Exercise guide
Exercise is safe and helpful at every stage of chronic kidney disease (CKD): before dialysis, on haemodialysis or peritoneal dialysis, and after a transplant. Guidelines recommend at least 150 minutes of moderate activity a week, or as much as you can manage, and trials show better fitness, walking and blood pressure. Whether exercise changes kidney function itself isn't known.
This guide covers how much to do and how to start, exercise during dialysis, looking after your fistula, fluid limits and tiredness, getting active again after a transplant, what the guidelines say about protein and creatine, and when to stop and call your kidney team.
The NHS says: "Do not be scared to exercise. Exercise is good for anyone with kidney disease, however severe." The international kidney guideline, KDIGO (Kidney Disease: Improving Global Outcomes), recommends at least 150 minutes a week of moderate activity, or as much as your heart and body can manage, and the National Institute for Health and Care Excellence (NICE) encourages everyone with CKD to exercise.
In 37 trials with 1,248 people, exercise improved fitness, added about 59 metres to a 6-minute walk and about 5 to the number of sit-to-stands people could do. Systolic blood pressure (the top number) fell by about 5 mmHg in pooled trials.
Exercise probably improves walking and low mood, according to a review of 89 trials. The UK guideline says exercise during haemodialysis is safe and should be offered in every unit, usually 30 minutes or more of cycling each session. In 1,211 people, a year of exercise during dialysis improved strength and walking and cut the days spent in hospital.
Walk a little every day from the first weeks. Moderate exercise is usually encouraged from 6 to 8 weeks if your recovery is going well, and most sports are possible, though not heavy contact sports such as rugby, martial arts or boxing.
Keep pressure and heavy lifting off your fistula arm, and check its buzz (thrill) every day. The UK guideline found no evidence that light arm exercise harms a fistula. On dialysis, stick to the fluid allowance your team gives you, even when you exercise.
KDIGO suggests about 0.8 g of protein per kg of body weight a day for CKD stages 3 to 5, and links creatine supplements used for bodybuilding with kidney inflammation. Both creatine and high-protein diets can distort the blood test for kidney function. Ask your renal team or dietitian before taking either.
CKD means the kidneys haven't worked as well as they should, or their structure has been abnormal, for at least 3 months. It's staged by the blood test that estimates kidney function (eGFR, the estimated glomerular filtration rate) and by how much protein leaks into the urine. It can get worse over time, but kidney failure is uncommon: it happens to about 2 in 100 people with CKD.
Advanced CKD may need dialysis or a kidney transplant. Haemodialysis filters your blood through a machine, usually through an arteriovenous fistula, an artery and vein joined in your arm, which takes about 10 weeks to be ready. Peritoneal dialysis (PD) uses the lining of your tummy, with fluid run in and out through a soft tube (catheter), and most people have it every day at home.
About 9 in 100 people worldwide have CKD. In the UK it's often linked with getting older and is more common in people who are black or of south Asian origin. Causes include high blood pressure, diabetes, high cholesterol, kidney infections and inflammation, inherited kidney cysts, and long-term use of some medicines, such as anti-inflammatory painkillers (NSAIDs) and lithium.
There are usually no symptoms early on. Later, tiredness, swollen ankles, feet or hands, shortness of breath, feeling sick and blood in the urine can appear. See a GP if you have persistent or worrying symptoms that could be caused by kidney disease.
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Heart and circulation disease is one of the main causes of death in people with kidney disease. Muscles tend to weaken and shrink, and tiredness is the most common symptom before dialysis: 70% of people with CKD report it, against 34% of people without it. Exercise can help with each of these.
The eGFR blood test is based on creatinine, which also comes from muscle and meat, so high muscle mass, protein supplements and creatine supplements can make kidney function look worse than it is. Exercise can also raise the protein in a urine test for a while.
With mild to moderate CKD, the NHS says you should be able to exercise as often and as hard as someone your age with healthy kidneys. With advanced CKD or on dialysis, you're likely to tire and get breathless sooner, but exercise still helps. CKD before dialysis is more common in women worldwide, but no guideline we read changes the exercise advice for women or men.
A 2024 review of 37 trials (1,248 people) found exercise improved peak fitness (by 2.7 mL/kg/min), the 6-minute walk (by about 59 metres), sit-to-stands (by about 5) and mental wellbeing a little. An older Cochrane review across all stages (45 trials, 1,863 people) found better fitness, walking, blood pressure and quality of life, though half the trials were at high risk of bias.
