International Journal of Family Medicine & Healthcare
Open AccessCounsellings on Exercise in Renal Patients
Authors: Anita L R Saldanha, Ana Paula Pantoja Margeotto, André Luis Valera Gasparoto, Rafaela Cristina Goebel Winter Gasparoto, Victoria Pantoja Margeotto, Tania Leme da Rocha Martinez.
Abstract
Exercise as a therapeutic intervention for patients with chronic kidney disease and end-stage renal disease is strongly supported by evidence but remains underused. Numerous studies and meta-analyses demonstrate that structured exercise programs - including aerobic, resistance, and combined modalities - significantly improve physical fitness, cardiovascular health, and quality of life. Aerobic training enhances peak oxygen consumption and walking capacity, while strength training produces marked gains in lower limb strength and health-related quality of life. Combined programs yield additional benefits for cardiovascular performance and exercise tolerance. Exercise also contributes to metabolic and nutritional improvements, increasing albumin and energy intake without worsening kidney function. Cardiovascular advantages include reductions in systolic and diastolic blood pressure and improved heart rate control-critical given the high prevalence of cardiovascular disease among chronic kidney disease patients. Implementation is feasible across settings: supervised outpatient programs, home-based exercises, and intradialytic training using bed ergometers have all proven safe and effective. Exercise during dialysis offers high adherence, while more intensive off-dialysis training maximizes fitness gains. Both pre-dialysis and dialysis patients show significant improvements in functional capacity and psychosocial well-being. Safety data indicate that exercise is well tolerated, with rare adverse events and risks far lower than those associated with inactivity. Current evidence and guidelines emphasize incorporating structured physical activity into routine renal care. Future research should refine optimal modalities, intensities, and durations, aiming to translate functional and quality-of-life improvements into reduced morbidity and mortality.
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