Physical activity and exercise training in patients with chronic kidney Disease: A narrative review

Abstract

Physical activity (PA) is a non-pharmacological intervention that may improve cardiovascular risk, functional capacity, muscle strength, inflammation, and quality of life in patients with chronic kidney disease (CKD). However, practical use of PA remains limited because exercise prescription should differ according to CKD stage, dialysis status, comorbidity burden, and baseline physical capacity.

The aim of this narrative review was to summarize mechanisms linking PA and CKD, evaluate clinical evidence for aerobic, resistance, balance, and low-intensity exercise, and formulate practical recommendations for non-dialysis and dialysis patients.

The reviewed evidence supports regular aerobic activity, resistance and balance training, and reduction of sedentary time in clinically stable non-dialysis CKD. Expected benefits include better cardiorespiratory fitness, muscle performance, endothelial function, inflammatory profile, and physical functioning.

For dialysis patients and patients with advanced CKD, individualized low-intensity activity, especially a home-based walking program with gradual progression, is a reasonable and safer starting strategy. Exercise should be prescribed as part of CKD care, monitored by symptoms, Borg scale, heart-rate response, gait speed, and the six-minute walk test.