Check in with your healthcare team before starting an exercise program, especially if you have severe kidney disease or high cardiovascular risk, advises Joseph Vassalotti, MD, a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City and the chief medical officer of the National Kidney Foundation. Your providers can offer individualized recommendations based on your current activity level, disease status, and personal preferences.
While there aren’t any official exercise guidelines for people with diabetic kidney disease, the standard evidence-based recommendations for adults include at least 150 minutes of moderate- to vigorous-intensity aerobic exercise a week, along with two to three resistance-training sessions.
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Aerobic exercise specifically may help decrease body mass index (BMI) and reduce blood pressure in people with diabetic kidney disease.
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There are many types of aerobic exercise to choose from, including walking, cycling, jogging, rowing, and swimming. “Make it a fun and enjoyable activity that makes you feel good while improving your overall health,” says Eichorst.
Meanwhile, resistance training is also important for people with diabetic kidney disease, especially for those who are older than 50 and those who are taking GLP-1 weight loss medications like semaglutide (Ozempic), tirzepatide (Mounjaro), or dulaglutide (Trulicity). This population tends to experience muscle loss from both age-related changes (sarcopenia) and side effects of these weight loss medications, says Dr. Vassalotti.
You can strength train using your body weight, resistance bands, exercise machines, or free weights. Work with your physician and a strength and conditioning specialist to choose the modality that best suits your needs.
Some physical activities can be challenging for people with complications such as neuropathy and osteoarthritis. For instance, intense or weight-bearing activities such as standing strength exercises and jogging can cause joint pain and balance issues. “Non-weight-bearing, low-impact activities such as swimming, cycling, and chair exercises may work for those with neuropathy or osteoarthritis of the knee and hip,” says Vassalotti. Ask your provider which exercises they recommend for you.
Also keep the following tips in mind when exercising with diabetic kidney disease:
- Start slowly. Ease into a new exercise routine to prevent injuries and overexertion. Start by working at a lower intensity and gradually building to a moderate intensity level, increasing your level of exertion by no more than 10 percent each week.
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- Hydrate well. Staying hydrated is essential for overall health, but it’s especially important when you have diabetic kidney disease. Sweating during exercise increases fluid loss, making it easier to become dehydrated. Drink plenty of water before, during, and after workouts to replenish fluids, particularly if you’re exercising in the heat. (People on dialysis may be advised to limit their fluid intake.)
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- Check your blood sugar frequently. Exercise generally lowers blood sugar. Intense workouts such as heavy strength training and competitive sports may cause you to produce stress hormones that raise blood sugar temporarily. By monitoring your blood sugar before, during, and after exercise, you can identify whether specific activities or foods make it difficult to keep your blood sugar in range.
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