How (and Why) to Exercise With Kidney Disease and Type 2 Diabetes

From everydayhealth.com

If you have both chronic kidney disease (CKD) and type 2 diabetes, you may rely on medications and nutrition to keep each condition under control. While those strategies are key to staying healthy, don’t overlook the importance of exercise as well.

Exercise has powerful effects on the body that can help address kidney disease and type 2 diabetes (also known as diabetic kidney disease) simultaneously, such as lowering blood sugar, strengthening muscles, improving heart health, and more. There are also some safety considerations to keep in mind when exercising with diabetic kidney disease, so be sure to have a conversation with your healthcare provider before getting started.

The Benefits of Exercise for CKD and Diabetes

Kidney disease and diabetes are managed mainly with medications and dietary changes, but exercise can also play a key role. 

“Regular physical activity can improve blood glucose and blood pressure, helping with both diabetes and kidney disease management,” says Barbara Eichorst, RD, CDCES, a Chicago-based certified diabetes care and education specialist and the vice president of healthcare programs at the American Diabetes Association. 

Exercise can also reduce oxidative stress and inflammation in the kidneys caused by high blood sugar, helping prevent further kidney damage. In fact, people with diabetes who perform moderate-intensity exercise at least twice a week may significantly slow the progression of kidney disease, with the most significant benefits associated with daily exercise.

Exercise and Type 2 Diabetes

The primary benefits of exercise for managing type 2 diabetes are improved blood glucose levels and insulin sensitivity, along with weight loss. 

Physical activity prompts your muscles to pull glucose from your bloodstream for fuel, not only lowering your blood sugar levels, but also encouraging your body to become more responsive to insulin (the hormone responsible for moving glucose into your cells) for up to 48 hours after exercise. With consistent exercise, your body becomes even more efficient at using blood glucose effectively, helping to keep your blood sugar levels under control.

In addition to a healthy diet, regular physical activity can also support weight loss in people with type 2 diabetes. Even modest weight loss of 3 to 7 percent of your body weight can result in improved blood glucose levels and may reduce your need for medications. Meanwhile, more substantial weight loss (more than 10 percent of your body weight) can significantly reduce the average amount of glucose in your blood over two to three months (also known as hemoglobin A1C).

Exercise and Chronic Kidney Disease

A significant benefit of exercise is its ability to lower blood pressure. In fact, regular physical activity can reduce blood pressure by 5 to 7 mmHg, which is helpful for managing kidney disease. High blood pressure (hypertension) is common in people with kidney disease, because kidney damage can cause blood pressure to rise, with elevated blood pressure further damaging the kidneys, creating a vicious cycle. By helping you to keep your blood pressure under control, exercise can also help prevent kidney damage.

Exercise may also improve symptoms of kidney disease, such as muscle loss and fatigue, by stimulating muscle growth and boosting the body’s release of nitric oxide. Nitric oxide is a gas produced naturally by the body that relaxes the blood vessels, helping them widen and increase blood flow. This response also allows more oxygen to travel to tissues throughout the body, which may improve energy.

Challenges and Barriers to Exercise

Benefits aside, symptoms and complications of diabetic kidney disease can make some activities tricky or even dangerous.

For example, when the kidneys remain inflamed for a long time (a hallmark of kidney disease), this inflammation can negatively impact other systems in the body that help with muscle building and energy support. As a result, a lot of people with kidney disease experience muscle loss and chronic fatigue. Combined, these effects can make everyday tasks feel like a struggle and exercise seem nearly impossible.

People with diabetic kidney disease are also more likely to have osteoarthritis, a joint disease that occurs when the cartilage in joints wears down. While physical activity helps keep joints with osteoarthritis healthy, it can be difficult to exercise during joint pain flares.

The high blood sugar that is characteristic of diabetes can also lead to nerve damage (neuropathy), often in the feet, and damage to the blood vessels in the eyes called retinopathy, which leads to declining eyesight. These complications can lead to foot numbness or pain and make it more challenging to maintain balance, thereby increasing your risk of falls during exercise.

Despite these risks, health experts encourage people with diabetic kidney disease to stay active.

How to Exercise With CKD and Diabetes

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. Aerobic exercise specifically may help decrease body mass index (BMI) and reduce blood pressure in people with diabetic kidney disease.

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.
• 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.)
• 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.

The Takeaway

• Exercise can help manage both CKD and type 2 diabetes simultaneously by improving blood glucose regulation, decreasing blood pressure, and reducing inflammation in the body.
• People with diabetic kidney disease often face additional challenges when it comes to exercise, including muscle loss, chronic fatigue, joint pain from osteoarthritis, and an increased risk of falls due to nerve damage.
• It's important to consult your healthcare team before starting a new exercise program to receive personalized recommendations, especially if you have advanced kidney disease or high cardiovascular risk.
• General exercise recommendations include at least 150 minutes of moderate- to vigorous-intensity aerobic exercise per week, along with two to three resistance training sessions. Low-impact activities like swimming or cycling may be better for those with joint pain or nerve damage.

https://www.everydayhealth.com/diabetes/how-to-exercise-with-kidney-disease-and-type-2-diabetes/