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There is increasing evidence about the benefits of regular physical activity in the chronically ill. Patients with chronic renal failure prior to and after renal transplant are one of the target groups in which increased controlled physical activity is highly recommended. Significant atrophy and increased non-contractile tissue are present in the muscle of predialytic and patients on hemodialysis, which is associated with poor physical performance and poor outcome of renal disease. Thus, interventions to increase physical activity or otherwise address atrophy may improve performance and quality of life in these patients. Other abnormalities in these patients, such as metabolic impairments, anemia, and hormonal changes, especially insulin resistance and lipid disorders, could be also modulated by certain therapeutic agents and physical activity. Increasing activity levels in this target group could be particularly important since it is well established that controlled physical exercise reduces the risk of cardiovascular disease in the general population. Patients who participate in regular physical activity following transplant will have higher health-related fitness and quality of life compared to those who remain inactive. The potential risk of physical activity can be reduced by medical evaluation, risk stratification, careful supervision, and education. © Wichtig Editore, 2005.