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Around three million people in the UK have kidney disease


Exercise and Lifestyle Clinical Study Group

Exercise and Lifestyle Clinical Study Group

Exercise is important for people with chronic kidney disease (CKD) because when kidney function has decreased, it can affect muscles and bones.

Physical activity can potentially have a positive impact on aerobic and functional ability, and the quality of life of all chronic kidney disease (CKD) patients regardless of the stage of their disease process. Physical activity is recommended in a number of national CKD guidelines, but it’s incorporation into routine care has been slow.

Who we are

The Exercise Clinical Study Group is chaired jointly by Pelly Koufaki and Jamie MacDonald.

Our multi-professional group has members from a wide-range of disciplines across the UK. We meet bi-annually to support active research in the field, as well as providing advice and encouragement for new research proposals and projects. In addition to the CSG co-chairs, individual members provide contact points for other CSG themes based on their area of expertise and experience.

Our aims:

To advance and encourage multi-disciplinary, collaborative, research in exercise training and exercise-based rehabilitation in the UK by:

  • Co-ordinating and encouraging collaborative research activities using multi-disciplinary approaches to contribute to the evidence base necessary to justify the promotion and recommendation of renal rehabilitation across all stages of CKD in the UK.
  • Encouraging and supporting multidisciplinary, multi-centre, grant application activity.
  • Being an expert forum for all members and the first point of reference for evaluation of exercise in CKD study protocols in the UK.

Evidence gaps and challenges:

  • Understanding the impact of physical activity and lifestyle interventions on progression of CKD - we are supporting ongoing projects in this area and have submitted an application to the NIHR EME scheme.
  • Can exercise rehabilitation have an impact on renal recovery after an episode of acute kidney injury (AKI)?-  we are working with the AKI CSG on an application for Seed Award funding through the Wellcome Trust to investigate this link.
  • Investigating physical inactivity and obesity as a cardiometabolic risk factor in young people with a kidney transplant - we are exploring research opportunities with the Paediatric CSG.

About our work

Find out more at the forthcoming RSM Frontiers Meeting - 'Living Well with Kidney Disease'

25 March 2020 at the Royal Society of Medicine.

Full programme and booking details here.


Ongoing studies:

PEDAL – a randomised clinical trial (RCT) investigating the effect of intradialytic cycling on quality of life. Led by Professor Iain Macdougall and Dr Sharlene Greenwood and funded by the NIHR.  (£2.1mill). Recruited to target in renal units across 5 regions in England, Scotland and Wales. Due to report by the end of 2019.


CYCLE-HD – a parallel RCT looking at the effect of intradialytic exercise on cardiovascular structure and function. Led by Professor James Burton as part of an NIHR Fellowship (£1.2mill). Recruited to target and database locked. Presented as a late breaking clinical trial at UK Kidney Week 2019.

Iron and Muscle –investigating whether IV iron in non-dialysis CKD patients can improve exercise capacity, muscle metabolism and physical function. Led by Drs Sharlene Greenwood, Kate Bramham and Obi Okonko (King’s) and jointly funded by Vifor Fresenius Medical Care Renal Pharma and Kidney Research UK (£1.7mill).


CULTURE-CKD –investigating cultural influences on physical activity and exercise beliefs in people with CKD. Funded by the British Renal Society and Kidney Care UK through collaboration with King’s College Hospital and Loughborough University.

ECSERT – a pilot study investigating the effects of a personalised home-based exercise intervention on cardiometabolic disease in renal transplant recipients. Led by Dr Matthew Graham-Brown and funded by Kidney Research UK.

ExeRTiOn - a pilot study assessing the acceptability of an online weight prevention programme for new kidney transplant recipients. Funded as a PhD Fellowship by Kidney Research UK to Ellen Castle.

PREHAB - a randomised pilot study assessing the impact of exercise, nutritional intervention and multidisciplinary education on outcomes in patients approaching and commencing dialysis. Led by Fiona Willingham and funded by Kidney Research UK.

QCKD: Increasing physical activity in chronic kidney disease - the patient perspective. Investigating how patients feel and think about taking up exercise and becoming more physically active, to help develop programmes to make that easier for them. Led by Alice Smith and funded by the British Renal Society.

PACE-KD: Participant Acceptability of Exercise in Kidney Disease - evaluating the feasibility (recruitment, retention and completion) of three different supervised aerobic exercise programmes in CKD patients. Led by Alice Smith and Lettie Bishop (Loughborough) and funded by Heart Research UK.

