How to Exercise Safely With IgA Nephropathy

But regular exercise has benefits, as the inflammation that occurs in the kidneys with IgAN can increase your risk of other health conditions, including high blood pressure and diabetes, says Ramy M. Hanna, MD, a board-certified nephrologist based in Orange, California. Staying physically active can reduce those risks and support your kidney health in the long term, he says.

Low-impact activities like walking and swimming are generally safe for people with IgAN, says Dr. Hanna, but it’s best to avoid strenuous exercise, like high-intensity interval training (HIIT) or long-distance running, which may lead to muscle breakdown and place added stress on the kidneys.

First, check with your care team before you start any new physical activity regimen. Once you’re ready, here’s how to safely exercise with IgAN.

Globensky notes that as long as your kidney care team hasn’t given you any special limits, combining these different types of exercise can help you stay strong and maintain your general physical well-being.

Aerobic Exercises

• Walking Move at a slow, steady pace. Start with 5 to 10 minutes once or twice a day, then gradually work toward 20 to 30 minutes most days.
• Stationary Cycling Pedal at a light to moderate effort. Begin with 5 to 10 minutes and build up to 20 to 30 minutes as you get stronger.
• Swimming Swim or walk laps in a pool at a gentle pace. The buoyancy of water helps take pressure off your joints, making it a great option if you have any discomfort with land-based activity.

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   Most people can start with 10 to 15 minutes.
• Elliptical Training An elliptical is a stationary exercise machine that simulates walking or running with less impact on your joints.

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   Start at an easy pace for 5 to 10 minutes and gradually increase your time.
• Dancing Try easy dance steps at home or in a group class. About 10 to 20 minutes each time is a good starting point.
• Gardening or Active Yard Work Digging, raking, and mowing can count as exercise if done at a steady pace.

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   Take breaks as needed and stay hydrated, especially in hot weather. If your healthcare team has prescribed a fluid restriction, follow their guidance on how much you should drink.

Mixing activities can help you stay consistent, says Marwa Ahmed, a National Academy of Sports Medicine certified personal trainer who works with people with kidney disease and the founder of the BodyMind Coach, a coaching practice in Toronto. You might swim twice a week, for example, then walk or cycle on two other days, but choose activities you enjoy and can see yourself doing regularly, she says.

Strength Training

Ahmed recommends starting with two sessions per week of about 20 minutes each, with a rest day in between. As you feel stronger, gradually increase your sessions to 45 to 60 minutes, or add a third day to target more specific muscle groups, but always start with light resistance and increase the challenge slowly, she says.

Below are beginner‑friendly full-body training exercises Ahmed recommends, aiming for two to three sets of each movement per session.

• Sit-to-Stand Sit near the edge of a sturdy chair with your feet flat on the floor, lean slightly forward, then push through your heels to stand. Lower yourself back down slowly with control. Repeat this movement 8 to 12 times, known as repetitions (or reps).
• Wall Push-Ups Stand about an arm’s length from a wall, place your hands flat at shoulder height, bend your elbows to lower your chest toward the wall, then push back to the start. This is a joint-friendly way to build chest, shoulder, and arm strength. Aim for 10 to 12 reps.
• Seated Leg Raises Sit upright in a sturdy chair and extend one leg straight out in front of you, squeezing your thigh at the top, then lower with control. Repeat with the other leg. This strengthens the muscles that support your knees and hips. Try for 10 to 12 reps per leg.
• Overhead Press Stand or sit upright with a light dumbbell in each hand at shoulder height with palms facing forward, then push the weights straight up until your arms are extended (avoid locking your elbows), and lower back down with control. This builds shoulder and upper back strength. Work toward 8 to 12 reps.
• Glute Bridges Lie on your back with your knees bent and feet flat on the floor. Press through your heels to lift your hips until your body forms a straight line from shoulders to knees, squeeze your glutes at the top, then lower with control. This strengthens the glutes and hamstrings and helps support the lower back. Aim for 10 to 15 reps.

Flexibility and Mobility

Globensky and Ahmed recommend the flexibility and mobility exercises below.

