Do You Have Kidney Problems or a Fatty Liver? Here's How to Exercise Properly!

By: dr. Darren Gosal, Sp.PD, AIFO-K

When diagnosed with chronic kidney disease (CKD) or fatty liver disease (NAFLD), many people immediately think, "Oh, that means I have to watch my diet and reduce my activity levels, and don't overexert myself." However, with the right "prescription," exercise can be a key factor in helping control blood pressure, blood sugar, weight, and fatty liver disease, in addition to other lifestyle changes.

The challenge is: how can you exercise safely for kidney and liver problems that already have problems?
dr. Darren with a Clinical Sports Physiology Expert certification (AIFO-K), combine assessments of body condition and organ function (kidney and liver) with sports physiology to develop a safe, measurable, and appropriate exercise program for your individual disease stage and condition.

Why kidney disease and fatty liver disease actually require measured physical activity

In chronic kidney disease and fatty liver disease, we often talk about the most common problems:

• Uncontrolled blood pressure
• Uncontrolled blood sugar and cholesterol
• Fat accumulation in the liver
• Fatigue and decreased fitness
• Decreased quality of life

Measured and planned physical activity can help:

• Lower blood pressure → good for slowing kidney damage
• Improve insulin sensitivity & aid weight loss → excellent for fatty liver
• Improve muscle strength & endurance → important for patients on fluid restrictions or special diets
• Improve sleep quality and mood, making it easier to endure long-term treatment

Jadi, untuk ginjal dan hati yang sudah bermasalah, olahraga bukan musuh, justru bisa menjadi salah satu “obat” non-farmakologis yang penting, selama dilakukan dengan dosis yang tepat.

Risks of exercise without assessment in patients with kidney and liver disorders

Problems arise when exercise is done without planning, for example:

• Strenuous exercise in the middle of a hot day
• High-intensity exercise that occurs after little movement
• Sweating is the key and not monitoring your heart rate
• Failing to regulate fluids and rest periods as recommended by your doctor

Risks that could occur:

1. Excessive dehydration, excessive fluid loss through sweating, even though drinking is restricted (in certain CKD conditions). This can burden the kidneys, causing blood pressure to drop too low or even spike.
2. Overtraining, extreme fatigue, excessive muscle soreness, and in extreme cases, can even lead to rhabdomyolysis (severe muscle damage that puts a strain on the kidneys).
3. Excessive fluctuations in blood pressure and heart rate are detrimental to the kidneys, heart, and brain, especially in patients with underlying health conditions.
4. Joint pain and injury. If you are overweight and immediately engage in high-impact activities (running, jumping), you can injure your knees and hips. Not knowing the load you're starting with weightlifting increases the risk of injury.

With proper medical assessment, these risks can be significantly reduced.

What does Sp.PD AIFO-K do before preparing a sports program?

Often, we simply copy someone else's exercise program, even though it may not be suitable for us. Before discussing "what exercises, how often, how hard," Sp.PD AIFO-K will:

1. Assess organ condition and risk factors

• Chronic kidney disease stage (eGFR, creatinine levels, etc.)
• Liver function and liver enzyme values ​​(SGOT, SGPT, GGT, etc.)
• Blood pressure, pulse rate, heart and lung status
• Current medications (including diuretics, blood pressure medications, diabetes medications, etc.)

2. Explore daily activities & complaints

• How active are you currently?
• Do you experience any of the following: fatigue, shortness of breath, leg swelling, upper right abdominal pain, or cramps?
• What is your primary goal: to lose weight, improve stamina, reduce waist circumference, or maintain a stable body condition?

3. Set up a “sports prescription framework” based on the FITT principle (Frequency, Intensity, Time, Type)

• Main type of exercise. Usually a combination of light to moderate aerobics and light strength training.
• Initial duration and frequency. For example, 10–15 minutes per session, 3–5 times a week, then gradually increase according to your ability as assessed in the initial session.
• Limit fluid intake and exercise time. Avoid excessive heat, and schedule your exercise sessions so they don't coincide with certain medication times.

With this approach, the exercise program becomes truly kidney and liver friendly, not just following an exercise trend.

Examples of types of exercise that are generally safe (and which ones you need to be careful about)

Every patient is unique, but in general the simplest and can be done daily at home:

Generally safer:

• Walking can be started with short distances around the house or complex, then gradually increased.
• Stationary cycling is good for patients with knee problems or obesity, as it places less stress on the joints.
• Light or low-impact exercise with controlled movements can be done at home or in a special class.
• Light strength training, such as standing up from a chair, and light weight training for the arms and legs. 

Need to be careful or assess first:

• High-intensity exercise (HIIT), long-distance running, and sprinting are not recommended as a starting point, especially if kidney and liver function are already compromised and you have heart risk factors.
• Exercising in very hot or humid weather increases the risk of dehydration, cramps, and blood pressure fluctuations.
• Lifting heavy weights without supervision can lead to sudden high blood pressure, muscle strain, or more serious injuries.
  The AIFO-K Specialist will help you decide which exercise is safe to start with and when you can progress to a higher level.

Intensity settings: when is enough, when is too much?

For kidney and fatty liver patients, the principle is: "It's better to do a little but regularly, than to do something heavy once in a while and then collapse."
Some practical guidelines:

• Talk test:
  • While exercising, you can still hold a short conversation without gasping for breath → generally a light-moderate intensity.
  • If you can't talk at all because you're too out of breath, the intensity is likely too high.
• Fatigue scale:
  • After exercise, you may feel mild-moderate fatigue, but still be able to carry out daily activities.
  • If you end up resting in bed all day after exercising, that's a sign of overdoing it.
• Watch for symptoms such as severe dizziness, chest pain, increased shortness of breath, palpitations, or extreme muscle pain → immediately reduce the intensity and consult a doctor.

Sp.PD AIFO-K will help define the “safe zone” of intensity based on your organ condition and risk factors.

When should you stop and immediately check with a doctor?

Even with careful planning, there are still conditions that require immediate attention:

• Sudden swelling in the legs or face that increases after starting exercise
• Shortness of breath that worsens or occurs even with light activity
• A marked decrease in urine output (significantly reduced urination)
• Right upper abdominal pain that persists or worsens after exercise (in patients with fatty liver)
• Severe dizziness, chest pain, or near-fainting during exercise

In this condition, stop exercising immediately and consult a doctor immediately. It's better to adjust your program early than to overexert yourself and worsen your organ condition.

FAQ

1. If I have chronic kidney disease, is it okay to exercise until I sweat a lot?

A little sweat isn't a problem, and exercise will certainly make you sweat. However, excessive fluid loss can put a strain on the kidneys, especially if your fluid intake is restricted. Therefore:
• The intensity and duration of exercise should be tailored to your kidney disease stage.
• A clear drinking schedule should be established (how much, when).
• Avoid exercising in very hot weather or in poorly ventilated spaces.
All of this should be discussed with your doctor to ensure safe exercise.

2. Can fatty liver improve with medication alone, without exercise?

In many cases, weight loss and increased physical activity are key pillars of improving fatty liver. Medications and supplements without lifestyle changes usually produce suboptimal results.
Regular exercise helps:
• Reduce body fat (including fat in the liver)
• Improve insulin sensitivity
• Support improved cholesterol profiles
So, medication may help, but the combination of medication, exercise, and a healthy diet is much more effective for fatty liver.

Do you have chronic kidney disease or fatty liver disease and are still unsure about safe exercise limits?
Schedule an "Organ-Friendly Exercise" consultation with Sp.PD AIFO-K and get a kidney and liver-friendly physical activity program, not just following an exercise trend.

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