Pooled trials before dialysis found exercise lowered systolic blood pressure by about 5 mmHg. The Cochrane review found falls of about 6 mmHg systolic and 2 mmHg diastolic across all stages of CKD.
Exercise isn't proven to improve kidney function. Across 31 trials, creatinine didn't change, and some reviews found eGFR about 2 units higher with exercise while others found no change. In these trials, exercise didn't make kidney function worse either.
In a UK trial of 340 people with CKD, a 12-week online activity programme (Kidney BEAM) improved mental wellbeing scores by 3.1 points compared with a waiting list.
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A 2022 Cochrane review of 89 trials (4,291 people), mostly exercise 3 times a week during dialysis, found exercise probably improves the 6-minute walk by about 50 metres, sit-to-stands and low mood (moderate certainty), and may help physical quality of life and tiredness (low certainty). Its effects on deaths and heart problems are uncertain, and there wasn't enough information to judge safety fully.
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In a German trial of 1,211 people, a year of combined endurance and strength exercise during dialysis improved sit-to-stands, the 6-minute walk (by 37.5 metres) and a timed up-and-go test, and cut median hospital days from 5 to 2 a year, with no more adverse events. In a UK trial of 379 people, 6 months of cycling during dialysis didn't significantly improve quality of life, but only 18% kept to the programme. A 5-year follow-up of another UK cycling trial found no change in deaths or hospital stays.
In 6 trials, exercise after a transplant improved fitness and quality of life without changing how well the new kidney worked. A 2026 review of 25 studies found better fitness, walking and sit-to-stands, with combined aerobic and strength training doing best, though the certainty of the evidence is low.
KDIGO recommends at least 150 minutes a week of moderate activity, or as much as your heart and body can manage, and avoiding long spells of sitting. If you're at higher risk of falls, you should get advice on the type and intensity of exercise that suits you.
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The UK Kidney Association adapts the UK activity guidelines for older adults as a cautious start: some activity every day; strength, balance and flexibility work on at least 2 days a week; building up gradually to 150 minutes a week of moderate activity; and breaking up long spells of sitting. It recommends combining aerobic and strength training. It doesn't recommend high-intensity interval training before dialysis, because the benefit isn't judged worth the risk.
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The Leicester Kidney Exercise Team's plan, published by the National Kidney Federation: warm up with about 10 minutes of gentle activity; do 30 minutes of aerobic exercise (or 2 bouts of 15, or 3 of 10) on at least 3 to 4 days a week; do strength exercises 2 to 3 times a week with a weight you can lift 10 to 12 times, lifting slowly, breathing normally and keeping weights below your head; and hold stretches for 20 to 30 seconds.
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Use the talk test: at a moderate effort you can talk but not sing. On the 6 to 20 Borg scale of effort, aim for 12 to 14.
Talk to your kidney team before you start, especially with advanced CKD, on dialysis or after a transplant: very high blood pressure or untreated anaemia may need treating first. Then start small and build up gradually. If you're doing very little now, even 10 minutes of activity a week can lower your risk of heart problems.
Supervised exercise helps people keep going, but the UK guideline says not having it shouldn't stop you becoming more active. Free programmes include Kidney BEAM, an online programme tested in a UK trial, and others listed by the National Kidney Federation.
Start with 10 minutes and build to 30 minutes on at least 3 to 4 days a week, at a level where you can talk but not sing (12 to 14 on the Borg scale). On dialysis, use the unit's bike with staff; on tired days, march seated.
2 to 3 times a week, with a weight you can lift 10 to 12 times, breathing normally and keeping weights below your head (Leicester Kidney Exercise Team); 2 sets of each is our editorial starting point. Keep to light work with your fistula arm, and ask your PD team before bridges.
3D demoSit to stand from a chairBeginner · A bench or box
3D demoWall push-upBeginner · A wall
3D demoLow step-upBeginner · A step
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoSlow calf raiseBeginner · A wall
3D demoStanding band hip extensionBeginner · A band + An anchor point
3D demoSplit squatIntermediate · No equipment
3D demoDumbbell biceps curlBeginner · A dumbbell
3D demoBand rowBeginner · A band + An anchor point
3D demoGlute bridgeBeginner · No equipmentBalance work on at least 2 days a week, next to a counter. Hold each stretch for 20 to 30 seconds (Leicester Kidney Exercise Team).
