Clinical practice guideline exercise and lifestyle in chronic kidney disease

Key points

• Physical activity should be encouraged in people with non-dialysis chronic kidney disease (CKD), on haemodialysis and with a kidney transplant, where there are no contraindications.
• The target in all three groups is 150 minutes of moderate-intensity activity a week, or 75 minutes of vigorous activity, in line with the UK Chief Medical Officers' guideline.
• Exercise during haemodialysis is described as safe and should be available in all units.
• Stopping smoking, keeping alcohol within national guidelines and avoiding recreational drugs are recommended throughout.
• Current evidence was judged insufficient for recommendations on exercise and mortality, disease progression, blood lipids, glycaemic control, inflammation or cognition in non-dialysis CKD.

Overview

This clinical practice guideline, developed by the UK Kidney Research Consortium Clinical Study Group for Exercise and Lifestyle, sets out evidence-based recommendations on physical activity, exercise, weight management and other lifestyle factors for adults with kidney disease. The authors describe it as the first document of its kind covering non-dialysis CKD, haemodialysis and kidney transplantation; recommendations are graded with the modified GRADE system.

Non-dialysis CKD (stages 1–5)

Patients are advised to follow the UK Chief Medical Officers' Physical Activity Guidelines (2019), slightly adapted: daily activity (some is better than none), muscle strength, balance and flexibility activities on at least 2 days a week, 150 minutes of moderate aerobic activity a week built up gradually, and breaking up long sedentary periods. More activity contributes to improvements in blood pressure and physical function and capacity (1B), functional limitations and health-related quality of life (1C), and exercise may improve depression and anxiety symptoms (2C). A combination of aerobic and muscle-strengthening exercise is recommended to improve muscle function (1C). The older adults guideline was used as a cautious starting point, so high-intensity interval training is not recommended.

Haemodialysis

Activity may combine exercise between and during dialysis sessions (1B). Intradialytic exercise is recommended to improve cardiovascular health and physical function (1B), with weaker grades for muscle strength, hospitalisations and blood pressure. Programmes should ideally be supervised by qualified staff, and patient and staff barriers addressed. A BMI between 20 and 30 kg/m2 is recommended (1C).

Kidney transplantation

Structured exercise at least 3 times a week (1C), combining aerobic and resistance training (1B), is suggested for recipients without contraindications, with programmes individualised to goals and graft status. Contact sports and prolonged extreme exercise must be considered carefully, and sport-enhancing supplements avoided. Candidates should not be excluded on BMI alone (1B); a post-transplant BMI of 25 kg/m2 or less is targeted (1B).

Frequently asked questions

Is high-intensity interval training recommended in non-dialysis CKD?

No. The guideline adapted the UK older adults guideline, which avoids recommending high-intensity interval training, judged not to have a high enough benefit-to-risk ratio in these patients.

Is exercise during dialysis safe?

The guideline states that intradialytic exercise is safe with no contraindications and recommends that it be available in all units.

Source

Baker LA, March DS, Wilkinson TJ, Billany RE, Bishop NC, Castle EM, et al. Clinical practice guideline exercise and lifestyle in chronic kidney disease. BMC Nephrology 2022;23:75. https://doi.org/10.1186/s12882-021-02618-1. Open access. This summary was prepared by Medpresso from the original publication and is not a substitute for the full text or medical advice.