Physical activity in kidney disease: evidence and implementation.

Despite over 30 years of research and guidelines promoting physical activity for people living with chronic kidney disease (CKD), widespread implementation of physical activity in routine care remains low worldwide. Consequently, the population with CKD remains highly inactive across all stages of the disease. Randomized controlled trials in people with CKD, people on dialysis and kidney transplant recipients consistently show that structured exercise is safe and can improve physical function, cardiorespiratory fitness, muscle strength and aspects of quality of life. However, these trials are of variable quality with modest sample sizes in some groups, and a need exists for larger, implementation-focused studies. Evidence generation in CKD has often been disconnected from service development, limiting workforce skills, resources and pathways for delivery. To achieve meaningful change, research must be designed with implementation in mind, using frameworks that consider context, sustainability and stakeholder involvement. Digital solutions and approaches targeting 24-h movement behaviours may extend the reach of physical-activity interventions, but barriers such as health-professional training, patient capability and system-level prioritization must be addressed. Embedding physical activity in clinical care offers a clear opportunity to improve outcomes and quality of life for people living with CKD.