INTRODUCTION:
The global burden of chronic kidney disease (CKD) is rising, with exercise emerging as a safe, low-cost, non-pharmacological strategy to improve clinical outcomes. Despite this potential, there is limited integration of CKD pathophysiology with actionable exercise prescriptions. This study synthesizes recent advances in CKD mechanisms and exercise interventions and proposes a translational framework to guide personalized exercise prescriptions in clinical practice.
METHODS:
We conducted a targeted literature search of databases (e.g., PubMed, Scopus) covering (years 2010–2026), identifying studies on CKD pathophysiology and exercise interventions. Studies were screened and qualitatively appraised using explicit criteria (population, intervention modality, outcomes, and risk of bias). We delineated core CKD pathophysiology and categorized exercise modalities (aerobic, resistance, combined training, HIIT), then integrated findings to assess applicability across CKD stages and subtypes.
RESULTS:
CKD progression involves mitochondrial dysfunction, oxidative stress, hemodynamic perturbations, and renin–angiotensin system activation, collectively accelerating renal decline. Our synthesis indicates that aerobic, resistance, combined, and HIIT modalities yield heterogeneous but generally favorable effects on renal function, cardiorespiratory fitness, and quality of life, with magnitude and direction of benefits influenced by modality, intensity, and disease stage. Notably, our prior animal work suggests moderate-to-low intensity aerobic exercise reduces renal oxidative stress and mitigates tissue damage in obesity-related models, supporting mechanistic plausibility for human CKD. Importantly, applicability varies by CKD type and stage, underscoring the need for individualized prescriptions and safety considerations.
CONCLUSION:
Personalized exercise prescription for CKD should be anchored in a clinically oriented framework that integrates disease subtype, stage, and patient-specific risks. The proposed approach emphasizes practical implementation, standardized monitoring, and safety safeguards to minimize adverse events while maximizing functional gains. Prospective trials and pragmatic studies are needed to validate feasibility and effectiveness in diverse CKD populations and care contexts, with tools to support decision-making in routine practice.