Kristal Higgins, 42, has been on dialysis to treat her chronic kidney disease since 2010. She goes to her kidney clinic three days a week for about three hours, and when she factors in travel time it takes up about four hours of her day. But she still makes time to walk for about 10 to 15 minutes with her two small dogs every day.
“When it comes to my health, there are many things I can’t control, like my kidney disease,” says Higgins, who lives in Olive Branch, Mississippi. “But I can make sure I at least get some exercise in to make me feel better, both physically and emotionally.”
It may seem tough, if not downright impossible, to fit regular exercise into your schedule if you’re on dialysis for chronic kidney disease. But it’s important that you do. A 2021 study published in the American Journal of Kidney Diseases found that people with advanced kidney disease who exercised regularly were about 50% less likely to die from any cause than those who didn’t.
“Regular exercise helps to reduce risk of other conditions that people with advanced kidney disease tend to be more vulnerable to, such as heart disease or type two diabetes,” explains Laura Maursetter, DO, a nephrologist at the University of Wisconsin School of Medicine in Madison. “It also boosts mood, which is important since patients on dialysis are more likely to experience anxiety and depression.”
Why Exercise Is So Important
Exercise is key for anyone, but it’s especially important for people with CKD who are on dialysis. Here are some of the benefits:
A healthier heart. People with CKD are more likely to develop heart disease. It’s unclear if kidney disease raises the risk of heart disease or vice versa. But people with CKD are also more likely to have risk factors such as type 2 diabetes or high blood pressure. A 2022 study published in the journal Cardiovascular Diabetology found that patients with CKD who exercise at least twice a week are less likely to experience a heart attack or stroke, or to die from heart disease.
Stronger kidneys. Exercise can’t reverse kidney disease, says Maursetter. But it can prevent it from getting worse. The effect of exercise on kidney function isn’t totally clear. But the Cardiovascular Diabetology study also found that patients with CKD who exercised regularly were less likely to see their condition advance to end stage kidney disease.
Improved quality of life. Studies show that people on dialysis who did any sort of exercise were able to walk farther, stand up from a chair faster, and go up and down stairs more quickly than those who were sedentary. “If you’re in better shape, you’ll find it easier to do activities of daily living like getting dressed, running errands, or even going to work,” explains Maursetter.
Better mood. People with advanced kidney disease who exercise regularly show fewer signs of anxiety or depression, according to a 2021 review published in International Journal of Urology and Nephrology.
Fewer complications. People with CKD are more likely to get hyperkalemia, a condition where you have high levels of potassium in your blood, which can cause heart problems. Regular exercise seems to make it less likely that you’ll develop this condition. “When you exercise, a stress hormone called adrenaline goes up, which helps potassium enter your cells,” explains David Goldfarb, MD, a nephrologist at NYU Langone Health in New York City.
Barriers to Exercise
There are a few reasons why people with CKD who are on dialysis find it so hard to stay active. The biggest barriers are:
Lack of time. “I have patients who tell me that dialysis for them is a full-day activity – it takes them two hours to get to their center in New York City, four hours for dialysis, and then two hours to get back home,” says Goldfarb. “If you do that, you have very little time to get to everything else you need to get done, including work, family, and running a household.”
Extreme fatigue. Many people feel exhausted after their dialysis, and it can take them a day or two to recover, says Maursetter. Fluid loss after dialysis, for example, can cause temporary low blood pressure in patients that leaves them feeling weak, dizzy, and nauseous. In addition, “your kidneys control the production of red blood cells, which carry oxygen that your body needs for energy,” Maursetter says. “When your kidneys aren’t working properly, they can’t do this as well. You’ll feel more tired as a result.”
