Sedentary behavior is more prevalent in the CKD population than in the non-CKD population. Independent of moderate/vigorous physical activities, sedentary activities are emerging as a risk factor for obesity, diabetes and mortality. There is a general consensus that sedentary activities must be decreased, but the critical unresolved questions are how much of the sedentary activities must be replaced and by which kind of activity. It is unlikely that moderate/ vigorous intensity (> 3 METs) activities could be a effective replacement for sedentary activities as most Americans do not even reach the current goals for these activities. Furthermore, assuming 16 awake hours/ day, achieving the currently recommended duration of moderate/ vigorous physical activities would account for only 2% of the total awake time (2.5 hours out of 112 awake hours/week). Therefore, decreasing sedentary activities must involve an increase in activities that are less intensive than moderate/ vigorous intensity physical activities. In other words, sedentary activities (< 1.5 METs) must be replaced by activities that are between 1.5 to 2.9 METs. As described in the preliminary data, our analyses of objectively measured physical activities in NHANES indicate that trade-off of each 2 min/hr. of sedentary duration with standing intensity (1.5 to 1.9 METs) type activities duration was not associated with survival benefit. However, a trade-off of each 2 min/hr. of sedentary duration with casual walking intensity (2 to 2.9 METs) type activities duration was associated with 41% lower hazard of death in the CKD subpopulation and 33% lower hazard of death in the entire cohort. Thus, interventions that replace sedentary activity with casual walking intensity activities might provide a survival benefit. This pilot study, titled `Sit Less, Interact, Move Moe (SLIMM) intervention for sedentary behavior in CKD' will test the hypothesis that the SLIMM intervention (with the goals of reducing sedentary duration by increasing casual walking duration and increasing breaks from sedentary activities) in CKD patients will be effective in decreasing sedentary duration and increasing casual walking duration. We will test this hypothesis in a 24 week RCT of 100 inactive, overweight/obese CKD participants randomized to either the SLIMM intervention or the standard of care. An accelerometer will be used to measure the posture and cadence (steps/min). Standardized protocols will be used to measure waist circumference, physical function and QOL and for sample collection, storage and assays of markers of inflammation and insulin resistance. Mixed effects models will be used for statistical analyses. The study is adequately powered. If the results of this pilot study show that replacing sedentary duration with casual walking duration is feasible, it will pave the way for larger RCTs targeting hard-endpoints in the high risk CKD population.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Exploratory/Developmental Grants (R21)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Narva, Andrew
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Utah
Internal Medicine/Medicine
Schools of Medicine
Salt Lake City
United States
Zip Code
Beddhu, Srinivasan; Greene, Tom; Boucher, Robert et al. (2018) Risk-benefit profile of intensive blood pressure treatment - Authors' reply. Lancet Diabetes Endocrinol 6:602
Bansal, Shweta; Wei, Guo; Boucher, Robert E et al. (2018) Self-reported Intentional Weight Loss and Risk of Death in Moderate Chronic Kidney Disease in the United States. J Ren Nutr 28:422-427
Tian, Mi; Tang, Li; Wu, Yuanyuan et al. (2018) Adiponectin attenuates kidney injury and fibrosis in deoxycorticosterone acetate-salt and angiotensin II-induced CKD mice. Am J Physiol Renal Physiol 315:F558-F571
Beddhu, Srinivasan; Chertow, Glenn M; Cheung, Alfred K et al. (2018) Response by Beddhu et al to Letters Regarding Article, ""Influence of Baseline Diastolic Blood Pressure on Effects of Intensive Compared With Standard Blood Pressure Control"". Circulation 137:2668-2669
Beddhu, Srinivasan; Greene, Tom; Boucher, Robert et al. (2018) Intensive systolic blood pressure control and incident chronic kidney disease in people with and without diabetes mellitus: secondary analyses of two randomised controlled trials. Lancet Diabetes Endocrinol 6:555-563
Kramer, Holly; Boucher, Robert E; Leehey, David et al. (2018) Increasing Mortality in Adults With Diabetes and Low Estimated Glomerular Filtration Rate in the Absence of Albuminuria. Diabetes Care 41:775-781
Beddhu, Srinivasan; Chertow, Glenn M; Cheung, Alfred K et al. (2018) Influence of Baseline Diastolic Blood Pressure on Effects of Intensive Compared With Standard Blood Pressure Control. Circulation 137:134-143
Beddhu, Srinivasan; Rocco, Michael V; Toto, Robert et al. (2017) Effects of Intensive Systolic Blood Pressure Control on Kidney and Cardiovascular Outcomes in Persons Without Kidney Disease: A Secondary Analysis of a Randomized Trial. Ann Intern Med 167:375-383
Raphael, Kalani L; Carroll, David J; Murray, Jennifer et al. (2017) Urine Ammonium Predicts Clinical Outcomes in Hypertensive Kidney Disease. J Am Soc Nephrol 28:2483-2490
Beddhu, Srinivasan; Chen, Xiaorui; Wei, Guo et al. (2017) Associations of Protein-Energy Wasting Syndrome Criteria With Body Composition and Mortality in the General and Moderate Chronic Kidney Disease Populations in the United States. Kidney Int Rep 2:390-399