3D demoSingle-leg standBeginner · A wall
3D demoTandem stance and heel-to-toe walkBeginner · A wall
3D demoSide-stepping (sideways walking)Beginner · A wall
3D demoWall calf stretch (gastrocnemius)Beginner · A wall
3D demoStanding Quad StretchBeginner · A wall
3D demoSupine hamstring stretch with a strapBeginner · No equipmentThe UK guideline says exercise during haemodialysis is safe and should be available in all units. The usual approach is cycling on a static bike for at least 30 minutes each session, avoiding the first 30 minutes, at a moderate effort (12 to 14 on the Borg scale), with staff checking how you feel and your last blood pressure first. Light strength work with bands or ankle weights can be added.
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The guideline advises against exercise in your first 3 months of haemodialysis; with an infection or fever; within 2 weeks of a heart attack, or with chest pain that hasn't been checked; with an unstable heart condition; with resting blood pressure above 200/110; or with symptoms from high or low blood pressure.
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Blood pressure drops in about 1 in 10 dialysis sessions. In a trial of 84 people, it was no more common when people exercised in the second half of the session than in the first.
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Kidney Care UK suggests resting for an hour or two after each session. Exercise during dialysis alone won't reach 150 minutes a week, so add walking or strength work on non-dialysis days, and tell your team if your dialysis schedule changes.
Kidney Care UK suggests exercising at least two or three times a week, because kidney disease makes your muscles weak. The Cochrane review of exercise on dialysis included 7 studies in people on PD.
PD makes a hernia more likely, by the belly button, near the catheter exit site or in the groin. Tell your team about any new lump or swelling.
We found no exercise guideline written for PD. Ask your team which tummy exercises and lifting loads suit you, whether to exercise with fluid in or drained, and about swimming with your catheter.
Keep it clean, and avoid watches, bracelets and tight sleeves on that arm. Try not to lift heavy objects with it or sleep on it, don't have your blood pressure taken on it, and check the buzz (thrill) every day; if you can't feel it, contact your kidney team straight away.
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The UK guideline found no evidence that light upper-body resistance exercise harms a fistula. Where light becomes heavy is our editorial line: a light band, or a weight you can lift 15 times or more without straining, is light; anything that takes a big effort, or presses on the fistula, goes on the other arm. Check with your renal team, as the advice can vary with your fistula.
Your team may give you hand exercises, such as squeezing a stress ball, to help a new fistula develop, once any swelling has gone down and the stitches have healed.
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A fistula lets you shower, bathe and swim without restriction. A dialysis line in the neck or chest must be kept dry and away from water.
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Get urgent help if your fistula is hot, swollen or painful, or your fingers become cold, painful or weaker. If the skin around your fistula or a catheter is painful, swollen or a different colour, ask for an urgent GP appointment or contact NHS 111. If your fistula bleeds between sessions, press on it (a bottle top over the site helps) and call 999.
Walk a little every day in the first few weeks to help prevent blood clots. The UK guideline says intensive physiotherapy in the first day or two isn't needed, but moving about is encouraged as standard.
If your recovery is going well, moderate exercise such as walking, jogging, swimming or cycling is usually encouraged from 6 to 8 weeks. Most sports and activities are possible, but avoid heavy contact sports such as rugby, martial arts and boxing, which risk damaging the new kidney.
The UK guideline recommends 150 minutes a week, with structured exercise at least 3 times a week that combines aerobic and strength training, supervised if possible. It asks for careful thought about contact sports and extreme endurance events such as marathons, and advises against sport supplements.
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Weight gain is common after a transplant, especially in the first year, and exercise alone doesn't seem to prevent it, so eating well matters too. Skin cancers are more common after a transplant: if you exercise outdoors, wear factor 50 sunblock, a hat and long sleeves, and avoid long spells in the sun.
NICE's targets in CKD: below 140/90 (aiming for 120 to 139 systolic) if the protein leak in your urine is low, and below 130/80 (aiming for 120 to 129) if it is high, which means a urine albumin-to-creatinine ratio (ACR) of 70 or more.
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Breathe normally during strength exercises and don't hold your breath. With high blood pressure, the National Kidney Federation suggests warming up, building up to 30 minutes on 5 days a week, and checking your blood pressure at home. Our high blood pressure guide has more.
