The risks of exercise.

Patients with end-stage renal disease (ESRD) can benefit from exercise. At a minimum, progressive deconditioning will be prevented and cardiovascular and musculoskeletal status quo maintained, but it is also possible that physical functioning will be improved and mortality reduced. The risks of exercise must be assessed along with potential benefits. The most serious inherent risk of exercise in this population is a cardiac event, but the most common injuries sustained are to the musculoskeletal system. The exercise prescription must include measures to minimize both cardiovascular and musculoskeletal risk. These include provision of a prolonged warm-up and exercise adaptation period and time allowance for adequate cool-down. If these guidelines are followed and the exercise is begun at a low to moderate intensity, the associated risk to the ESRD patients should be minimal. For most ESRD patients, the risk benefit ratio will fall in favor of exercise, with the majority of patients exposed to greater risk by not exercising. Increased physical activity should be fostered in ways so that it becomes a routine part of the medical therapy and the mindset of the patient who then strives for self-improvement.