{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T12:48:30Z","timestamp":1792759710897,"version":"4.5.0"},"reference-count":113,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T00:00:00Z","timestamp":1696809600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Physical inactivity has been identified as a risk factor for multiple disorders and a strong association exists between chronic kidney disease (CKD) and a sedentary lifestyle. Even though physical activity is crucial in the development and progression of disease, the general focus of the current medical practice is the pharmacological perspective of diseases with inadequate emphasis on lifestyle intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this narrative review we explain the pathophysiological mechanisms underlying the beneficial effects of physical exercise on CKD in addition to discussing the clinical studies and trials centred on physical exercise in patients with CKD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Physical activity influences several pathophysiological mechanisms including inflammation, oxidative stress, vascular function, immune response and macromolecular metabolism. While exercise can initially induce stress responses like inflammation and oxidative stress, long\u2010term physical activity leads to protective countermeasures and overall improved health. Trials in pre\u2010dialysis CKD patients show that exercise can lead to reductions in body weight, inflammation markers and fasting plasma glucose. Furthermore, it improves patients' functional capacity, cardiorespiratory fitness and quality of life. The effects of exercise on kidney function have been inconsistent in these trials. In haemodialysis, peritoneal dialysis and kidney transplant patients exercise interventions improve cardiorespiratory fitness, walking capacity and quality of life. Combined training shows the best performance to increase peak oxygen uptake in haemodialysis patients. In kidney transplant recipients, exercise improves walking performance, quality of life and potentially arterial stiffness. However, exercise does not affect glucose metabolism, serum cholesterol and inflammation biomarkers. Long\u2010term, adequately powered trials are needed to determine the long\u2010term feasibility, and effects on quality of life and major clinical outcomes, including mortality and cardiovascular risk, in all CKD stages and particularly in kidney transplant patients, a scarcely investigated population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Physical exercise plays a crucial role in ameliorating inflammation, oxidative stress, vascular function, immune response and macromolecular metabolism, and contributes significantly to the quality of life for patients with CKD, irrespective of the treatment and stage. Its direct impact on kidney function remains uncertain. Further extensive, long\u2010term trials to conclusively determine the effect of exercise on major clinical outcomes such as mortality and cardiovascular risk remain a research priority.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.14105","type":"journal-article","created":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T02:39:59Z","timestamp":1697078399000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Physical exercise in kidney disease: A commonly undervalued treatment modality"],"prefix":"10.1111","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1297-0675","authenticated-orcid":false,"given":"Mehmet","family":"Kanbay","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Medicine Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidar","family":"Copur","sequence":"additional","affiliation":[{"name":"Department of Medicine Koc\u00a0University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8921-2736","authenticated-orcid":false,"given":"Abdullah B.","family":"Yildiz","sequence":"additional","affiliation":[{"name":"Department of Medicine Koc\u00a0University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cem","family":"Tanriover","sequence":"additional","affiliation":[{"name":"Department of Medicine Koc\u00a0University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Mallamaci","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit Azienda Ospedaliera \u201cBianchi\u2010Melacrino\u2010Morelli\u201d &amp; CNR\u2010IFC, Institute of Clinical Physiology Research Unit of Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria  Reggio Calabria Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6616-1996","authenticated-orcid":false,"given":"Carmine","family":"Zoccali","sequence":"additional","affiliation":[{"name":"Renal Research Institute  New York New York USA"},{"name":"Institute of Molecular Biology and Genetics (Biogem)  Ariano Irpino Italy"},{"name":"Associazione Ipertensione Nefrologia Trapianto Renal (IPNET), c\/o Nefrologia Grande Ospedale Metropolitano  Reggio