Exercise and Bone Health for Kidney Disease

July 13, 2023

Exercise is a great way to strengthen your body and bones but always check with your healthcare provider before starting or stopping any exercise program.

Almost everyone with kidney disease has some mineral or bone disorder that worsens as kidney function declines1. This may sound alarming but there are ways to keep your body and bones strong! Brittany Glazer, a clinical exercise physiologist at the University of Delaware working in kidney disease rehabilitation, explains how. 

Bone health and kidney disease

Exercise and Bone Health. What CKD Patients Should Know

The kidneys are incredibly important, not only for filtering toxins and wastes out of the body but also for maintaining healthy bones. Kidneys preserve the balance of phosphorus and calcium and activate vitamin D. If kidneys aren't working correctly, blood phosphorus increases and blood vitamin D decreases. As a result, the body makes a hormone that causes calcium to leave the bones and enter the blood. Over time, bones become brittle, and the calcium in the blood can bring on or worsen heart disease. 
 
 
To treat a bone or mineral disorder, your may need to:
  • Eat less phosphorus, especially from processed foods with phosphorus-based additives like trisodium phosphate, and/or take phosphate binders
  • Take a healthcare provider-recommended vitamin D supplement
  • Take calcimimetics, a drug that acts like calcium, or calcium supplements 
  • Get surgery to remove some or all of the parathyroid gland
  • Do strengthening and weight-bearing exercises
"The entire skeletal muscle system benefits greatly from exercise. Regular participation in aerobic and resistance training can increase bone density, which is important as we age to help prevent osteopenia, osteoporosis, and muscle wasting," said Glazer." It will also help improve cardiovascular and respiratory function and reduce cardiovascular disease risk factors like high blood pressure. Exercise may also help reduce insulin needs for those who have diabetes, improve glucose tolerance, and decrease mortality rates." 
 

What are the benefits of exercise?

Exercise may help prevent or slow the progression of kidney disease.

"The rehabilitation center I work for has patients who already have kidney disease or are on dialysis, so we're not going to prevent that initial occurrence, and we're not going to reverse the damage," said Glazer. "But we want to prevent another event from happening, like cardiovascular disease, and help build overall strength."

Exercise increases strength and endurance, making daily activities like walking up stairs easier, but the benefits don't stop there. 

"Exercise can help decrease anxiety and depression while improving cognitive function and sleep quality. It lowers the risk of falls and fall-associated injuries like fractures and promotes independent living," Glazer said. "Exercising regularly helps keep risk factors like high blood pressure, high cholesterol, and elevated blood sugar to a minimum in the short and long term."

Glazer has seen these benefits firsthand.

"I worked with a couple of individuals on the kidney transplant waitlist. The transplant team was hesitant to give them a transplant because they were frail. By working with us, they were able to get their transplant," said Glazer. "We had one individual who was a stroke patient on dialysis that needed a gait belt to help him get up and go from machine to machine. He was one of the most consistent patients in our lab and is now able to move himself to the end of his chair, push himself up, and walk over to the machine by himself."

Learn more about the benefits of exercising with kidney disease.

How to get started

Group of people boxing outside

The CDC recommends adults get 150 minutes of moderate-intensity exercises a week, like walking or swimming, and do two days of muscle-strengthening activities, like weight lifting.2

"You can build up to the recommended levels of exercise. When you're first starting, anything is better than nothing. My main goal is to get you moving and help people create a routine that builds strength, stamina, and endurance. Do what you can and slowly improve from there," Glazer said. "As long as you have clearance from your doctor, there isn't anything you can't do depending on your stage of kidney disease." 

So, start with a few minutes and increase from there. You can also try breaking exercise into smaller sessions over a day–for example, you can take a ten-minute walk in the morning, at lunch, and after dinner. 

"Walking is one of the best aerobic exercises because you can do it anywhere and you don't need any equipment. For resistance training, I recommend patients who don't have weights or a resistance band to grab two cans of beans out of the pantry and bicep curl or shoulder press with them," said Glazer. "Be sure to warm up, whether that's stretching for five minutes or riding a recumbent bike to help avoid injuries. My biggest recommendation would be to start off small and listen to your body. Be patient and consistent."

Need help sticking with a new exercise routine? Join NKF Peers to find out how others living with kidney disease have incorporated exercise into their health routines.

Sources

1“Mineral & Bone Disorder in Chronic Kidney Disease.” National Institute of Diabetes and Digestive and Kidney Diseases, www.niddk.nih.gov/health-information/kidney-disease/mineral-bone-disord…. Accessed 16 May 2023.
2“How Much Physical Activity Do Adults Need?” Centers for Disease Control and Prevention, 2 June 2022, www.cdc.gov/physicalactivity/basics/adults/index.htm.