**3. Types of physical exercises**

Patients with CKD who have PE had better outcomes overall, as previously mentioned. These individuals were indicated for a wide range of PEs, including the ones listed below:

#### **3.1 Aerobic exercise (AE)**

Aerobic energy production efficiency improves and cardiorespiratory fitness improves after taking AEs. Walking, running, cycling, rowing, and swimming are all examples of low-impact exercise. There are numerous health benefits to doing this, including higher insulin sensitivity (IS), greater mitochondrial density, increased levels of antioxidant enzymes in the body, improved lung and immune system performance, and increased cardiac output [13]. Patients with chronic diseases benefit from AEs because they lower their blood pressure (BP) and increase their maximum oxygen intake. Aside from improving physical function and aerobic capacity, these treatments may also provide other benefits for the patients. CKD patients on haemodialysis who engage in regular aerobic physical activity see some improvement in their diminished functional capacity [14]. AE may improve renal function and quality of life in CKD patients [15]. In-between-session AEs have shown encouraging benefits [16–18].

#### **3.2 Resistance exercise (RE)**

All main muscle groups are used in RE, which uses weight or resistance to make the body's skeletal muscles contract. In addition to lowering glycated haemoglobin levels, it has been linked to improvements in CV, body mass, physical function, glycaemic control, insulin sensitivity, blood pressure, and lipid profiles. Comparatively, it has a lower risk of hypoglycaemia and blood glucose fluctuations [13]. In order to help patients achieve functional independence, the RE is designed to include activities and context-oriented practice in areas that are important to each patient. It targets the antigravity muscles in particular and aims for the greatest possible carryover into daily activities. Body weight, gravity, resistance bands, free weights, and a weight vest can all act as resistance [19].

## **3.3 Combined exercise (CE)**

It incorporates elements of AE and RE in one module. With CE, health and general cardiovascular benefits can be optimised while minimising risk factors associated with sedentary lifestyles. Because of this, it leads to better blood pressure regulation as well as lower insulin and glucose levels, glycated haemoglobin, visceral adipose tissue, and microalbuminuria [13].

#### **3.4 Flexibility and balance exercises**

Individuals benefit from it because it stretches muscles and improves balance and postural stability, allowing them to move more freely during other workouts and in daily life. It is possible for these to be static (e.g. not bending the knees) or dynamic (e.g. high knees). Exercises that improve balance and save you from falling include balance training. If you want to walk backwards or heel-toe in a straight line, you can do so [13].

Patients with severe renal impairment benefit equally from resistance and balance exercises, which both increase physical activity and improve renal function. Thus, to enhance the therapy effects of exercise in dialysis patients, it is better to combine these components in a balanced fashion or to change them individually [20].
