Abstract Background and Aims Structural and functional changes in the cardiovascular system in patients with chronic kidney disease (CKD) will lead to decreased exercise tolerance, decreased quality of life, and, ultimately, premature death. The aim of this study was to study morphometric changes in the left ventricle of the heart depending on the direction of therapeutic physical training. Method The study involved 60 patients with CKD stage C3. The average age of the patients was 54.2 ± 3.40 years. The average level of GFR for the sample as a whole was 79.1 ± 9.4 ml / min / 1.73 m2. The control group (CG) consisted of 20 people (10 men and 10 women) comparable to the main group in terms of gender and age. The examination of patients included a general examination, assessment of complaints, collection of anamnestic data, anthropometry with calculation of BMI cardiopulmonary stress test, echocardiography. According to the data of the cardiopulmonary stress test, 3 groups were formed on the basis of the predominant manifestation of any physical quality in the course of therapeutic training: group 1 (n = 20) - with a respiratory orientation of the training process; 2nd group (n = 20) - with a focus on cardio loads; 3rd group (n = 20) - development of predominantly endurance. Results Of all groups of patients with CKD, the LVMM indicator reached the highest values in men in group 2 (with a cardio-load orientation of the treatment-training process), as well as in women in group 3 (predominantly endurance development). It is this orientation of the training process that has the greatest effect on the increase in the mass of the left ventricular myocardium in patients with CKD. The 2nd group of patients with CKD stage CKD had the highest values of LVTD in diastole both among men and women. In addition, men in this group had the highest RTI per systole. In patients of the 2nd group, undergoing mainly cardio load, the change concerned a slightly more pronounced increase in the wall thickness of the left ventricle. In the 3rd group of patients with CKD stages C3, both men and women had the maximum values of TMV in diastole, as well as LVTD in systole. Types of physiotherapy exercises with a predominance of endurance in physical exertion are distinguished by the most pronounced signs of left ventricular myocardial hypertrophy. Conclusion The present study has shown that patients with pre-dialysis CKD have decreased maximal and submaximal exercise tolerance. Analysis of the data obtained made it possible to reveal the peculiarities of adaptation of the cardiovascular system of patients with CKD stages CKD to a specific type of therapeutic training and to determine the quantitative values of echocardiographic parameters in patients with CKD.