THE IMPACT OF PHYSICAL ACTIVITY ON CHRONIC KIDNEY DISEASE: BENEFITS, SCIENTIFIC PROOFS, SAFETY, AND GUIDELINES FOR EXERCISE PRESCRIPTION
DOI:
https://doi.org/10.31435/ijitss.3(47).2025.4070Keywords:
CKD, Chronic Kidney Disease, Physical Activity, Aerobic Exercises, Resistance TrainingAbstract
Chronic Kidney Disease (CKD) is a significant global health issue characterized by progressive loss of kidney function, impacting quality of life and increasing the risk of morbidity and mortality. This paper explores the multifaceted role of physical activity in managing CKD, focusing on its benefits, safety considerations, and best practices for exercise prescription, based on systematic reviews of literature sourced from PubMed and Google Scholar. While physical activity has been shown to offer substantial benefits, such as improved cardiovascular outcomes, enhanced physical function, and reduced inflammation, safety concerns are paramount. These include potential risks associated with exercise intensity and its effects on kidney function and overall health. The paper also evaluates best practices for integrating exercise into CKD management, based on recent evidence and expert recommendations. Our findings suggest that regular physical activity is a crucial component of CKD management, with significant potential to improve patient outcomes. However, tailored exercise programs that account for individual patient conditions and disease stages are essential to maximize benefits and minimize risks. This review underscores the need for ongoing research and refined guidelines to optimize exercise interventions for CKD patients, ensuring safe and effective integration into standard care practices.
References
Abreu, C. C., Cardozo, L. F. M. F., Stockler-Pinto, M. B., Esgalhado, M., Barboza, J. E., Frauches, R., & Mafra, D. (2017). Does resistance exercise performed during dialysis modulate Nrf2 and NF-κB in patients with chronic kidney disease? Life Sciences, 188, 192–197. https://doi.org/10.1016/J.LFS.2017.09.007
Albarrati, A. M., Alghamdi, M. S. M., Nazer, R. I., Alkorashy, M. M., Alshowier, N., & Gale, N. (2018). Effectiveness of Low to Moderate Physical Exercise Training on the Level of Low-Density Lipoproteins: A Systematic Review. BioMed Research International, 2018, 5982980. https://doi.org/10.1155/2018/5982980
Aoike, D. T., Baria, F., Kamimura, M. A., Ammirati, A., de Mello, M. T., & Cuppari, L. (2015). Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease. International Urology and Nephrology, 47(2), 359–367. https://doi.org/10.1007/S11255-014-0894-8
Arazi, H., Mohabbat, M., Saidie, P., Falahati, A., & Suzuki, K. (2022a). Effects of Different Types of Exercise on Kidney Diseases. Sports, 10(3), 42. https://doi.org/10.3390/SPORTS10030042
Arazi, H., Mohabbat, M., Saidie, P., Falahati, A., & Suzuki, K. (2022b). Effects of Different Types of Exercise on Kidney Diseases. Sports (Basel, Switzerland), 10(3). https://doi.org/10.3390/SPORTS10030042
Baião, V. M., Cunha, V. A., Duarte, M. P., Andrade, F. P., Ferreira, A. P., Nóbrega, O. T., Viana, J. L., & Ribeiro, H. S. (2023). Effects of Exercise on Inflammatory Markers in Individuals with Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Metabolites, 13(7). https://doi.org/10.3390/METABO13070795
Barcellos, F. C., Del Vecchio, F. B., Reges, A., Mielke, G., Santos, I. S., Umpierre, D., Bohlke, M., & Hallal, P. C. (2018a). Exercise in patients with hypertension and chronic kidney disease: a randomized controlled trial. Journal of Human Hypertension, 32(6), 397–407. https://doi.org/10.1038/S41371-018-0055-0
