The benefits of exercise on human health are numerous, and many of today’s medical gurus are leading by example by participating in a variety of aerobic or appropriate anaerobic exercises. Aerobic exercise not only has a preventive effect on cardiovascular disease, but its aerobic capacity to improve the quality of life of patients with hypertension, diabetes, dyslipidemia, obesity, smoking, and chronic obstructive pulmonary disease, all of which are counted in the hundreds of millions of diseases or risk factors in our country, can not only change the relevant indicators on the lab tests, but also significantly change the quality of life of patients. More importantly, it can reduce overall mortality and increase life expectancy. Have you started exercising yet? Current research has found that patients with chronic kidney disease (CKD) age significantly faster than the normal population, and the reasons for this may be related to the reduced physical function, vascular dysfunction, vascular calcification, atherosclerosis, high levels of systemic inflammation and oxidative stress caused by CKD. In a long-term study, the Ulf G. Bronas research team at the University of Illinois at Chicago noted that cognitive impairment associated with CKD may also be related to cerebral small vessel disease and damage to the integrity of the brain’s white matter. Poor physical function, vascular dysfunction, and cognitive dysfunction put CKD patients at increased risk of independence, reduced quality of life, and increased morbidity and mortality. 1. Cognitive dysfunction and dementia in CKD The incidence of cognitive dysfunction or dementia is significantly higher in CKD patients than in normal elderly groups. Long-term cognitive dysfunction can have a significant negative impact on patients, leading to functional dependence and behavioral symptoms, reduced medication and medical coverage, and poor outcomes. Studies have confirmed that cognitive dysfunction is positively correlated with increasing proteinuria in patients with CKD. Patients with CKD have at least a 2-4 fold increased risk of cognitive impairment when glomerular filtration rate eGFR is reduced below 90 compared to those without CKD. 2. Risk factors associated with cognitive decline in CKD (1) Demographic factors: African-American, Hispanic, female, older age, low education. (2) Clinical factors: hypertension, diabetes mellitus, dyslipidemia, sleep quality. (3) Vascular environment: oxidative stress, inflammation, homocysteinemia, uremia, proteinuria. Specific risk factors for cognitive dysfunction in end-stage renal disease: weight and electrolyte disturbances, cerebral edema, cerebral underperfusion, hypotension during dialysis, excessive cytokine release, microembolism, etc. The Ulf G. Bronas research team noted that exercise prevents brain atrophy and even increases hippocampal volume in the general population. The reason for this may be related to increased brain-derived neurotrophic factors and exercise-induced vascular, neurological, and synaptogenesis. Exercise training can improve the vascular environment and help improve cognitive function in patients with CKD. In a study reported in a dialysis population, exercise training appeared to improve the vascular environment in CKD patients by reducing systemic inflammation, oxidative stress, arterial stiffness, and improving vascular function. In addition, exercise training may reduce traditional risk factors for cerebrovascular disease (e.g., blood pressure and hyperlipidemia). Importantly, the pleiotropic nature of exercise may improve quality of life, improve physical function, reduce the risk of renal replacement therapy and improve survival in patients with stage 3-5 CKD. Similar findings have also shown a correlation between prolonged sedentary time and renal function decline, while higher levels of physical activity may reduce creatinine levels and the risk of renal damage. Therefore, clinicians should recommend that CKD patients develop an exercise program early and increase their level of daily physical activity to benefit both mentally and physically. The Ulf G. Bronas research team concluded that cognitive impairment is common in patients with CKD and has a negative impact on a healthy quality of life. Clinicians must screen patients for cognitive impairment early and initiate preventive and therapeutic measures. Importantly, the decline in cognitive function appears to be multifaceted and requires the support of a multidisciplinary medical team as well as the community to enhance patient health education. Exercise training may be a reasonable adjunct to improve cognitive impairment and quality of life in patients with CKD and deserves further in-depth study.