Calabria Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,9]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/cphy.c110025"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kisu.2021.11.003"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)30045-3"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfaa012"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-022-00675-9"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7793.2001.0329c.xd"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1023\/a:1026070911202"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s004210170012"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2004.066779"},{"key":"e_1_2_9_11_1","first-page":"42","article-title":"Does the aging skeletal muscle maintain its endocrine function?","volume":"10","author":"Pedersen M","year":"2004","journal-title":"Exerc Immunol Rev"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1096\/fj.02-0670fje"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1128\/iai.63.4.1158-1164.1995"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1084\/jem.179.5.1529"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M111.310581"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0167-5699(97)01103-1"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.iy.11.040193.001121"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2222.1999.00456.x"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0801059105"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2016040453"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12165358"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2000-8852"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.35.3.170"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-021-00529-7"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2022.02.028"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-013-9969-z"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1978.45.6.927"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0006-291x(82)80124-1"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/0167-4889(85)90019-9"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1996.81.3.1197"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1992.73.5.1797"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1089\/ars.2012.4623"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M114.619072"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1373.1999.d01-142.x"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1113\/jp270646"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/0003-9861(88)90623-6"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1093\/geronj\/40.3.281"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00031.2007"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1994.77.5.2177"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.1997.272.1.R363"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1096\/fj.07-102541"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1084\/jem.189.11.1699"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.12371213"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1177\/2040622318785575"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-20-0407"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1996.81.2.943"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01371.2010"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1101\/cshperspect.a029819"},{"key":"e_1_2_9_49_1","first-page":"105","article-title":"Exercise training inhibits inflammation in adipose tissue via both suppression of macrophage infiltration and acceleration of phenotypic switching from M1 to M2 macrophages in high\u2010fat\u2010diet\u2010induced obese mice","volume":"16","author":"Kawanishi N","year":"2010","journal-title":"Exerc Immunol Rev"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2016.02.014"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00157.2015"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pharmthera.2014.02.005"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1210\/en.2008-0816"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.33549\/physiolres.932997"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature10777"},{"key":"e_1_2_9_56_1","doi-asserted-by":"publisher","DOI":"10.1249\/jes.0000000000000068"},{"key":"e_1_2_9_57_1","doi-asserted-by":"publisher","DOI":"10.1139\/cjpp-2013-0486"},{"key":"e_1_2_9_58_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.00648"},{"key":"e_1_2_9_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0167-5699(98)01255-9"},{"key":"e_1_2_9_60_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4684-5344-7_102"},{"issue":"4","key":"e_1_2_9_61_1","first-page":"412","article-title":"The effect of exhaustive exercise on salivary immunoglobulin a","volume":"32","author":"McDowell S","year":"1992","journal-title":"J Sports Med Phys Fitness"},{"key":"e_1_2_9_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lfs.2017.09.007"},{"key":"e_1_2_9_63_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfad076"},{"key":"e_1_2_9_64_1","first-page":"155","volume-title":"Why Does Moderate Exercise Enhance, But Intense Training Depress, Immunity? Behaviour and Immunity","author":"Smith