| Move Right, Kidneys Right — Physical Activity Guide | W.G.M. Rivero MD · FPCP · DPSN · · williamriveromd.com · 2026 |
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A Patient Guide · Physical Activity & Sports
Move Right, Kidneys Right
Safe, simple movement for Filipino kidney patients
— non-dialysis & on dialysis |
🏃
W.G.M. Rivero MD
FPCP · DPSN Nephrologist
williamriveromd.com
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150 min Moderate activity per week (KDIGO target) |
11–13 Borg RPE = "moderate" — talk but can't sing |
2× / week Strength work — the only fix for muscle loss |
🫀 Heart & vessels Lowers blood pressure, relaxes vessel walls, improves insulin sensitivity — slows eGFR decline. |
💪 Muscle Fights sarcopenia (muscle loss). In CKD, muscle predicts frailty, falls, and survival. |
🧠 Mood & sleep Lifts energy, mood, and sleep — and regular training helps your body handle potassium better over time, not worse. |
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Ask your doctor first if you have…
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STOP right away — during activity — if you feel…
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| For educational use only. This guide supports — it does not replace — individualized clearance from your nephrologist or cardiologist. References: KDIGO 2024 CKD Guideline (Kidney Int) · Global Renal Exercise Network Practical Guide (CJASN 2025) · Renal Association Exercise & Lifestyle in CKD (BMC Nephrol 2022). | williamriveromd.com Page 1 of 5 · williamriveromd.com/guides/physical-activity-sports-ckd.html |
Your Weekly Movement Plan — by CKD Stage & Dialysis Modality Start low · progress over weeks, not days |
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| Group | Weekly aerobic target | Intensity (RPE) | Resistance | Key adjustment |
|---|---|---|---|---|
| CKD G1–G3a | ≥150 min moderate (or 75 min vigorous) | 11–13 (up to 14–16 if cleared) | 2–3×/week, submaximal | Near-normal prescription; full sport participation usually fine when cleared. |
| CKD G3b–G4 | ≥150 min moderate, matched to heart tolerance | 11–13 | 2–3×/week, no 1-rep-max | Favor lower-impact sport variants; watch your BP response. |
| CKD G5, non-dialysis | As tolerated; frailty-screen first | 11–13, start lower | 2×/week, light–moderate | Consider a physical-therapy or frailty screen (e.g. SPPB) before starting. |
| Hemodialysis | 150 min moderate / 75 min vigorous, split across dialysis + off days | 11–13 | 2×/week, spare a catheter limb | Exercise in the first half of the session (lower low-BP risk); stand up slowly afterward. |
| Peritoneal dialysis | Same 150-min target | 11–13 | 2×/week, no full sit-ups / straining | Empty dialysate before vigorous activity when you can; skip open-water swimming. |
F · I · T · T Frequency — most days · Intensity — RPE 11–13 · Time — build to 30 min · Type — walk, cycle, dance, sport you enjoy. |
V · P Volume — reach 150 min/week in total · Progression — add ~5 minutes a week. Short bouts add up toward the total. |
Golden rule Warm up, move at a "somewhat hard" pace you can talk through, cool down. If a session feels wrong, stop — there is always tomorrow. |
| For educational use only. Prescriptions are individualized to your kidney function, heart health, and frailty. The 150-minute weekly moderate-activity target is a Level 1, Grade A recommendation of the KDIGO 2024 CKD Guideline (Kidney Int 2024;105(4S):S117–S314). | williamriveromd.com Page 2 of 5 · williamriveromd.com/guides/physical-activity-sports-ckd.html |
Filipino Activity Intensity Heat-Map Match the sport to your tier — MET values from the 2024 Adult Compendium |
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| Activity | MET | Rating | Best-suited group & note |
|---|---|---|---|
| 🟢 LIGHT (under 3 MET) — everyone, including frail patients and CKD G5 | |||
| Walking, leisurely (<3 km/h) | 2.0 | SAFE FOR ALL | The safest place to start; build up minutes before pace. Great on dialysis days. |
| Household chores (sweep, mop) | 2.5 | SAFE FOR ALL | "Hidden" activity credit — stack several across a day if you are less mobile. |
| Tai chi | 3.0 | SAFE FOR ALL | Best for balance and fall prevention — important with renal bone disease. |
| 🟡 MODERATE (3–6 MET) — the everyday target for CKD G1–G4 and dialysis off-days | |||
| Cycling, leisure (<16 km/h) | 4.0 | THE TARGET | Low-impact and joint-friendly; stationary bikes work well indoors and during HD. |
| Walking, brisk (5–5.5 km/h) | 4.3 | THE TARGET | The workhorse of the 150-minute target; free and available everywhere. |
| Pickleball, recreational doubles* | 4.8 | THE TARGET | Lower-impact racket option for older/deconditioned patients; mind quick side-steps. |
| Basketball, shootaround / half-court | 5.0 | THE TARGET | The realistic barangay-court option — non-competitive form for most who love the game. |
| Swimming, slow freestyle | 5.0 | THE TARGET | Excellent joint-sparing aerobic work. PD patients: avoid open water. |
