Therefore, this article aims to summarize what is currently known about exercise in pre-dialysis patients with CKD, discuss the physiological effects and highlight the need for further research in order to optimize exercise prescription for this patient group. For this narrative review, PubMed, Medline and Google Scholar were searched for studies investigating the effect of exercise training in pre-dialysis CKD patients. Search terms ‘exercise’, ‘exercise training’, ‘aerobic exercise’, ‘resistance exercise’, ‘strength exercise’,

‘pre-dialysis’, ‘chronic kidney disease’ and Gefitinib ‘renal disease’ were used to identify studies, and those that implemented an exercise intervention in pre-dialysis CKD patients were included

and can be found in Table 1. n = 10 exercise, age 47 ± 8 years n = 9 control, age 46 ± 10 years 15 ± 7 13 ± 6 Sig improvement in exercise capacity & thigh muscle function (static & dynamic muscle endurance) No significant changes in BP, THb or eGFR n = 15 exercise, age 45 years n = 15 control, age 44 26 24 Sig improvement in VO2peak No significant improvements in eGFR progression and BP Sig improvements in VO2peak, VT & Knee flexion peak torque Sig reductions in SBP & DBP n = 16 ex group, age 76 ± 6 years n = 9 comparison, age 72 ± 6 years 18 ± 5 16 ± 5 Sig. increases in: muscle strength, dynamic muscular endurance,

walking capacity & Functional mobility No significant. group effect on muscle fibre type area or buy YAP-TEAD Inhibitor 1 proportions. Castaneda et al. 2001[25] & 2004[26] Balakrishnan et al. 2010[27] n = 14 Res Training + low protein diet, age 65 ± 9 years n = 12 control, age 64 ± 13 years 24.76 27.53 Sig. increases in: muscle strength (1RM), muscle fibre size (type I & II), total body potassium, leucine oxidation, serum pre-albumin & eGFR Sig reductions of CRP & IL-6 Sig increase in mtDNA & mitochondrial biogenesis n = 17 exercise, age 52 years n = 9 control, age 48 years 62.9 ± 5.9 69.8 ± 12.3 Sig increases peak O2 pulse, ventilation, work next load at peak and glutathione. Improvements in Vo2peak & eGFR but non-significant. Sig reductions in proteinuria, cystatin-C, lipid peroxidase and resting blood pressure n = 7 exercise n = 4 control Mean age 66 Sig improvements in exercise tolerance. No significant changes in proteinuria, eGFR, BP & C RP n = 10 ex group, age 64 years n = 10 control, age 72.5 years 27 28 Sig improvements in: VO2peak, endurance time & arterial stiffness Clinically important improvements noted in EQ-5D & SF-36 scores Gregory et al. 2011[32] Headley et al. 2012[33] n = 10 ex group, age 57.5 ± 11.5 n = 11 control, age 52.5 ± 10.6 33.2 ± 20.1 48.5 ± 23.