Physical Exercise in Patients With Chronic Kidney Disease: A Call to Action

Chronic Kidney Disease (CKD) is often thought of in terms of medications, diet, dialysis, and transplantation. But there’s mounting evidence: physical exercise deserves a seat at the table. In their recent editorial “Physical Exercise in Patients With Chronic Kidney Disease: A Call to Action,” Garibotto, Macciò, Moore and colleagues appeal to the nephrology community to more vigorously integrate exercise into CKD care. Here’s what they argue—and why we should listen.

Why Exercise in CKD Matters

The authors highlight several overlapping reasons why exercise training is not merely an optional adjunct, but a potentially central component of CKD care:

1. High prevalence of physical dysfunction: Patients with CKD experience reduced aerobic capacity, loss of muscle strength, fatigue, poor balance, and limited mobility—even in early stages. These impair quality of life and increase risks of hospitalization. AJKD+3ScienceDirect+3Oxford Academic+3

   
   

2. A vicious cycle of inactivity: As CKD progresses, patients often become less active. Inactivity contributes to further muscle atrophy, cardiovascular risk, metabolic abnormalities (e.g., insulin resistance), inflammation, and frailty. This accelerates decline. Taylor & Francis Online+2Karger+2

   
   

3. Evidence of benefit: Clinical trials and observational studies show that exercise—whether aerobic, resistance, or combined—improves physical function, muscle strength, cardiovascular health, and overall quality of life. Exercise may even offer nephroprotective effects by improving systemic factors like blood pressure, glucose tolerance, and body composition. AJKD+3ScienceDirect+3Oxford Academic+3

   
   

4. Safety, when appropriately prescribed: Exercise is generally safe across CKD populations, including in dialysis and transplant settings—provided that medical evaluation, monitoring, and individual tailoring are performed. Adverse events are rare when programs are designed carefully. ScienceDirect+2AJKD+2

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Where the Gaps Are

Despite what we know, there are still big barriers to making exercise standard practice for CKD patients:

• Under-prescription in routine care: Many nephrology and dialysis centers do not routinely assess physical activity or provide exercise counselling or programs. ResearchGate+2BioMed Central+2

• Lack of standardization: There’s heterogeneity in how exercise is prescribed (type, intensity, frequency, setting). What is “exercise” or “physical activity” differs between studies and practice. AJKD+2Taylor & Francis Online+2

• Barriers: These include patient-related factors (fatigue, comorbidities, socioeconomic constraints), treatment-related obstacles (dialysis schedule, lack of resources), and health-system issues (awareness, staff training, funding). Taylor & Francis Online+3BioMed Central+3ResearchGate+3

  
  

What the Call to Action Proposes

Garibotto et al. urge a shift from “optional extra” to integrated standard of care. Key recommendations include:

• Routine assessment of physical activity & physical function in all CKD patients. Use validated questionnaires and performance tests to identify deficits early.

• Personalized exercise prescriptions: Tailored programs based on patient’s stage of CKD, comorbidities, current fitness, preferences, and capacity. Incorporate both aerobic and resistance training.

• Safe implementation: Ensure appropriate medical evaluation before starting; adapt according to patient tolerance; monitor progress and adverse events.

• Multidisciplinary teams: Nephrologists, nurses, physiotherapists/exercise physiologists, dietitians, potentially psychologists all play roles.

• Overcoming structural barriers: This includes addressing funding, healthcare policy, resource allocation, and integrating exercise into clinical pathways (dialysis units, outpatient nephrology clinics, etc.).

  
  

  

Implications: For Patients, Clinicians, and Policy

For Clinicians & Nephrology Clinics

• Begin asking every CKD patient about physical activity level and functional ability.

• Where feasible, establish or connect with exercise/rehab programs that CKD patients can access.

• Educate patients about what types of exercise are safe and helpful, and how to progress slowly.

  
  

For Patients

• You may have more control over your physical function and quality of life than you think.

• Even moderate exercise—walking, resistance bands, or supervised strength training—can lead to meaningful improvements.

• Speak up—ask your care team whether exercise is part of your CKD treatment plan.

  
  

For Health Systems & Policy Makers

• Recognize exercise/rehabilitation services for CKD as crucial, not optional.

• Allocate resources and reimbursement to support these services.

• Support more research for best practices: what combination of exercise types, frequency/intensity, and settings optimize outcomes and are scalable.

  
  

Looking Forward

This Call to Action arrives at an opportune moment. As guideline bodies increasingly include physical activity recommendations for CKD (e.g., KDIGO, consensus statements like those from the Italian Society of Nephrology), there is momentum. Oxford Academic+1

But momentum isn’t enough. The translation from evidence to everyday care demands infrastructure, training, cultural shifts, and policy support. If those are achieved, exercise can become a standard tool in slowing CKD progression, improving patient well-being, and reducing healthcare burdens.

Conclusion

Garibotto, Macciò, Moore et al. make a clear, compelling case: exercise is medicine in CKD. Not as a supplement, but as a required pillar of treatment. To improve outcomes for millions living with kidney disease, the call is to move from “could be” to “should be”—from recommendation to routine.