Exercise Improves Physical Function in Chronic Kidney Disease

Chronic kidney disease (CKD) profoundly impacts physical function, muscle mass, and quality of life for millions globally. Historically, these complications were considered unavoidable consequences of the disease. However, a growing body of research demonstrates that structured exercise programs can significantly improve health outcomes for individuals across the spectrum of CKD, from those not yet on dialysis to kidney transplant recipients.

The Shifting Paradigm in CKD Care

Fatigue, reduced exercise tolerance, and progressive muscle wasting are common across all stages of CKD, contributing to increased frailty, hospitalization, and mortality. But the notion that these are simply inevitable is being challenged. Studies consistently show that regular physical activity can improve cardiorespiratory fitness, muscle strength, functional capacity, and overall well-being in CKD patients. Improvements in physical function—measured by walking capacity, sit-to-stand performance, and handgrip strength—are particularly important, as they’ve been identified as strong predictors of hospitalization and survival.

This isn’t to say the evidence is uniform. Some trials have reported more modest or inconsistent effects depending on the specific outcomes measured, the patient subgroups studied, and the type of exercise intervention used. These mixed findings highlight both the potential of exercise and the need for continued refinement in how, when, and for whom exercise interventions are delivered.

Integrating Exercise into Routine Kidney Care

Successful exercise programs implemented worldwide offer models for integrating physical activity into kidney care. Initiatives in Portugal, Canada, Mexico, and Germany have demonstrated that sustained exercise interventions in dialysis settings can improve physical capacity and patient engagement when supported by multidisciplinary teams and structured program design. These programs demonstrate that even in medically complex patients undergoing hemodialysis, exercise can be implemented safely and effectively.

The benefits of physical activity extend beyond dialysis populations. Increasing attention is being given to exercise interventions across the entire CKD spectrum, including earlier disease stages and post-transplant care. For kidney transplant recipients, maintaining physical health through regular exercise is essential to support long-term graft survival, cardiovascular health, and overall well-being. Structured exercise may even improve activity levels in older adults awaiting kidney transplants, according to research published in Nephrology News & Issues.

Prescribing Exercise: Guidance and Resources

Despite these promising developments, exercise remains underutilized in routine nephrology practice. One barrier is uncertainty among clinicians regarding how to safely prescribe exercise for patients with CKD. Fortunately, practical guidance is increasingly available. Several organizations, including Kidney Disease: Improving Global Outcomes (KDIGO), the UK Kidney Association/Renal Association, and the National Kidney Foundation, have published recommendations supporting exercise implementation for people with CKD. These guidelines generally recommend encouraging regular physical activity tailored to the patient’s functional status and comorbidities, aiming for about 150 minutes per week of moderate-intensity aerobic activity, combined with resistance/strength training and reduced sedentary time.

The Global Renal Exercise Network (https://grexercise.arizona.edu/renal-exercise-education-resources/exercise-ckd-course) offers educational resources to support clinicians interested in promoting exercise in CKD populations. These resources emphasize that promoting exercise doesn’t necessarily require specialized equipment or advanced training. Simple strategies, such as encouraging walking programs, light resistance exercises, or intradialytic cycling, can help patients gradually increase their activity levels.

The Role of Exercise Specialists

Exercise specialists, physiotherapists, and exercise physiologists play a crucial role in developing structured exercise programs for CKD populations. Their expertise ensures exercise prescriptions are individualized, safe, and tailored to patients’ functional capacity and medical conditions. Collaborative care models that include nephrologists, dietitians, rehabilitation professionals, and exercise specialists offer an ideal approach for integrating physical activity into comprehensive CKD management.

Novel approaches may also help make physical activity promotion more practical and scalable. For example, AI-based health coaching apps or digital agents could provide personalized encouragement, goal setting, symptom monitoring, and adaptive feedback, helping patients incorporate exercise more consistently into daily life whereas reducing the burden on clinical teams. Further research is needed to determine how these tools can be most effectively integrated into CKD care.

Empowering Patients and Looking Ahead

Communicating positive and empowering messages to patients is equally important. Many individuals with CKD believe fatigue and physical decline are inevitable. However, the growing number of successful exercise programs and patient experiences tell a different story. Patients who participate in structured exercise interventions frequently report improvements in strength, mobility, independence, and overall confidence in their physical abilities.

Moving forward, continued collaboration among clinicians, researchers, and exercise professionals will be essential to expand access to exercise programs and translate existing evidence into clinical practice. By promoting physical activity across all stages of CKD, the nephrology community can help patients maintain physical function, enhance quality of life, and transform the experience of living with kidney disease.

For more information:

Geovana Martin-Alemañy, PhD, is a postdoctoral research associate in the School of Nutritional Science and Wellness at University of Arizona. She can be reached at [email protected].

Kenneth R. Wilund, PhD, is a professor and director of the School of Nutritional Science and Wellness at University of Arizona. He is also founder of the Global Renal Exercise Network, an international group of researchers, clinicians and patient partners. He can be reached at [email protected].

Sources/Disclosures: Martin-Alemañy and Wilund report no relevant financial disclosures.