Background and aimsEvidences on the benefits of physical exercise in kidney transplant patients (KTx) are not conclusive and concerns on safety remain. We here gather and interpret current evidence on the benefits/harms of exercise training intervention in KTx.MethodsSystematic review of exercise training programs in KTx.ResultsA total of 24 studies including 654 KTx patients on intervention and 536 controls were evaluated. The median age was 46years; the transplant vintage was 2days to 10years. The intervention was an aerobic or resistance exercise program or a combination of both; interventions consisted of 20-60min’ sessions, 2-3 times per week repetitions and 5.5months’ median duration. Most studies improved cardiorespiratory fitness (expressed as VO2peak) as well as maximum heart rate, which was associated with a significant increase in muscle performances and strength. No significant changes in body weight or composition were observed, but a trend towards weight reduction in overweight or obese patients on stable KTx was noted. The arterial blood pressure reduced a little after exercise when it was high at start. Exercise intervention had no clinically relevant impact on anaemia, glycaemia or lipidaemia. In contrast, exercise training improved several aspects of quality of life. No data on long-term hard outcomes or on high-risk subpopulations such comorbid or elderly patients were available.ConclusionsIn adult kidney transplant patients, a structured physical exercise program improved the aerobic capacity and ameliorated muscle performance and quality of life. No harms were observed in the short-term, but long-term RCTs are required. Overall, in mid-age kidney transplant patients without major comorbidities, an aerobic or resistance supervised exercise lasting 3-6months could be suggested within the comprehensive treatment of kidney transplant.