How to Exercise Safely With C3G

Even so, the exercise plan that makes sense for you will depend on your kidney health, blood pressure, other symptoms, and fitness level. Work with your care team to understand what’s safe for you, then use the tips below to create a routine you can stick to while living with C3G.

Not only should an appropriate exercise plan work with your current health needs, it should also include activities you enjoy and be adjusted when you’re feeling more tired or your symptoms change, LeCavalier notes.

Think of your weekly exercise routine as a meal, suggests Jennifer Nash, DPT, an associate clinical professor at the University of Nevada in Reno. Aerobic exercise is the main course, strength training is the side dish, and balance and flexibility work “is the dessert people often skip but should not,” she says.

Keeping your care team’s recommendations in mind, here’s how each type of physical activity can help and how to implement them.

Aerobic Exercise

For people with CKD whose blood pressure is controlled and who have no new or worsening symptoms, the long-term goal is at least 150 minutes of moderate aerobic activity per week, or roughly 30 minutes, five days a week, says Marwa Ahmed, a National Academy of Sports Medicine certified personal trainer who works with people with kidney disease and is the founder of the BodyMind Coach, a coaching practice in Toronto.

Start with 10 to 15 minutes of walking or another comfortable activity three days a week, especially if you haven’t been active lately, LeCavalier suggests. You can split a 10-minute walk into two 5-minute walks if that feels more manageable, Nash says.

Here are a few aerobic activities to try.

• Walking It’s free, easy to start, and you can do it almost anywhere.

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   Wear shoes with good heel and arch support, especially if your feet tend to swell, Nash says.
• Cycling A stationary or outdoor bike offers a low-impact option.

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   If leg swelling makes running or jumping uncomfortable, cycling may be a good alternative, Ahmed says.
• Water Exercise Swimming, water aerobics, or moving in a pool may feel comfortable when your legs feel heavy, Nash says. “The water gently squeezes your legs like a soft compression sock and can feel wonderful.”
• Seated Cardio Seated exercises are a good way to stay active when standing is uncomfortable or your legs are swollen, suggests Ahmed.

As cardio activity becomes easier, gradually add time, Ahmed says. Short sessions count, so there’s no need to rush toward a full 30 minutes at first.

Check with your nephrology team before starting a workout routine if swelling is new or noticeably worse. If it increases during or after exercise, stop the activity, rest, and discuss it with your care team before working out again, LeCavalier advises.

Strength Training

Some beginner strength-training options Ahmed recommends include:

• Sit-to-Stands Sit near the front of a sturdy chair with your feet flat on the floor, about hip-width apart. Lean slightly forward and slowly stand up. Once upright, lower yourself back into the chair with control.
• Wall Push-Ups Stand about an arm’s length from a wall and place your palms against it at chest height. Keeping your body straight, slowly bend your elbows to bring your chest toward the wall. Push back to the starting position.
• Resistance-Band Rows Sit on the floor with your legs stretched out in front of you, keeping a small bend in your knees. Loop the middle of a resistance band around the soles of both feet and hold one end of the band in each hand. Sit up tall, then pull the band toward the sides of your ribs, drawing your elbows back and gently squeezing your shoulder blades together. Slowly return your hands to the starting position.
• Heel Raises Stand behind a sturdy chair or at a counter, holding it for balance. Slowly lift both heels off the floor, keeping the balls of your feet on the ground, then lower your heels with control.

A physical therapist or qualified exercise professional can help you choose the right starting resistance and number of reps for your current strength, symptoms, and fitness level.

Flexibility and Mobility

• Calf Stretch Stand facing a wall with your hands against it for support. Step one foot back, keeping that leg straight and your heel on the floor. Slowly bend your front knee until you feel a stretch in the back of your lower leg. Hold for about 30 seconds, then switch sides.
• Shoulder Stretch Bring one arm across your chest. Use your other hand to gently support it above or below the elbow, holding for about 30 seconds. Switch arms and repeat.
• Shoulder Rolls With your arms relaxed at your sides, slowly roll your shoulders back and down. Keep the movement gentle rather than forcing your shoulders into a large circle.

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If you prefer a guided activity, yoga is another option LeCavalier suggests, particularly when you want something less demanding than your usual workout.

Balance Exercises

For someone with C3G, balance work may be especially useful if illness, inactivity, or muscle weakness has made it harder to stay steady on their feet, says Ahmed, who suggests the following balance exercises.

• Tandem Stance Stand with one foot directly in front of the other, with the heel of your front foot touching the toes of the foot behind it. Keep a counter or sturdy chair within reach for support. Hold the position as comfortably as you can, then switch.
• Heel-to-Toe Walking Walk slowly in a straight line, placing the heel of one foot just in front of the toes of the other with each step. Practice alongside a counter so you have support if needed.

If you’ve fallen or feel unsteady, a physical therapist can determine what may be affecting your balance and show you how to safely regain it, Nash advises.

A good rule of thumb when exercising with C3G is to “move more and sit less,” while remembering to “start low, go slow,” says Nash. Your workouts will be different depending on your energy, blood pressure, and kidney health on any given day. There are a variety of exercise options and modifications that you can choose from each day.

