Fitness and Exercise on Dialysis

Most people on peritoneal dialysis or home hemodialysis with a catheter can still be active, but they have to protect the access site. With peritoneal dialysis, the main concern is avoiding pulling on the catheter or putting direct pressure where the catheter enters the abdomen. Many patients do very well with walking, beginner yoga, light stretching, and low impact strength work while wearing a supportive binder or belt that keeps the catheter secure. Movements that involve deep twisting at the waist, heavy abdominal crunches, or contact sports that might hit the catheter should be avoided unless a nephrologist gives very clear approval.

For home hemodialysis catheters, the priority is preventing infection and keeping the line secure. Sweating itself is not the problem. The problem is moisture or friction that breaks down the skin around the catheter or pulls on the tubing. Short walks, indoor cycling with a secure harness, and light resistance exercises for the arms and legs are often reasonable, but anything that tugs on the catheter or risks a fall is not. At Home Dialysis Therapies of San Diego, patients are encouraged to ask their nurse to physically show them safe ranges of motion and comfortable clothing or belts that protect the access before they change their routine.

Always ask: “Could this movement pull, bend, or hit my catheter or PD line?” If the honest answer is yes or even maybe, it is a movement to avoid until your care team clears it.

There is no single perfect schedule for everyone on dialysis, but timing matters. Many home hemodialysis patients feel best if they move on non-treatment days or several hours after a run of dialysis, once blood pressure and fluid levels have settled. Right after a treatment, some people feel light-headed, thirsty, or wiped out. Those are not ideal conditions to push the heart and muscles. Others actually feel their clearest and strongest right after dialysis and prefer short walks at that time. The pattern is dependent on what makes you comfortable, but it should always be discussed with your nephrologist because low blood pressure, cramping, and arrhythmias are real risks if you push too hard at the wrong time.

Peritoneal dialysis creates different timing questions. Many PD patients exercise with fluid in their abdomen, but some feel more comfortable and balanced after they drain. Activities that involve bending forward or fast twisting are usually easier when the abdomen is not completely full. If you are doing automated PD overnight, daytime may be the best time for planned exercise, when your schedule is less tied to the machine. At Home Dialysis Therapies of San Diego, our team encourages patients to track how they feel before and after treatments for a few weeks and bring that log to clinic. That data lets your nephrologist and nurse help you decide whether “pre-dialysis,” “post-dialysis,” or “off-day” movement fits your blood pressure, energy, and lifestyle best.

Strength training is not only safe for many dialysis patients, it is often one of the most valuable tools they have. Kidney disease and dialysis can lead to muscle loss, frailty, and poor balance. Building and preserving muscle helps with walking, getting out of chairs, carrying groceries, and staying independent. The goal is not bodybuilding. The goal is controlled resistance that challenges the muscles without straining the access site, spine, or joints.

For most people on dialysis, the starting point is very light: body-weight movements, resistance bands, or light dumbbells used in slow, controlled repetitions. Shoulder presses, rows, seated leg extensions, sit-to-stand from a chair, and heel raises are often good first options. Heavy straining that makes you hold your breath, turn red, or feel pressure in your head is not. That “bearing down” can spike blood pressure and is not safe. If you ever feel pain at the fistula, graft, or catheter site during a strength exercise, you stop immediately.

Home Dialysis Therapies of San Diego encourages patients to ask for a referral to physical therapy if they are interested in a real strength program. A physical therapist can design a short, specific routine that respects the fistula, graft, or catheter and fits within the blood pressure and fluid limits set by the nephrologist.

Movement has real physiologic effects in people with chronic kidney disease. Regular moderate exercise can help lower blood pressure over time, improve insulin sensitivity, and assist with weight management. That matters because high blood pressure and diabetes are two of the biggest drivers of kidney disease and heart problems. However, the short-term effects of exercise can be more complicated in someone on dialysis. During or right after exercise, blood pressure can temporarily rise or fall. If you already have low blood pressure after dialysis or during fluid removal, that drop can make you dizzy or put you at risk of fainting. That is why your care team may adjust your dry weight, fluid removal goals, or blood pressure medicines once you start moving more.

Exercise can also influence fluid balance. Sweating removes some fluid, which may help a bit with swelling in ankles or legs, but it never replaces careful fluid limits or dialysis. Overestimating “how much you sweated out” and drinking more afterward is a common mistake. The rule is simple: fluid limits and sodium limits come from your care team, not from the scale after a workout. Over the long term, some patients see improvements in labs like hemoglobin, cholesterol, and markers of inflammation when they stick with an activity plan, because movement supports heart health, appetite, and overall conditioning.

At Home Dialysis Therapies of San Diego, we often tell patients to view exercise as a partner to dialysis, not a replacement for it. Our staff monitors blood pressure trends, weight, and labs across several visits and then adjusts prescriptions as needed when a patient becomes more active.

Yes, there are types of movement that are usually poor fits for people on dialysis, especially those with vascular access or catheters. Anything that puts direct pressure on a fistula or graft for a long period of time, such as heavy contact sports, grappling, or exercises where you lean your full weight on that arm, can damage the access or increase clot risk. Activities with high impact and a high risk of falls, like downhill skiing, aggressive outdoor biking on rough terrain, or competitive contact sports, often carry more risk than reward once someone has fragile bones, anemia, neuropathy, or balance issues.

For peritoneal dialysis, repeated heavy lifting that strains the abdominal wall can contribute to hernias or leaks, especially in the early months after catheter placement. Sit-ups, full planks, or high-intensity core workouts are often discouraged unless a surgeon specifically clears them. Chronic kidney disease also changes how your body handles electrolytes and blood pressure, so “extreme” environments like hot yoga in very high heat, long workouts in hot weather, or endurance events without careful medical supervision can be dangerous.

The safest strategy is to avoid any activity where a fall, a direct blow to the abdomen or access, or sudden spikes in blood pressure would be hard to manage quickly. When in doubt, our patients at HDT are encouraged to describe the exact activity to their nephrologist or nurse, so our team can help guide you on the safest way to active.

Caregivers are often the difference between a plan that lives on paper and a plan that actually happens. A spouse, adult child, or friend can be your strongest motivator to stay active. What they can do is help structure the environment. That might mean keeping a clear walking path in the home, placing the stationary bike where it is easy to reach, or putting resistance bands where they are visible rather than in a drawer. Many patients keep their walking shoes or light weights near the dialysis supplies as a visual reminder that “part of my treatment is moving.”

Caregivers can also help monitor safety without turning into a referee. Checking in on how the patient feels before and after a walk, watching for signs of dizziness or shortness of breath, and gently suggesting rest when something looks off are simple but powerful tasks. Some families schedule short walks around TV shows or meals, so exercise becomes a shared routine rather than a chore. When questions come up about symptoms during activity, a caregiver can write them down and bring the list to the next visit at Home Dialysis Therapies of San Diego so nothing is forgotten.

The most useful thing a caregiver can say is usually not “you should exercise,” but “let’s do this together for ten minutes and see how you feel!” That kind of partnership keeps patients safer, more motivated, and more likely to stay active over the long term.