FLEX-HD: Understanding Frailty, Falls and the Role of Exercise in Haemodialysis (HD) Patients. Understanding the essential components of a falls and frailty intervention designed specifically for the HD population and how this might best be delivered. An NIHR funded PhD Fellowship led by Hannah Young.

Studies in development:

RECOVER-AKI - investigating the effect of an exercise rehabilitation programme on recovery of kidney function after an episode of acute kidney injury (AKI). Currently under review with the Wellcome Foundation and led by Daniel March.

Investigating the impact of paediatric kidney transplantation on physical activity, quality of life, cardiometabolic health and psychosocial adjustment: a longitudinal, cohort, feasibility study. Led by Pelly Koufaki in collaboration with researchers and clinicians in Glasgow, Edinburgh, Leeds and Manchester.



MOVE: A web resource including guides and videos helping kidney patients to get more active. Developed by the University of Bangor led by Drs Jennifer Cooney and Jamie Macdonald in collaboration with the Wales Kidney Research Unit (

Setting research priorities for patients with non-dialysis CKD in the area of renal rehabilitation, healthy lifestyle, physical activity, and diet/weight management. This followed a workshop in November 2018 and presented as a poster at UKKW 2019.

Guidelines on ‘Physical Activity and Lifestyle in People with Chronic Kidney Disease’. Proposed by our CSG and now being developed by the UK Renal Association. This is the first of its kind within the international renal community and due to be completed in the first quarter of 2020 .

Selected publications

  1. Greenwood SA, Castle E, Lindup H, Mayes J, Waite I, Grant D, Mangahis E, Crabb O, Shevket K, Macdougall IC, MacLaughlin HL. Mortality and morbidity following exercise-based renal rehabilitation in patients with chronic kidney disease: the effect of programme completion and change in exercise capacity. Nephrol Dial Transplant. 2019;34:618-625.
  2. Gould DW, Watson EL, Wilkinson TJ, Wormleighton J, Xenophontos S, Smith AC. Ultrasound assessment of muscle mass in response to exercise training in chronic kidney disease: a comparison with MRI. Journal of Cachexia, Sarcopenia and Muscle 2019; in press.
  3. Wilkinson TJ, Gould DW, Nixon DGD, Watson EL, Smith AC. Quality over quantity? Effects of skeletal muscle myosteatosis and fibrosis on physical functioning in chronic kidney disease. Nephrology Dialysis and Transplantation 2018; gfy139: 1-18.
  4. Kirkman DL, Scott M, Kidd J, Macdonald JH. The effects of intradialytic exercise on hemodialysis adequacy: A systematic review. Seminars in Dialysis; 2019; 1–11.
  5. Young HML, March DS, Graham-Brown MPM, Jones AW, Curtis F, Grantham CS, Churchward DR, Highton P, Smith AC, Singh SJ, Bridle C, Burton JO. Effects of intradialytic cycling exercise on exercise capacity, quality of life, physical function and cardiovascular measures in adult haemodialysis patients: a systematic review and meta-analysis. Nephrol Dial Transplant. 2018; 33(8):1436-1445.
  6. March DS, Graham-Brown MP, Young HM, Greenwood SA, Burton JO. 'There is nothing more deceptive than an obvious fact': more evidence for the prescription of exercise during haemodialysis (intradialytic exercise) is still required. Br J Sports Med. 2017;51:1739.
  7. O'Connor EM, Koufaki P, Mercer TH, Lindup H, Nugent E, Goldsmith D, Macdougall IC, Greenwood SA. Long-Term pulse wave velocity outcomes with aerobic and resistance training in kidney transplant recipients - A pilot Randomised controlled trial. PLoS One. 2017 Feb 3;12(2):e0171063. doi: 10.1371/journal.pone.0171063.
  8. Graham-Brown MP, March DS, Churchward DR, Stensel DJ, Singh A, Arnold R, Burton JO, McCann GP. Novel cardiac nuclear magnetic resonance method for non-invasive assessment of myocardial fibrosis in hemodialysis patients. Kidney Int 2016;90:835-44.
  9. Greenwood SA, O'Connor E, Mercer TH, Koufaki P, Tuffnell R, Rush R, Lindup H, Haggis L, Dew T, Nugent E, Abdulnassir L, Goldsmith D, Macdougall IC. Aerobic or Resistance Training and Pulse Wave Velocity in Kidney Transplant Recipients: A 12-Week Pilot Randomised Controlled Trial (The Exert Study). Am J Kidney Dis. 2015.
  10. Koufaki P, Greenwood S, Painter P, Mercer T. The BASES expert statement on exercise therapy for people with chronic kidney disease. J Sports Sci. 2015 Mar 25:1-6.
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