Barcellos, F. C., Del Vecchio, F. B., Reges, A., Mielke, G., Santos, I. S., Umpierre, D., Bohlke, M., & Hallal, P. C. (2018b). Exercise in patients with hypertension and chronic kidney disease: a randomized controlled trial. Journal of Human Hypertension, 32(6), 397–407. https://doi.org/10.1038/S41371-018-0055-0
Beetham, K. S., Howden, E. J., Fassett, R. G., Petersen, A., Trewin, A. J., Isbel, N. M., & Coombes, J. S. (2019). High-intensity interval training in chronic kidney disease: A randomized pilot study. Scandinavian Journal of Medicine & Science in Sports, 29(8), 1197–1204. https://doi.org/10.1111/SMS.13436
Böhm, J., Monteiro, M. B., Andrade, F. P., Veronese, F. V., & Thomé, F. S. (2017). Acute effects of intradialytic aerobic exercise on solute removal, blood gases and oxidative stress in patients with chronic kidney disease. Jornal Brasileiro de Nefrologia, 39(2), 172–180. https://doi.org/10.5935/0101-2800.20170022
Bronas, U. G., Puzantian, H., & Hannan, M. (2017). Cognitive Impairment in Chronic Kidney Disease: Vascular Milieu and the Potential Therapeutic Role of Exercise. BioMed Research International, 2017. https://doi.org/10.1155/2017/2726369
Chen, P. Y., Huang, Y. C., Kao, Y. H., & Chen, J. Y. (2010). Effects of an exercise program on blood biochemical values and exercise stage of chronic kidney disease patients. The Journal of Nursing Research : JNR, 18(2), 98–107. https://doi.org/10.1097/JNR.0B013E3181DDA726
Chen, T. K., Knicely, D. H., & Grams, M. E. (2019). Chronic Kidney Disease Diagnosis and Management: A Review. JAMA, 322(13), 1294–1304. https://doi.org/10.1001/JAMA.2019.14745
Chu, N. M., & McAdams-DeMarco, M. A. (2019). Exercise and cognitive function in patients with end-stage kidney disease. Seminars in Dialysis, 32(4), 283–290. https://doi.org/10.1111/SDI.12804
Corrêa, H. L., Moura, S. R. G., Neves, R. V. P., Tzanno-Martins, C., Souza, M. K., Haro, A. S., Costa, F., Silva, J. A. B., Stone, W., Honorato, F. S., Deus, L. A., Prestes, J., Simões, H. G., Vieira, E. C., de Melo, G. F., Moraes, M. R., & Rosa, T. S. (2020). Resistance training improves sleep quality, redox balance and inflammatory profile in maintenance hemodialysis patients: a randomized controlled trial. Scientific Reports, 10(1). https://doi.org/10.1038/S41598-020-68602-1
Greenwood, S. A., Koufaki, P., Mercer, T. H., MacLaughlin, H. L., Rush, R., Lindup, H., O’Connor, E., Jones, C., Hendry, B. M., Macdougall, I. C., & Cairns, H. S. (2015). Effect of exercise training on estimated GFR, vascular health, and cardiorespiratory fitness in patients with CKD: A pilot randomized controlled trial. American Journal of Kidney Diseases, 65(3), 425–434. https://doi.org/10.1053/j.ajkd.2014.07.015
Headley, S., Germain, M., Milch, C., Pescatello, L., Coughlin, M. A., Nindl, B. C., Cornelius, A., Sullivan, S., Gregory, S., & Wood, R. (2012). Exercise training improves HR responses and V˙O2peak in predialysis kidney patients. Medicine and Science in Sports and Exercise, 44(12), 2392–2399. https://doi.org/10.1249/MSS.0B013E318268C70C
Hill, N. R., Fatoba, S. T., Oke, J. L., Hirst, J. A., O’Callaghan, C. A., Lasserson, D. S., & Hobbs, F. D. R. (2016). Global Prevalence of Chronic Kidney Disease – A Systematic Review and Meta-Analysis. PLOS ONE, 11(7), e0158765. https://doi.org/10.1371/JOURNAL.PONE.0158765
Hiraki, K., Shibagaki, Y., Izawa, K. P., Hotta, C., Wakamiya, A., Sakurada, T., Yasuda, T., & Kimura, K. (2017). Effects of home-based exercise on pre-dialysis chronic kidney disease patients: a randomized pilot and feasibility trial. BMC Nephrology, 18(1). https://doi.org/10.1186/S12882-017-0613-7
