Benefit and risk of exercise training in chronic kidney disease patients

Chronic kidney disease (CKD) is a worldwide public health problem. In CKD patients, exercise endurance is lowered, and this phenomenon becomes more distinct as the renal dysfunction advances. This is due to the combined effects of uremic acidosis, protein-energy wasting, and inflammatory cachexia, which lead to and are further aggravated by a sedentary lifestyle. Together, these factors result in a progressive downward spiral of deconditioning. This review focuses on the benefits and risks of exercise training in CKD patients. In Japan, we have established the Japanese Society of Renal Rehabilitation in 2011 to evaluate and promote renal rehabilitation (RR). We use a comprehensive approach to RR including physical exercise and psychological, vocational, and dietary counseling. RR is a feasible, effective, and safe secondary prevention strategy following CKD and offers a promising model for new field of rehabilitation. Urgent efforts should be made to increase the implementation rate of the RR.