1186/1741-7015-10-138.
Pi-Sunyer X, Astrup A, Fujioka K, Greenway F, Halpern A, Krempf M, et al. A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management. New England Journal of Medicine 2015;373:11–22. https://doi.org/10.1056/NEJMoa1411892.
Wadden TA, Bailey TS, Billings LK, Davies M, Frias JP, Koroleva A, et al. Effect of Subcutaneous Semaglutide vs Placebo as an Adjunct to Intensive Behavioral Therapy on Body Weight in Adults With Overweight or Obesity. JAMA 2021;325:1403. https://doi.org/10.1001/jama.2021.1831.
Malin SK, Braun B. Impact of Metformin on Exercise-Induced Metabolic Adaptations to Lower Type 2 Diabetes Risk. Exerc Sport Sci Rev 2016;44:4–11. https://doi.org/10.1249/JES.0000000000000070.
Chen X, He H, Xie K, Zhang L, Cao C. Effects of various exercise types on visceral adipose tissue in individuals with overweight and obesity: A systematic review and network meta-analysis of 84 randomized controlled trials. Obes Rev 2024;25:e13666. https://doi.org/10.1111/obr.13666.
Chang Y-H, Yang H-Y, Shun S-C. Effect of exercise intervention dosage on reducing visceral adipose tissue: a systematic review and network meta-analysis of randomized controlled trials. Int J Obes (Lond) 2021;45:982–97. https://doi.org/10.1038/s41366-021-00767-9.
Chen C, Zhang D, Ye M, You Y, Song Y, Chen X. Effects of various exercise types on inflammatory response in individuals with overweight and obesity: a systematic review and network meta-analysis of randomized controlled trials. Int J Obes 2025;49:214–25. https://doi.org/10.1038/s41366-024-01649-6.
Chen X, Li H, Wang K, Liang X, Wang W, Hu X, et al. Aerobic Exercise Ameliorates Myocardial Inflammation, Fibrosis and Apoptosis in High-Fat-Diet Rats by Inhibiting P2X7 Purinergic Receptors. Front Physiol 2019;10. https://doi.org/10.3389/fphys.2019.01286.
Kitzman DW, Brubaker PH, Morgan TM, Stewart KP, Little WC. Exercise training in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. Circ Heart Fail 2010;3:659–67. https://doi.org/10.1161/CIRCHEARTFAILURE.110.958785.
Donohue PK, Boss RD, Aucott SW, Keene EA, Teague P. The impact of neonatologists’ religiosity and spirituality on health care delivery for high-risk neonates. J Palliat Med 2010;13:1219–24. https://doi.org/10.1089/jpm.2010.0049.
Views:
16
Downloads:
8
Copyright (c) 2025 Kacper Trząsalski, Katarzyna Oświeczyńska, Aleksandra Sowa, Sebastian Kupisiak, Patrycja Jędrzejewska-Rzezak
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