On dialysis, your team tells you how much to drink each day, because fluid builds up between sessions and too much can lead to heart failure. Needing a lot of fluid taken off at dialysis also leaves you tired and washed out. Don't drink extra for exercise beyond your allowance without asking your team (our editorial advice).
Talk to your doctor before exercising in very hot and humid, or very cold, weather, and stop if you feel dizzy.
Tiredness is the most common symptom before dialysis. Causes include waste building up in the blood, anaemia, feeling washed out after haemodialysis, poor sleep, itching, restless legs and low mood, so ask your team about the ones that can be treated.
Kidney Care UK says: "Physical activity may help to reduce your fatigue", and "It's fine to only be physically active on your better days. It is also normal to feel more tired immediately after being active." On dialysis, exercise may ease tiredness, though the evidence is low certainty. The Leicester team's leaflet says even 15 to 20 minutes a day helps people feel less tired.
Plan activity for the times you feel least tired, rest for an hour or two after haemodialysis, and keep any naps to half an hour.
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KDIGO suggests about 0.8 g of protein per kg of body weight a day for CKD stages 3 to 5, and avoiding more than 1.3 g/kg a day if your kidneys are at risk of getting worse. Older people with frailty or muscle loss may need more. NICE advises against low-protein diets (below 0.6 to 0.8 g/kg a day). On dialysis, your renal dietitian sets your protein needs.
KDIGO notes that creatine supplements used for bodybuilding "have been associated with allergic interstitial nephritis", a kind of kidney inflammation, and advises reviewing and limiting over-the-counter and herbal remedies that might harm the kidneys.
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Creatine supplements, high-protein diets and a lot of muscle can make the eGFR test underestimate your kidney function, and NICE advises not eating meat in the 12 hours before an eGFR blood test. Exercise can raise the protein in a urine test, so avoid hard exercise the day before one (our suggestion, as in our type 2 diabetes guide).
The NHS says to check with a doctor or pharmacist before taking over-the-counter medicines, such as painkillers, or nutritional supplements. After a transplant, the UK guideline advises against sport supplements.
No guideline recommends protein shakes or creatine for people with CKD. If you want to try either, ask your renal team or dietitian first, and tell them before your blood tests.
The strength and balance session covers the UK guideline's strength, balance and flexibility work. With a fistula, use a light band on that arm or work the other arm. The chair workout suits tired days and dialysis days, and the cardiac rehab-style session is for people with heart disease, with their team's agreement.
A 40-minute strength and balance session for over-65s, built from the Otago home programme and NHS exercises, using a chair, a counter and a step.
40 minBeginner18 movesA bench or box, Something with weightA 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.
20 minBeginner11 movesA bench or box, Something with weightA gentle 20-minute beginner home workout with a chair, a wall and a band: sit-to-stands, wall push-ups, band rows, step-ups and dead bugs.
20 minBeginner11 movesA bench or box, A wallA 10-minute session for low-energy days: marching, sit-to-stands, wall push-ups, step-ups and bridges, then a short walk. Doing a little counts.
10 minBeginner7 movesA bench or box, A wallA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 25-minute standing cardio circuit with no jumping: marching, step jacks, sit-to-stands, punches, step-ups and wall push-ups, with a seated option for most moves.
25 minBeginner9 movesA bench or box, A stepBalance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxA 45-minute home session built like a UK cardiac rehab class: a 15-minute warm-up, 20 minutes of cardio mixed with light strength, and a 10-minute cool-down.
45 minBeginner14 movesA wall, A bench or boxBoth plans build up gradually. Talk to your kidney team before you start, and fit the sessions around your dialysis days.
A 12-week exercise plan for over-65s: strength and balance three times a week, short balance sessions and daily walks, based on falls-prevention trials.
3 training days40 minBeginner2 days a weekYour first four weeks: two, then three short strength sessions a week at home plus walks, building gently to a full routine.
2 training days20 minBeginnerSource 10
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Stop if:
The UK guideline advises against exercise:
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Before starting or changing your exercise; if your medicines or dialysis schedule change; with a fever, joint or bone problems that get worse with exercise, or any change in your condition; and before taking any supplement.
The NHS says exercise is good for anyone with kidney disease, however severe, and KDIGO recommends it. In trials, creatinine didn't change with exercise before dialysis, and exercise after a transplant didn't change how well the new kidney worked.