Weak muscles. People with CKD who are on dialysis are more likely to experience muscle wasting, or loss of muscle mass and strength, says Goldfarb. That’s what happened to Kim Betts, 61, a retired nurse in Nashville, Tennessee, who had to go on dialysis after she experienced kidney failure from medications two years ago. “I went from being a triathlete to someone who could barely walk a mile,” she recalls. “I used to be able to run 6 miles a day, but once I went on dialysis I was so nauseated that I threw up daily.”
Ways to Get Started
The CDC recommends that all adults get 150 minutes of moderate-intensity exercise like brisk walking a week and do two days of muscle-strengthening activity like lifting weights. But most people on dialysis aren’t able to do that, at least initially, says Maursetter. Here are some exercise guidelines for CKD patients on dialysis:
Check with your doctor. People with CKD often have other conditions, like heart disease, that can make exercise more of a challenge, says Goldfarb. Your doctor can recommend whether you need to see other specialists, like a heart doctor, before you begin an exercise program. If you have been very sedentary, there may be some steps you need to do first. “We often have patients start with physical therapy, where they are under professional supervision, and meet with a dietitian to make sure they get enough protein and calories to prevent muscle wasting,” Goldfarb explains.
Start small. Most people who are on dialysis for their CKD can often only do a few minutes of exercise before they fatigue, says Maursetter. “I often recommend that people focus on short, five-minute bursts of activity during the day and then gradually build up to one longer 30-minute session,” she says. If you’re watching TV, for example, stand up and walk around the room during commercial breaks. Or walk your dog in two 10-minute bursts each day. As you build muscle and stamina, you’ll be able to be active for longer, reassures Maursetter.
Work in weights. Resistance training is important for people with CKD since it helps ward off muscle loss. But it can be tough to find time. “I often recommend patients bring resistance bands to dialysis so that they can do some easy exercises while they wait, or even just chair yoga,” says Maursetter. Research shows that this is safe and makes you stronger so you can do more things.
Don’t overdo it. While it’s always good to push yourself, people with CKD need to pace themselves, especially if there has been a change in their dialysis plan or in their medication, warns Maursetter. Not sure? Check your breathing. You should still be able to talk to someone while you work out, according to the National Kidney Foundation.
When Betts started dialysis, she was so weak she could barely walk for more than a few minutes. But over time, she was able to build up to a couple of miles, with rest breaks built into the workout. Recently, she hasn’t been able to exercise at all, but for a good reason: She just received a kidney transplant. “In a few weeks, I’ll be cleared to start exercise again, and I hopefully will be able to start a run/walk program,” says Betts. “I can’t wait to be able to race a triathlon again.”
Show Sources
Photo Credit: Maskot/Getty Images
SOURCES:
Kristal Higgins, 42, CKD advocate, Olive Branch, Mississippi.
Laura Maursetter, DO, nephrologist, University of Wisconsin School of Medicine, Madison.
David Goldfarb, MD, nephrologist, NYU Langone Health, New York City.
Kim Betts, 61, retired nurse, Nashville, Tennessee.
American Journal of Kidney Disease: “Association of Physical Activity and Poor Health Outcomes in Patients With Advanced CKD.”
National Kidney Foundation: “The Heart and Kidney Connection, Staying Fit With Kidney Disease.”
Cardiovascular Diabetology: “Association between exercise frequency with renal and cardiovascular outcomes in diabetic and non-diabetic individuals at high cardiovascular risk.”
American Journal of Physiology: “Exercise interventions for improving objective physical function in patients with end-stage kidney disease on dialysis: a systematic review and meta-analysis.”
International Urology and Nephrology: “Exercise interventions improve depression and anxiety in chronic kidney disease patients: a systematic review and meta-analysis.”
Journal of Renal Nutrition: “Managing Hyperkalemia: Another Benefit of Exercise in People With Chronic Kidney Disease?”
CDC: “Adult Activity: An Overview | Physical Activity Basics.”
Journal of Renal Nutrition: “Effect of intradialytic resistance band exercise on physical function in patients on maintenance hemodialysis: a pilot study.”
