Systematic Review of Exercise Interventions and HRQOL in Predialysis CKD

Health-related quality of life (HRQOL) is frequently impaired among individuals with chronic kidney disease (CKD), even before dialysis initiation. Exercise has been proposed as a strategy to improve HRQOL, but the extent of this association remains unclear in patients with predialysis CKD. This systematic review aimed to characterize the literature examining the relationship between exercise and HRQOL in patients with predialysis CKD.

A systematic review was conducted, guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and its extension for reviews without meta-analysis. PubMed and Embase were searched in August 2025. Eligible studies included observational or interventional studies assessing physical activity or exercise among patients with CKD stages 1-5 (not on dialysis) and reporting HRQOL outcomes.

A total of 18 publications representing 16 randomized controlled trials met the inclusion criteria. Most studies evaluated aerobic exercise interventions, typically walking-based programs performed for 30-60 minutes, 2-4 times per week for 12 weeks to 6 months. HRQOL was assessed using standardized patient-reported outcome measures. Eleven studies reported improvements in HRQOL after exercise interventions, primarily in physical and social domains, including improvements in fatigue, sleep quality, pain, uremic symptoms, social functioning, and social interaction, whereas 5 studies reported no significant change.

Exercise interventions appear to improve HRQOL among patients with predialysis CKD, particularly in physical and social domains, although heterogeneity in interventions and outcome measures limits comparability. Future interventions should aim for clinically meaningful improvements besides statistical significance.