Honda, S., Kawasaki, T., Kamitani, T., & Kiyota, K. (2017). Rhabdomyolysis after High Intensity Resistance Training. Internal Medicine (Tokyo, Japan), 56(10), 1175–1178. https://doi.org/10.2169/INTERNALMEDICINE.56.7636
Howden, E. J., Coombes, J. S., Strand, H., Douglas, B., Campbell, K. L., & Isbel, N. M. (2015a). Exercise training in CKD: efficacy, adherence, and safety. American Journal of Kidney Diseases : The Official Journal of the National Kidney Foundation, 65(4), 583–591. https://doi.org/10.1053/J.AJKD.2014.09.017
Howden, E. J., Coombes, J. S., Strand, H., Douglas, B., Campbell, K. L., & Isbel, N. M. (2015b). Exercise training in CKD: Efficacy, adherence, and safety. American Journal of Kidney Diseases, 65(4), 583–591. https://doi.org/10.1053/j.ajkd.2014.09.017
Iatridi, F., Carrero, J. J., Gall, E. C. Le, Kanbay, M., Luyckx, V., Shroff, R., & Ferro, C. J. (2025). KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease in Children and Adults: a commentary from the European Renal Best Practice (ERBP). Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 40(2), 273–282. https://doi.org/10.1093/NDT/GFAE209
Kosmadakis, G. C., John, S. G., Clapp, E. L., Viana, J. L., Smith, A. C., Bishop, N. C., Bevington, A., Owen, P. J., McIntyre, C. W., & Feehally, J. (2012). Benefits of regular walking exercise in advanced pre-dialysis chronic kidney disease. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 27(3), 997–1004. https://doi.org/10.1093/NDT/GFR364
Leehey, D. J., Collins, E., Kramer, H. J., Cooper, C., Butler, J., McBurney, C., Jelinek, C., Reda, D., Edwards, L., Garabedian, A., & O’Connell, S. (2016). Structured Exercise in Obese Diabetic Patients with Chronic Kidney Disease: A Randomized Controlled Trial. American Journal of Nephrology, 44(1), 54–62. https://doi.org/10.1159/000447703
Leehey, D. J., Moinuddin, I., Bast, J. P., Qureshi, S., Jelinek, C. S., Cooper, C., Edwards, L. C., Smith, B. M., & Collins, E. G. (2009). Aerobic exercise in obese diabetic patients with chronic kidney disease: a randomized and controlled pilot study. Cardiovascular Diabetology, 8. https://doi.org/10.1186/1475-2840-8-62
Moinuddin, I., & Leehey, D. J. (2008). A comparison of aerobic exercise and resistance training in patients with and without chronic kidney disease. Advances in Chronic Kidney Disease, 15(1), 83–96. https://doi.org/10.1053/J.ACKD.2007.10.004
Pan, Y., Wang, P., Yue, C., & Liu, C. (2025). Effect of nine different exercise interventions on insulin sensitivity in diabetic patients: a systematic review and mesh meta-analysis. Frontiers in Endocrinology, 16. https://doi.org/10.3389/FENDO.2025.1409474
Parsons, T. L., Toffelmire, E. B., & King-VanVlack, C. E. (2006). Exercise Training During Hemodialysis Improves Dialysis Efficacy and Physical Performance. Archives of Physical Medicine and Rehabilitation, 87(5), 680–687. https://doi.org/10.1016/j.apmr.2005.12.044
Pechter, Ü., Raag, M., & Ots-Rosenberg, M. (2014). Regular aquatic exercise for chronic kidney disease patients: a 10-year follow-up study. International Journal of Rehabilitation Research. Internationale Zeitschrift Fur Rehabilitationsforschung. Revue Internationale de Recherches de Readaptation, 37(3), 251–255. https://doi.org/10.1097/MRR.0000000000000063
Pei, G., Tang, Y., Tan, L., Tan, J., Ge, L., & Qin, W. (2019). Aerobic exercise in adults with chronic kidney disease (CKD): a meta-analysis. International Urology and Nephrology, 51(10), 1787–1795. https://doi.org/10.1007/S11255-019-02234-X
Sakhaee, K. (2008). Recent advances in the pathophysiology of nephrolithiasis. Kidney International, 75(6), 585. https://doi.org/10.1038/KI.2008.626
