Sao Paulo Medical Journal · 2026
Home-based versus center-based exercise in patients with chronic kidney disease: a systematic review and meta-analysis
By Varandas ACM, Lessa CT, Varandas HM et al.
BACKGROUND: Chronic kidney disease (CKD) is associated with cardiovascular morbidity, functional impairment, and reduced quality of life. Physical exercise is recommended; however, the optimal delivery setting remains uncertain, with no previous meta-analysis directly comparing home-based (HB) versus center-based (CB) exercise. OBJECTIVES: To compare the effects of home-based (HB) versus center-based (CB) exercise on blood pressure, renal outcomes, and functional capacity in adults with CKD. DESIGN AND SETTING: Systematic review and meta-analysis of randomized controlled trials. METHODS: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for trials comparing HB with CB exercise lasting ≥ 16 weeks. Random-effects models were used for pooled analyses. RESULTS: Six trials (n = 246; HB = 121, CB = 125) were included. CB exercise reduced diastolic blood pressure (DBP) compared with HB (mean difference [MD] 4.58 mmHg; 95% CI 0.46 to 8.70; p = 0.03), with no between-group differences in systolic blood pressure (SBP) or serum creatinine. CB exercise also improved Timed Up and Go (MD −0.99 seconds; 95% CI −1.95 to −0.04; p = 0.04) and Six-Minute Walk Test distance (MD +37.53 m; 95% CI +2.40 to +72.67; p = 0.04). No significant differences were observed in other functional tests or health-related quality of life. CONCLUSIONS: In adults with CKD, who were predominantly undergoing hemodialysis, CB exercise was associated with modest reductions in DBP and improvements in selected mobility and functional capacity measures compared with HB exercise, with no consistent differences in renal function, SBP, or health-related quality of life. Given the small number of trials, the limited sample sizes, and relatively low certainty of evidence for several outcomes, these findings should be interpreted with caution rather than as proof of overall superiority of CB exercise. HB exercise remains a feasible alternative when access to CB programs is limited. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420251012210. URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251012210.