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Exercise Effects


  • While exercise cannot guarantee protection against kidney disease, it is known to be effective in reducing the risk by decreasing the number and severity of risk factors.
  • Exercise programs reduce obesity, hypertension, and diabetes, the three main causes of chronic kidney disease.
  • The main goal of preventative exercise programs is the maintain healthy kidney function by decreasing these risk factors.

Exercise with chronic kidney disease

  • Patients with chronic kidney disease often express fatigue and loss of strength, making exercise intrervention an even more difficult task.
  • It is crucial, however, for patients to realize the importance of exercise pre-dialysis, while on dialysis, and before and after transplant surgery. Numerous studies have shown that exercise is both safe and beneficial to such patients [2, 6, 8, 9, 13, 14, 18, 23, 26, 34-37, 44, 47, 49, 51, 52, 53, 57-60, 63, 69] .
  • Successful rehab for ESRD comes down to the five "essential E's" [29]
    1. Encouragement
    2. Education
    3. Exercise
    4. Employment
    5. Evaluation
  • Many times patients with chronic disease fall into a downward spiral of sickness and deconditioning that can and must be broken by exercise prescription. [55]
  • Bed rest during CKD can exacerbate cardiac dysfunction, anemia, muscle weakness, glucose intolerance, and bone weakness. [38]
  • Within the U.S. dialysis population, exercise at least 2-3 times/week is associated with improved survival. [68]

Downward Spiral

Click Image to see larger version
image copied from Painter and Johanson (1999) [55]

  • Overall, the consenus is that appropriately prescribed exercise involving aerobic and/or resistance training modalities is safe and beneficial to CKD and ESRD patients on dialysis.
  • Exercise improves body composition, muscular strength and endurance, increased insulin sensitivity, decreased serum glucose, decreased blood pressure, decreased LDL (bad) cholesterol, increased HDL (good) cholesterol, increased self-esteem, decreased anxiety, and increased overall quality-of-life.
  • Cardiovascular benefits include improved left ventricular mass, ejection fraction, cardiac output, stroke volume, and HR variability.

General Exercise Prescription Guidelines

  • Numerous studies have used a variety of exercise programs utilizing either aerobic and/or resistance training segments. While both aerobic [18, 34, 44, 49, 51, 59, 60] and resistance [23, 52] exercise protocols produced improvements, those including a combination of both produced the best results [8, 9, 13, 34, 35, 37, 53, 58, 63]. Overall, the following exercise guidelines are as follows [3, 16, 26]:
    • (pre-ESRD)
      • Aerobic exercise 3-5 times per week with 30-90 minutes sessions
      • Intensity should vary with each patient, but generally 40-70% VO2max
      • Common modalities include: walking/jogging, cycling, aerobics, calisthenics, swimming, and ball games.
      • Resistance training 2-3 times per week, 1-3 sets with 10-15 repetitions
      • Intensity should start at light (40-60% 1-RM) and progress to moderate (60-80% 1-RM).
      • Overall time should be progressed first, then intensity
    • (ESRD - during dialysis)
      • Aerobic exercise 4-6 times per week with a goal of 30 minutes continuous
      • Progress time up to 90 minutes
      • The rating of perceived exertion (RPE) scale should be used to monitor intensity
      • Progress intensity up to moderate (50-80% HRmax)
      • Resistance exercise 3-4 times per week, 1-2 sets with 10-15 repetitions
      • Light intensity (≤50% 1-RM)

Exercise Recommendations for Post-Transplant Patients [56]

    • The ultimate end goal after renal transplantation is that patients regain the ability to perform physical and functional activities.
    • While most patients report feeling better and a spontaneous increase in physical activity after transplantation, many are afraid or unmotivated to begin an exercise program.
    • Cardiovascular disease is the most common cause of death in the post-renal transplant period.
    • While no ideal exercise program has been established, regular physical activity is especially important for transplant recipients to reduce risk factors for cardiovascular disease, increase exercise capacity, and improve overall quality of life.

Exercise after renal transplant - the U.S. and World Transplant Games

While it is unknown how high the exercise capacity after renal transplant can be, participants in the U.S. and World Transplant Games are living proof that athletes can return to high levels of performance after transplant surgery. The U.S. Transplant Games began in small in 1982 with only a few competitors but attracted over 7000 athletes to the 2004 games in Minneapolis, Minnesota. The world games take place every two years with over 1500 athletes from over 64 countries competing. Head to for more information.





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