Spada, T. C., Silva, J. M. R. D., Francisco, L. S., Marçal, L. J., Antonangelo, L., Zanetta, D. M. T., Yu, L., & Burdmann, E. A. (2018). High intensity resistance training causes muscle damage and increases biomarkers of acute kidney injury in healthy individuals. PloS One, 13(11). https://doi.org/10.1371/JOURNAL.PONE.0205791
Stringuetta Belik, F., Oliveirae Silva, V. R., Braga, G. P., Bazan, R., Perez Vogt, B., Costa Teixeira Caramori, J., Barretti, P., De Souza Gonçalves, R., Fortes Villas Bôas, P. J., Hueb, J. C., Martin, L. C., & Da Silva Franco, R. J. (2018). Influence of Intradialytic Aerobic Training in Cerebral Blood Flow and Cognitive Function in Patients with Chronic Kidney Disease: A Pilot Randomized Controlled Trial. Nephron, 140(1), 9–17. https://doi.org/10.1159/000490005
Tang, Q., Yang, B., Fan, F., Li, P., Yang, L., & Guo, Y. (2017). Effects of individualized exercise program on physical function, psychological dimensions, and health-related quality of life in patients with chronic kidney disease: A randomized controlled trial in China. International Journal of Nursing Practice, 23(2). https://doi.org/10.1111/IJN.12519
Van Craenenbroeck, A. H., Van Craenenbroeck, E. M., Van Ackeren, K., Vrints, C. J., Conraads, V. M., Verpooten, G. A., Kouidi, E., & Couttenye, M. M. (2015). Effect of Moderate Aerobic Exercise Training on Endothelial Function and Arterial Stiffness in CKD Stages 3-4: A Randomized Controlled Trial. American Journal of Kidney Diseases, 66(2), 285–296. https://doi.org/10.1053/j.ajkd.2015.03.015
Viana, J. L., Kosmadakis, G. C., Watson, E. L., Bevington, A., Feehally, J., Bishop, N. C., & Smith, A. C. (2014). Evidence for anti-inflammatory effects of exercise in CKD. Journal of the American Society of Nephrology : JASN, 25(9), 2121–2130. https://doi.org/10.1681/ASN.2013070702
Villanego, F., Naranjo, J., Vigara, L. A., Cazorla, J. M., Montero, M. E., García, T., Torrado, J., & Mazuecos, A. (2020). Impacto del ejercicio físico en pacientes con enfermedad renal crónica: revisión sistemática y metaanálisis. Nefrología, 40(3), 237–252. https://doi.org/10.1016/j.nefro.2020.01.002
Watson, E. L., Gould, D. W., Wilkinson, T. J., Enophontos, S., Clarke, A. L., Vogt, B. P., Viana, J. L., & Smith, A. C. (2018). Twelve-week combined resistance and aerobic training confers greater benefits than aerobic training alone in nondialysis CKD. American Journal of Physiology. Renal Physiology, 314(6), F1188–F1196. https://doi.org/10.1152/AJPRENAL.00012.2018
Weiner, D. E., Liu, C. K., Miao, S., Fielding, R., Katzel, L. I., Giffuni, J., Well, A., & Seliger, S. L. (2023). Effect of Long-term Exercise Training on Physical Performance and Cardiorespiratory Function in Adults With CKD: A Randomized Controlled Trial. American Journal of Kidney Diseases : The Official Journal of the National Kidney Foundation, 81(1), 59–66. https://doi.org/10.1053/J.AJKD.2022.06.008
Wilund, K. R., Thompson, S., Viana, J. L., & Wang, A. Y. M. (2021). Physical Activity and Health in Chronic Kidney Disease. Contributions to Nephrology, 199, 43–55. https://doi.org/10.1159/000517696
Yin, J., Zhang, X., Wang, Z., Qu, Z., Sun, X., Song, Y., & Zhang, H. (2024). Application of exercise therapy in patients with chronic kidney disease-induced muscle atrophy: a scoping review. BMC Sports Science, Medicine & Rehabilitation, 16(1). https://doi.org/10.1186/S13102-024-00876-8
Zhang, L., Wang, Y., Xiong, L., Luo, Y., Huang, Z., & Yi, B. (2019). Exercise therapy improves eGFR, and reduces blood pressure and BMI in non-dialysis CKD patients: evidence from a meta-analysis. BMC Nephrology, 20(1). https://doi.org/10.1186/S12882-019-1586-5
Downloads
Published
Issue
Section
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.
How to Cite