How to Choose Your Workout

As you narrow down your workout options, consider these factors.

• Your Energy Level Schedule activity for the time of day when you tend to feel your best, Nash advises, and plan for shorter sessions when C3G-related fatigue sets in.
• Weather and Surroundings Hot weather can increase the risk of dehydration.

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   Choose an indoor workout on very hot days, and consider exercising earlier in the morning, or later in the evening when temperatures are lower. Your care team can guide you on managing fluids during exercise.
• Precautions Steroids, like prednisone, and other immunosuppressive medications prescribed for C3G can increase infection risk.

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   Think about this risk when using shared gyms and during group classes. In general, washing your hands, wiping down shared equipment, covering open cuts, and not sharing water bottles or towels will lower your exposure to germs, Ahmed says. She also advises avoiding hot tubs if your immune system is weakened.
• Drink Choices Sports or energy drinks can contain substantial amounts of sodium and potassium.

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   Whether those ingredients are a concern depends on your kidney function and any fluid or dietary restrictions set by your care team. Ask your nephrologist or renal dietitian what’s right for you before including sports drinks in your workout routine.

How to Get Started

Once your kidney care team gives you the all-clear and you have a planned exercise routine, it’s important to check in with yourself and listen to your body before, during, and after each workout.

Follow these tips.

• Before each workout, consider your energy level, any swelling, and changes in your blood pressure or weight, suggests Ahmed. Notify your nephrologist of any new or worsening symptoms.
• Discuss exercise guidance with your care team and be sure to understand which blood pressure readings mean you should skip or stop exercising, Ahmed advises.
• Begin with 10 to 15 minutes of comfortable aerobic activity three days a week, LeCavalier suggests.
• Ahmed recommends adding one or two brief strength-training sessions each week and giving your muscles a day of rest between sessions.
• Use the talk test to guide your pace.

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   You should be able to speak in full sentences while you exercise. If you can’t, slow down, reduce the resistance, or take a break, Ahmed says.
• Focus on consistency before trying to reach a weekly exercise target, LeCavalier suggests, and gradually add a few minutes as activity becomes more manageable.
• Look for small opportunities to move throughout the day, such as short walking or stretching breaks, standing up regularly, or doing a few chair exercises, Ahmed recommends.
• Consider working with a physical therapist if pain, weakness, balance concerns, or a long period of inactivity makes it hard to know where to start exercising, or if you have other conditions such as heart disease or diabetes, suggests Nash.

If you choose a trainer, look for one experienced with chronic conditions and, preferably, certified by a recognized organization, Ahmed says. Examples include the American College of Sports Medicine (ACSM), National Academy of Sports Medicine (NASM), American Council on Exercise (ACE), or National Strength and Conditioning Association (NSCA). Bring your medication list, recent lab results, blood pressure log, and any restrictions from your nephrology team to your first session, she advises.

“When in doubt, ask first. Your care team would much rather answer a question than treat a problem,” Nash says.

Exercising may feel more challenging some days, and it’s okay to adjust your plans. If you’re more tired than usual, try reducing the resistance or taking longer breaks, suggests LeCavalier. A slow-paced walk or short stretching session allows you to still stay active.

If mild swelling is typical for you, choose seated exercises, Ahmed notes, but let your nephrology team know if swelling becomes worse.

It’s also smart to stop exercising well before you’re exhausted and give yourself time to recover afterward. If it takes more than an hour to feel back to normal, the session may have been too demanding, Ahmed notes. That’s a reason to try a shorter workout or lower intensity next time rather than giving up on exercise altogether, she says.

You can make small modifications to your workouts yourself, but symptoms that linger or feel unusual deserve a conversation with your care team. If you’re working with a trainer, they can provide you with various levels of modifications for many exercises and determine what is best for you.

A few adjustments to your workout may help you stay active, but some days simply call for rest. Skip exercise and notify your healthcare provider if you have a fever, severe or unusual fatigue, significant dizziness, or breathlessness that’s out of the ordinary for you, LeCavalier advises.

• Chest pain or pressure
• Severe or unexpected shortness of breath
• Faintness or significant lightheadedness
• A racing or irregular heartbeat
• A sudden severe headache

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• Nausea or vomiting

Call 911 for chest pain or severe breathing difficulty rather than waiting to see if rest helps.

Other changes also warrant a break from activity and a conversation with your healthcare provider. LeCavalier and Ahmed recommend contacting your provider if you notice:

• New or worsening swelling
• Visible blood in the urine (hematuria)
• Rapid, unexpected weight gain
• Blood pressure above the exercise limit your care team has set
• Unusual exhaustion or dizziness
• Severe muscle pain or tea- or cola-colored urine, which can be signs of muscle breakdown and may appear hours or days after exercise

When you can restart exercising depends on why you stopped, LeCavalier says. Check with your care team first if symptoms are new, severe, or if you don’t know what caused them. Once you’re cleared to resume exercising, begin with shorter, less-intense sessions and gradually build up as you feel able.