The Work Group recognizes a higher prevalence of comorbidity and frailty in CKD compared to the general population and is uncertain about whether regular physical activity increases or decreases adverse events. Nonetheless, the Work Group believes that most CKD patients would bene t from regular physical activity. Quality of evidence. Intervention studies and systematic re- views in the general population have rmly established the effects of regular physical activity on BP lowering, improved strengthening, physical tness, lower body weight, and lower risks of dysglycemia and diabetes. In populations with CKD, however, the evidence is much more limited. Our systematic review in CKD populations found low-quality evidence from 1 study conducted over 12 months showing that physical activity may improve SBP and DBP, and low-quality evidence from the same study showing that physical activity may improve eGFR These ndings, however, were inconsistent with other studies suggesting little or no differences.76 82 The updated Cochrane systematic review nds that physical activity decreases weight and improves the mental components of quality of life in CKD.83 patients from 6 studies, the systematic review found very low-quality evidence supporting the association of physical activity with increased study-reported adverse events (including pain, kidney infection, hypotension, dizziness, etc.), an important consideration given the high burden of comorbidity and frailty in CKD populations (Supplementary ). Observational data also show a dose response relationship between greater levels of physical activity and lower risk of mortality in CKD patients.84 Overall, the available literature did not allow differentiation between resistive and aerobic physical activity, or between supervised and unsupervised physical activity programs, leading to uncertainty about the critical elements of physical activity interventions in CKD populations. Nevertheless, it was the opinion of the Work Group that recommendations for the general population are likely to apply in CKD. Values and preferences. 