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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Exercise and activity

In short

Moving more helps your heart, blood pressure, mood, strength and glucose. KDIGO recommends at least 150 minutes a week of moderate activity, such as brisk walking, or as much as your heart and body allow, and less time sitting (KDIGO 2024, recommendation 3.2.2.1 and practice point 3.2.2.2). The ADA says there is no evidence that hard exercise speeds up kidney disease, and people with CKD in general do not need special limits (ADA 2026 §5). With type 1 diabetes, the key is planning: check glucose before you start, check ketones if glucose is high, and carry fast sugar (exercise consensus). On dialysis, protect your access.

Your numbers

Weekly goals (KDIGO 2024; ADA 2026 §5):

What Goal
Moderate activity (such as brisk walking) 150 minutes or more a week, spread over at least 3 days, with no more than 2 days in a row off; or as much as you can manage
Muscle-strengthening (bands, light weights, sit-to-stand) 2–3 sessions a week, not on back-to-back days
Sitting Get up and move at least every 30 minutes

Glucose before you start (exercise consensus, panel 1):

Glucose before exercise What to do
Under 90 mg/dL Take 10–20 g of fast carbohydrate; wait until you are above 90 and watch for a low
90–124 mg/dL Take about 10 g of fast carbohydrate before aerobic exercise
126–180 mg/dL Good range to start
182–270 mg/dL You can start; intense exercise may push glucose higher
Over 270 mg/dL with no recent meal to explain it Check blood ketones first (table below)
Glucose before exercise What to do
Under 5.0 mmol/L Take 10–20 g of fast carbohydrate; wait until you are above 5.0 and watch for a low
5.0–6.9 mmol/L Take about 10 g of fast carbohydrate before aerobic exercise
7.0–10.0 mmol/L Good range to start
10.1–15.0 mmol/L You can start; intense exercise may push glucose higher
Over 15.0 mmol/L with no recent meal to explain it Check blood ketones first (table below)

Blood ketones before exercise (exercise consensus):

Blood ketones What to do
Under 0.6 mmol/L Light to moderate exercise is fine; keep checking glucose
0.6–1.4 mmol/L Light exercise only, under 30 minutes, and follow your team's plan for high glucose
1.5 mmol/L or more Do not exercise. Start your sick-day plan; at 1.6 or more, call your diabetes team now
3.0 mmol/L or more Urgent: see Get help now

After a severe low in the last 24 hours (one where you needed someone's help, or glucose of 50 mg/dL (2.8 mmol/L) or less), do not exercise (exercise consensus).

What to do

  • Ask your team what kind and how much exercise is safe for you, especially if you have heart disease, serious eye disease from diabetes, or nerve damage that affects your heart rate or blood pressure (exercise consensus).
  • Start slowly, warm up, and build up a few minutes at a time (NKF).
  • Check glucose before, during long sessions, and after. Lows can come hours later, including overnight (exercise consensus).
  • Carry glucose tablets every time. Treat a low straight away with 15 g and recheck in 15 minutes (ADA 2026 §6; Treating a low).
  • Ask your diabetes team for a written plan for insulin and food around exercise. This handbook never gives doses.
  • If you have fallen or feel unsteady, ask how hard to exercise and which kind suits you: aerobic, strength, or both (KDIGO 2024, practice point 3.2.2.3).
  • Ask before heavy weightlifting or long, hard competitions. The exercise consensus warns against these for some people with long-standing diabetes, especially with kidney failure (exercise consensus).
  • If you have a fluid limit, ask how to handle hot days and long walks.

On dialysis

  • During hemodialysis: some units have pedal bikes you can use during a session; ask (NKF).
  • On dialysis days: glucose often falls during a session, and most lows come in the 24 hours after it (JBDS–Renal Association; JBDS 2022). Check before you exercise, and have a snack and glucose tablets with you.
  • Fistula or graft arm: do not carry heavy things or put heavy pressure on that arm, and do not wear tight sleeves, watches or bands over it (NKF). Ask your unit which arm exercises are safe.
  • PD catheter: ask your PD unit about lifting, sit-ups and swimming before you start; rules differ between units.

Examples

A walk after dinner. You walk for 15 minutes after dinner, five days a week. That is 75 minutes, halfway to the weekly goal. Add two 20-minute walks at the weekend and you are at 115. Your glucose before the walk is 140 mg/dL (7.8 mmol/L), a good range to start (exercise consensus).

A high reading before the gym. Your glucose is 290 mg/dL (16.1 mmol/L) and you have not eaten for three hours. You check ketones: 1.7 mmol/L. You skip the gym, start your sick-day plan, and call your team as it says (exercise consensus; Sick days).

Low before a bike ride. Your glucose is 82 mg/dL (4.6 mmol/L). You take 4 glucose tablets (16 g), wait, and start when you are above 90 mg/dL (5.0 mmol/L) (exercise consensus). Glucose tablets add no potassium, phosphorus or fluid.

Ask your care team

  1. How much exercise is safe for me, and is there any kind I should avoid?
  2. What is my plan for insulin and snacks before and after exercise?
  3. Can I exercise during dialysis at my unit?
  4. Which arm exercises are safe with my fistula or graft? What about lifting with a PD catheter?
  5. Could I see a physical therapist or join an exercise program?

Get help now if…

Call 911 (or your local emergency number)

Chest pain that does not settle when you stop and rest, severe breathlessness, fainting, or a low the person cannot treat themselves (give glucagon, then call). Blood ketones of 3.0 mmol/L or more, or any ketones with vomiting so you cannot keep fluids down. Full list: Get help now.

Stop exercising and rest if…

You feel chest tightness, very short of breath, dizzy or light-headed, or your heart races or skips. Check your glucose. Call your team the same day if it happens again.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.