• Calf Stretch Stand facing a wall about an arm’s length away and place your palms flat against it at shoulder height for support. Step one leg straight back, pressing that heel firmly into the floor and leaning your hips slightly forward until you feel a gentle stretch in your lower leg. Hold for 15 to 30 seconds and repeat 2 to 4 times on each side.
• Chest Stretch Stand in a doorway and place your forearms against the doorframe with your elbows bent. Step forward slightly until you feel a gentle stretch across your chest and the front of your shoulders. Hold for 15 to 30 seconds and repeat 2 to 4 times.
• Shoulder Rolls Relax your arms at your sides, then slowly roll your shoulders up toward your ears, back, and down in a circular motion. Repeat 10 to 15 times, then reverse direction.
• Cat-Cow Start on your hands and knees with your wrists under your shoulders and your knees under your hips. Slowly arch your back and lift your head, then round your spine and tuck your chin toward your chest. Repeat 5 to 10 times, moving slowly with your breath.

Balance Exercises

Here’s what balance exercises might look like, according to Globensky.

• Tandem Stance Stand with one foot directly in front of the other, heel to toe, while holding onto a counter or sturdy surface for support. Hold for 10 to 30 seconds and repeat 2 to 4 times per side.
• Single-Leg Stand Stand on one foot and lift the other foot just off the floor, keeping a chair or wall within reach for support. Hold for 10 to 20 seconds and repeat 2 to 4 times per side.
• Heel-to-Toe Walking Walk in a straight line, placing the heel of one foot directly in front of the toes of the other with each step. Try to do 10 to 20 steps.

Some things to keep in mind when exercising with IgAN are to move often, start small, and stay in the easy-to-moderate zone, says Globensky. Keep the following in mind.

How to Choose Your Workout

Then consider your fitness level. If you haven’t exercised in a while, start with walking 10 to 15 minutes three to four days a week to ease into it, says Ahmed.

Get Started

Before your first session, Globensky recommends running through the checklist below to stay safe.

• Discuss your exercise plan with your kidney care team and get the all-clear from them.
• If you’re unsure how to get started, consider working with a physical therapist or a certified personal trainer with experience helping people with kidney disease.
• Choose one activity you can do safely and consistently, such as walking, stationary cycling, or chair exercises.
• Use the “talk test,” meaning you should be able to carry on a conversation while exercising.
• Stay hydrated during exercise unless your healthcare team has prescribed a fluid restriction.
• Once you’re comfortable with aerobic exercise, add strength training two days per week using light resistance.
• Finish each workout with a short cooldown and gentle stretching.

If you plan on lifting weights, have a friend or workout buddy with you for safety, especially when you’re first getting started, says Hanna. Hold off on competitive sports for now, he adds, as the drive to win can tempt you to go harder than your body is ready for.

Stay on top of your regular nephrology appointments and lab work as you become more active, Hanna says. Your healthcare team can help make sure your exercise routine continues to align with your kidney health.

This week-by-week progression plan from Ahmed may help you build confidence and consistency.

Week 1–2

• Start with 5- to 10-minute walks or light activity 2 to 3 times per day.
• Set a timer to stand up every hour and march in place or do small squats using a chair for support if needed.
• Add light stretching for 5 minutes.

Week 3–4

• Build in to 15- to 20-minute walks most days.
• Add 1 day of light strength training with 1 to 2 sets of 8 to 10 reps.
• Add 5 to 10 minutes of stretching or gentle yoga.

Week 5–8

• Aim for 30- to 40-minute sessions of walking, cycling, or aerobic exercise 2 to 3 days per week.
• Add 2 days of strength training (2 to 3 sets of 8 to 12 reps).
• Include balance and flexibility work 2 to 3 days per week.

On days when fatigue, swelling, or poor sleep are making things harder, lighten your resistance, or break your workout into smaller chunks, like three 10-minute sessions instead of one longer one, says Globensky.

During strength work, avoid heavy straining or holding your breath, and give yourself extra rest of about 60 to 90 seconds between sets, says Ahmed. You may need more recovery time than you expect, and that’s okay with a chronic condition.

“Temporary discomfort that goes away with adequate rest is okay, but pain or symptoms that stay after exercise and do not clear with rest mean you need to scale down your intensity and, of course, consult with your medical doctor,” Ahmed says.

If you experience any of the following, stop your activity right away and notify your care team, note Globensky and Ahmed:

• Visible blood in the urine (hematuria)
• Elevated blood pressure
• New or worsening swelling in the legs, ankles, or around the eyes
• Severe muscle pain that doesn’t improve with rest

Once your healthcare team gives you the all-clear to exercise again, start back slowly with short, low-intensity sessions and gradually build up from there.