Maybe, but it isn't proven: some reviews find a small rise in eGFR and others none. What exercise reliably improves is fitness, strength, walking and blood pressure.
The UK guideline says exercise during haemodialysis is safe and should be offered in every unit. In a 1,211-person trial, it improved strength and walking and cut hospital days, and a Cochrane review found it probably improves walking and mood.
Avoid pressure and heavy lifting on that arm. But the UK guideline found no evidence that light upper-body exercise harms a fistula, and hand exercises are used to help a new one develop. Check the details with your renal team.
KDIGO suggests about 0.8 g of protein per kg a day for CKD stages 3 to 5, and avoiding more than 1.3 g/kg if your kidneys are at risk of getting worse. It links creatine supplements with kidney inflammation, and both creatine and high-protein diets distort kidney blood tests. No guideline recommends either for CKD.
Not if you're on dialysis: your team sets your fluid allowance, because extra fluid builds up between sessions and can lead to heart failure. Ask your team before drinking more for exercise or hot weather.
Most sports are possible. NHS Blood and Transplant asks you to avoid heavy contact sports such as rugby, martial arts and boxing, and moderate exercise usually starts from 6 to 8 weeks.
Yes, for most people. The NHS says not to be scared to exercise, because it's good for anyone with kidney disease, however severe, and the National Kidney Federation says activity is safe and helpful as long as other conditions such as heart disease or diabetes are stable. Talk to your kidney team before you start, especially with advanced CKD, on dialysis or after a transplant.
Guidelines recommend at least 150 minutes a week of moderate activity, or as much as your heart and body can manage. The UK guideline adds strength, balance and flexibility work on at least 2 days a week, and breaking up long spells of sitting. Start low and build up slowly; even a little activity helps.
It isn't proven. Some reviews found a small rise in eGFR with exercise and others found none, and creatinine didn't change across 31 trials. What exercise reliably improves is fitness, walking, strength and blood pressure.
No: Kidney Care UK says strength exercises like moderate weight-lifting can be beneficial, and the UK guideline recommends combining aerobic and strength training. Use a weight you can lift 10 to 12 times, breathe normally rather than holding your breath, and keep weights below your head. With a fistula, keep heavy loads off that arm.
Yes. Exercise during haemodialysis is safe and should be offered in every unit, usually 30 minutes or more of cycling each session, avoiding the first 30 minutes. A Cochrane review of 89 trials found exercise on dialysis probably improves walking and mood. Add activity on non-dialysis days too, but don't start in your first 3 months of haemodialysis or with a fever or infection.
Yes. The UK guideline found no evidence that light upper-body exercise harms a fistula, but avoid pressure and heavy lifting on that arm, wear no watch or tight sleeve on it, and don't have your blood pressure taken on it. Check the buzz (thrill) every day, and ask your renal team how much you can lift with that arm.
Yes: Kidney Care UK suggests exercising at least two or three times a week, because kidney disease weakens muscles. PD makes hernias more likely, so report any new lump or swelling, and ask your PD team which tummy exercises and lifting loads are safe for you.
Walk a little every day from the first weeks to help prevent blood clots. Moderate exercise such as walking, jogging, swimming and cycling is usually encouraged from 6 to 8 weeks if your recovery is going well. Most sports are possible, but avoid heavy contact sports such as rugby, martial arts and boxing.
Ask your renal team or dietitian first: no guideline recommends it for CKD. KDIGO notes that creatine supplements used for bodybuilding have been linked with kidney inflammation, and creatine can make your kidney blood test look worse than it is. KDIGO also suggests about 0.8 g of protein per kg a day for CKD stages 3 to 5, so check before using protein shakes too.
Probably. Kidney Care UK says activity may help reduce tiredness and that it's fine to be active only on your better days, and on dialysis, exercise may ease tiredness, though the evidence is low certainty. Ask your team about treatable causes such as anaemia, and rest for an hour or two after haemodialysis.
If you're on dialysis, stick to the daily fluid allowance your team gives you, because extra fluid builds up between sessions. Ask your team before drinking more for exercise or hot weather. If you're not on dialysis, ask your team what's right for you.
Stop if you feel very tired, dizzy or light-headed, get leg cramps, become short of breath, have chest pain, get an irregular or racing heartbeat, or feel sick. Call 999 (911 in the US) for chest pain that feels tight or spreads, or if your fistula bleeds between dialysis sessions.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
