Can exercise reduce fatigue in people living with kidney disease?

Purpose of review In people living with kidney disease (KD) Fatigue is a whole-body tiredness that is not related to activity or exertion. Often self-reported, fatigue is a common and highly burdensome symptom, yet poorly defined and understood. While its mechanisms are complex, many fatigue-related factors may be altered by exercise and physical activity intervention. Thus, this review aims to review the latest research on exercise in reducing fatigue in people living with KD. Recent findings The benefits of exercise in KD are well known, yet recent data from clinical trials on fatigue are scarce. Favourable effects on fatigue were found through a myriad of physical activity and exercise-based interventions, including using exercise-based video games, exercise during dialysis, nurse-led exercise programs, and home-based exercise delivered by a novel digital health intervention. Yet, whilst the handful of recent trials show positive efficacy on fatigue across the spectrum of KD, contemporary exercise-based research was impacted critically by COVID-19, and the field is limited by underpowered trials and heterogeneity of assessment tools. Summary Fatigue remains, at best, a secondary outcome measure in trials despite it being the most commonly reported symptom in KD. Given its importance to the people it impacts most, better quality evidence is needed to fully understand and optimize the impact of exercise in this group.