| Badminton, social doubles | 5.5 | THE TARGET | Doubles over singles — less lunging and direction change (joint / fall stress). |
| 🔴 VIGOROUS (over 6 MET) — cardiac-cleared, higher-functioning non-dialysis patients only | |||
| Badminton, competitive match play | 7.0 | CLEARED ONLY | Reserve for G1–G3a after cardiac clearance; abrupt lunges raise fall/joint risk. |
| Dancing — Zumba / aerobics | 7.3 | CLEARED ONLY | Very popular & free — but vigorous. Use a low-impact modification: smaller steps, no jumps. |
| Basketball, full-court game | 8.0 | CLEARED ONLY | Highest common intensity here; cardiac clearance first. Half-court is the default. |
| For educational use only. *Pickleball has no official 2024 Compendium code; its value is a careful estimate, not a fixed guideline figure. MET values: Herrmann et al., 2024 Adult Compendium of Physical Activities, J Sport Health Sci 2024;13(1):6–12. | williamriveromd.com Page 3 of 5 · williamriveromd.com/guides/physical-activity-sports-ckd.html |
Building a Safe Session — Warm-Up to Cool-Down Plus a no-equipment home routine for strength, balance & flexibility |
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1 · Warm-Up 5 min easy — gentle marching, arm circles, slow breathing |
→ | 2 · Conditioning 20–30 min aerobic at RPE 11–13 — walk, cycle, dance, sport |
→ | 3 · Strength 2×/week — bands or bodyweight, submaximal, never a 1-rep max |
→ | 5 min Cool-down & stretch — walk it off, breathe, hydrate |
🪑 Chair-based Frail · elderly · G5 · dialysis days Sit-to-stands, seated marching, seated leg extensions, wall push-ups. 2 sets of 8–12. |
🧍 Standing bodyweight Stronger days Modified squats, calf raises, step-ups on a low step, wall plank. Add resistance-band rows. |
⚖️ Balance Fall prevention Single-leg stand near a wall, tai-chi weight shifts. Vital with renal bone disease & post-HD dizziness. |
🤸 Flexibility Every session Gentle calf, hamstring, and shoulder stretches after the cool-down — hold, don't bounce. |
| Instead of… | Do this | |
| Full sit-ups (on peritoneal dialysis) | → | Partial crunches & isometric holds — no straining or breath-holding |
| Outdoor exercise 10 AM–4 PM | → | Sunrise (5:30–7 AM) or early evening (5–7 PM), out of the heat |
| Sports / energy drinks | → | Plain water in small sips, matched to your fluid limit |
| Resistance work on a catheter arm | → | Train the other limb until your team clears the access |
| Skipping a day when tired | → | A gentle 10-minute walk — even a little breaks the inactivity spiral |
| For educational use only. Intradialytic exercise is safe with no contraindications and should be available in dialysis units. References: Young et al., Intradialytic cycling — systematic review & meta-analysis, Nephrol Dial Transplant 2018;33(8):1436–1445 · Global Renal Exercise Network, CJASN 2025. | williamriveromd.com Page 4 of 5 · williamriveromd.com/guides/exercise-guide-ckd.html |
Dialysis Days, Heat, Diabetes & Your Weekly Plan Plus a stop-signs card to print and keep |
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| HD | Dialysis days: move in the first half of the session; rise slowly afterward (post-HD blood pressure dips); skip vigorous same-day exercise if you are already tired. |
| HEAT | Philippine heat: avoid 10 AM–4 PM; go at sunrise or evening; sip plain water to your fluid limit; know heat-exhaustion signs (headache, nausea, clammy skin) and stop early. |
| DM | Diabetes: guard against low blood sugar during and after; time activity around insulin/tablets; check your feet before and after every session. |
| HEART | Heart disease: a recent cardiac event, known coronary disease, or an uncontrolled irregular heartbeat means cardiac clearance — often a stress test — before any vigorous program. |
| Profile | Mon · Wed · Fri | Tue · Thu · Sat | Sunday |
|---|---|---|---|
| CKD G3–G4, working-age | 30-min brisk walk or leisure cycle | Band strength routine + social badminton doubles | Rest or gentle stretch |
| CKD G5, conservative / frail | 10-min gentle walk + chair routine | Tai chi / balance, short and seated | Rest |
| Hemodialysis (Tue–Thu–Sat) | Off-day: 20–30-min walk + light bands | Dialysis day: pedal / bands in the first half | Rest; slow post-HD recovery |
| Peritoneal dialysis | Walk + standing bodyweight (empty if vigorous) | Pickleball or modified Zumba + partial-crunch core | Rest or gentle stretch |
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STOP & rest if you feel
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Call your nephrologist if
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| For educational use only. This guide supports, and never replaces, your own doctor's individualized clearance. References: KDIGO 2024 CKD Guideline · Global Renal Exercise Network (CJASN 2025) · Renal Association Exercise & Lifestyle in CKD (BMC Nephrol 2022) · 2024 Adult Compendium of Physical Activities (J Sport Health Sci). | williamriveromd.com Page 5 of 5 · williamriveromd.com/guides/physical-activity-sports-ckd.html |