JA","year":"2019"},{"key":"e_1_2_9_65_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-014-0154-1"},{"key":"e_1_2_9_66_1","doi-asserted-by":"publisher","DOI":"10.1139\/h10-089"},{"key":"e_1_2_9_67_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2003-43265"},{"key":"e_1_2_9_68_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.164.1.31"},{"key":"e_1_2_9_69_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12944-018-0879-1"},{"key":"e_1_2_9_70_1","doi-asserted-by":"publisher","DOI":"10.3390\/biom10121699"},{"key":"e_1_2_9_71_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-013-0110-5"},{"key":"e_1_2_9_72_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12944-017-0515-5"},{"issue":"5","key":"e_1_2_9_73_1","first-page":"343","article-title":"Serum myostatin\u2010immunoreactive protein is increased in 60\u201092 year old women and men with muscle wasting","volume":"6","author":"Yarasheski KE","year":"2002","journal-title":"J Nutr Health Aging"},{"key":"e_1_2_9_74_1","doi-asserted-by":"publisher","DOI":"10.1159\/000356740"},{"key":"e_1_2_9_75_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0531-5565(02)00025-6"},{"key":"e_1_2_9_76_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glr025"},{"key":"e_1_2_9_77_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfz210"},{"key":"e_1_2_9_78_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2017010020"},{"key":"e_1_2_9_79_1","doi-asserted-by":"publisher","DOI":"10.1681\/asn.2021050668"},{"key":"e_1_2_9_80_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nefro.2020.01.002"},{"key":"e_1_2_9_81_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-019-02234-x"},{"key":"e_1_2_9_82_1","doi-asserted-by":"publisher","DOI":"10.1681\/asn.2016030378"},{"key":"e_1_2_9_83_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfad083"},{"key":"e_1_2_9_84_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfad102"},{"key":"e_1_2_9_85_1","doi-asserted-by":"publisher","DOI":"10.1177\/2054358118779821"},{"key":"e_1_2_9_86_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-022-00623-7"},{"key":"e_1_2_9_87_1","doi-asserted-by":"publisher","DOI":"10.2215\/cjn.03340410"},{"key":"e_1_2_9_88_1","doi-asserted-by":"publisher","DOI":"10.1249\/mss.0000000000001886"},{"key":"e_1_2_9_89_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfab022"},{"key":"e_1_2_9_90_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-200207150-00008"},{"key":"e_1_2_9_91_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0171063"},{"key":"e_1_2_9_92_1","unstructured":"Accessed June 20 2023.https:\/\/songinitiative.org\/projects\/song\u2010tx\/."},{"key":"e_1_2_9_93_1","doi-asserted-by":"publisher","DOI":"10.1111\/sms.13436"},{"key":"e_1_2_9_94_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2019.04.001"},{"key":"e_1_2_9_95_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00539.2018"},{"key":"e_1_2_9_96_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0251652"},{"key":"e_1_2_9_97_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-021-01429-w"},{"key":"e_1_2_9_98_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2022.06.008"},{"key":"e_1_2_9_99_1","doi-asserted-by":"publisher","DOI":"10.1111\/hdi.12664"},{"key":"e_1_2_9_100_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2019.03.018"},{"key":"e_1_2_9_101_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfy376"},{"key":"e_1_2_9_102_1","doi-asserted-by":"publisher","DOI":"10.1111\/sms.13304"},{"key":"e_1_2_9_103_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18179205"},{"key":"e_1_2_9_104_1","doi-asserted-by":"publisher","DOI":"10.23736\/S1973-9087.21.06694-6"},{"key":"e_1_2_9_105_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbmt.2021.06.022"},{"key":"e_1_2_9_106_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0257918"},{"issue":"3","key":"e_1_2_9_107_1","first-page":"81","article-title":"Effects of home\u2010based exercise program using Thai\u2013style braided rubber rope on blood pressure, muscle strength and quality of life in patients on continuous ambulatory peritoneal dialysis","volume":"29","author":"Aramrussameekul W","year":"2019","journal-title":"ASEAN J Rehabil Med"},{"key":"e_1_2_9_108_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfy351"},{"key":"e_1_2_9_109_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-39074-9"},{"key":"e_1_2_9_110_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xkme.2020.01.005"},{"key":"e_1_2_9_111_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jrn.2018.03.001"},{"key":"e_1_2_9_112_1","doi-asserted-by":"publisher","DOI":"10.5500\/wjt.v8.i1.13"},{"key":"e_1_2_9_113_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13450"},{"key":"e_1_2_9_114_1","doi-asserted-by":"publisher","DOI":"10.1111\/tri.13570"}],"container-title":["European Journal of Clinical Investigation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/eci.14105","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T09:57:31Z","timestamp":1706003851000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/eci.14105"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,9]]},"references-count":113,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1111\/eci.14105"],"URL":"https:\/\/doi.org\/10.1111\/eci.14105","archive":["Portico"],"relation":{},"ISSN":["0014-2972","1365-2362"],"issn-type":[{"value":"0014-2972","type":"print"},{"value":"1365-2362","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,9]]},"assertion":[{"value":"2023-07-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-29","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14105"}}