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Physical Activity, Rehabilitation and Wellbeing Group

People living with chronic kidney disease (CKD) need to be able to live well with their condition. To achieve this, physical rehabilitation (physical activity advice and provision of exercise programmes) and psychosocial rehabilitation (psychological, psychiatric, and social care interventions) is required.

Physical activity is encouraged in people living with CKD. National CKD Guidelines on Exercise and Lifestyle in Chronic Kidney Disease recommend physical activity for all non-dialysis CKD patients, haemodialysis patients, and transplant patients, as long as patients are without contraindications and have stable, controlled comorbidities. Benefits may include improved physical function, enhanced health-related quality of life, and reduced risk of cardiovascular disease.

Physical activity may positively impact wellbeing, but specific psychosocial management is also often required by people living with CKD. Interventions include NHS talking therapies, psychology, counselling, psychotherapy, liaison psychiatry, and effective social prescribing.

However, there is inequality in patient access to physical and psychosocial rehabilitation management. Many people living with CKD remain sedentary and their wellbeing remains poor. To enhance health and wellbeing of patients and their families living with CKD, evidence generation through research, support and advocacy for patients and the renal multidisciplinary team, and renal care quality improvement initiatives are all required.

Who we are

The Physical Activity, Rehabilitation and Wellbeing Group (PARWG) is chaired jointly by Pelly Koufaki, Jamie Macdonald and Vicky Pursey.

Our multi-professional group has members from a wide range of disciplines across the UK. We meet bi-annually to discuss, support and facilitate research initiatives, that address physical activity behaviours and well-being of all people with chronic kidney disease (CKD).

Jamie Macdonald

Jamie Macdonald. Professor in Sport and Exercise Science, Institute for Applied Human Physiology, School of Psychology and Sport Sciences, Bangor University.

Dr Pelagia Koufaki

Pelly Koufaki. Reader in Clinical Exercise Physiology and Rehabilitation, Queen Margaret University.


Vicky Pursey. ACS Physio in Renal Rehab and Renal Physio Outpatients, York Hospital.



Our mission, objectives and strategy:

PAWeB CSG_strategic plan_objectives_tasks_measures

About our work

Ongoing studies:

Completed studies:

Studies in development:

Investigating the impact of paediatric kidney transplantation on physical activity, quality of life, cardiometabolic health and psychosocial adjustment: a longitudinal, cohort, feasibility study. Led by Pelly Koufaki in collaboration with researchers and clinicians in Glasgow, Edinburgh, Leeds and Manchester.


Selected publications

Completed studies:

  1. Greenwood SA, Koufaki P, Macdonald JH, Bulley C, Bhandari S, Burton J, et al. Randomized Trial - PrEscription of intraDialytic exercise to improve quAlity of Life (PEDAL) in patients receiving hemodialysis. Kidney Int Rep, 2021:
  2. Greenwood SA, Castle E, Lindup H, Mayes J, Waite I, Grant D, Mangahis E, Crabb O, Shevket K, Macdougall IC, MacLaughlin HL. Mortality and morbidity following exercise-based renal rehabilitation in patients with chronic kidney disease: the effect of programme completion and change in exercise capacity.
  3. Gould DW, Watson EL, Wilkinson TJ, Wormleighton J, Xenophontos S, Smith AC. Ultrasound assessment of muscle mass in response to exercise training in chronic kidney disease: a comparison with MRI.
  4. Wilkinson TJ, Gould DW, Nixon DGD, Watson EL, Smith AC. Quality over quantity? Effects of skeletal muscle myosteatosis and fibrosis on physical functioning in chronic kidney disease.
  5. Kirkman DL, Scott M, Kidd J, Macdonald JH. The effects of intradialytic exercise on hemodialysis adequacy: A systematic review.
  6. Young HML, March DS, Graham-Brown MPM, Jones AW, Curtis F, Grantham CS, Churchward DR, Highton P, Smith AC, Singh SJ, Bridle C, Burton JO. Effects of intradialytic cycling exercise on exercise capacity, quality of life, physical function and cardiovascular measures in adult haemodialysis patients: a systematic review and meta-analysis.
  7. March DS, Graham-Brown MP, Young HM, Greenwood SA, Burton JO. 'There is nothing more deceptive than an obvious fact': more evidence for the prescription of exercise during haemodialysis (intradialytic exercise) is still required.
  8. O'Connor EM, Koufaki P, Mercer TH, Lindup H, Nugent E, Goldsmith D, Macdougall IC, Greenwood SA. Long-Term pulse wave velocity outcomes with aerobic and resistance training in kidney transplant recipients - A pilot Randomised controlled trial.
  9. Graham-Brown MP, March DS, Churchward DR, Stensel DJ, Singh A, Arnold R, Burton JO, McCann GP. Novel cardiac nuclear magnetic resonance method for non-invasive assessment of myocardial fibrosis in hemodialysis patients.
  10. Greenwood SA, O'Connor E, Mercer TH, Koufaki P, Tuffnell R, Rush R, Lindup H, Haggis L, Dew T, Nugent E, Abdulnassir L, Goldsmith D, Macdougall IC. Aerobic or Resistance Training and Pulse Wave Velocity in Kidney Transplant Recipients: A 12-Week Pilot Randomised Controlled Trial (The Exert Study).
  11. Koufaki P, Greenwood S, Painter P, Mercer T. The BASES expert statement on exercise therapy for people with chronic kidney disease.
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