Prescribing Physical Activity and Exercise for People with CKD: A Practical Guide by the Global Renal Exercise Network.

Physical activity (PA) and exercise are fundamental to optimizing and maintaining health. The evidence on the benefits of PA and exercise in people with CKD is well-established. Yet patients remain inactive, partly driven by a lack of knowledge and confidence from the healthcare providers involved in their management. A potential key element in improving PA in CKD includes better provisions around education, tools, and training resources among nephrology healthcare providers on PA recommendations, counseling, prescription, and referral to appropriate professionals for assessment, implementation, and monitoring. Much like other pharmacologic therapies, an effective prescription should be prescribed at the correct dose, strength, and frequency to the individual, titrated (and progressed) to optimize adherence and safety, and reviewed regularly to ensure maximum effectiveness. Aside from a formal prescription of exercise, many people would benefit from modest improvements in daily PA, and an emphasis on reducing sedentary behavior is likely to confer beneficial effects on outcomes. The purpose of this article is to outline the key components of successful PA and exercise prescriptions, including understanding the barriers and facilitators individuals may have, taking a PA history, and how to tailor exercise "dose" to each patient with the ultimate goal of increasing accessibility of PA for all people living with CKD. To do this, we will use worked examples to demonstrate what an exercise prescription may consist of across each of the major CKD stages.