The effects of exercise on pulmonary function and respiratory muscle strength in patients with chronic kidney disease: a systematic review and meta-analysis.

BACKGROUND

Patients with chronic kidney disease (CKD) have impaired respiratory function. Although exercise provides several benefits in this population, its effects on respiratory outcomes remain unclear. This study aims to evaluate the effects of different exercise modalities on pulmonary function and respiratory muscle strength in patients with CKD across different stages.

METHODS

Systematic review and meta-analysis of experimental studies. Searches were conducted from database inception to May 2026 in MEDLINE/PubMed, CENTRAL, EMBASE, PEDro, Web of Science, LILACS and supplementary searches of grey literature sources, without language or publication-year restrictions. Outcomes included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, peak expiratory flow (PEF), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). Random-effects models were used for meta-analyses.

RESULTS

Thirteen studies were included in the meta-nalyses. Exercise significantly improved FVC (MD=0.25 L; 95% CI: 0.01-0.50; I2=51%), MIP (MD=11.47 cmH2O; 95% CI: 7.73-15.22; I2=52%), and MEP (MD=10.42 cmH2O; 95% CI: 5.53-15.31; I2=58%), whereas no significant effects were observed for FEV1, FEV1/FVC, or PEF. In exploratory subgroup analyses, both respiratory interventions and peripheral exercise significantly improved MIP and MEP. However, no significant subgroup differences between exercise modalities were observed for MIP (p=0.67), MEP (p=0.20), or FVC (p=0.70).

CONCLUSIONS

Exercise may improve FVC and respiratory muscle strength in patients undergoing haemodialysis. Exploratory analyses did not provide evidence effects between respiratory interventions and peripheral exercise. These findings suggest that exercise may be considered a complementary strategy to improve respiratory function in rehabilitation programmes for these patients.