With nearly 40% of the total plastics produced being used for packaging, up to five trillion plastic bags are consumed in the world annually. The inadequate disposal of plastic waste and its persistence has become a serious challenge/risk to the environment, health, and well-being of living creatures, including humans. The natural degradation of plastics is extremely slow; large pieces of plastic may break down into microplastics (MPs) (1 μm–5 mm) or nanoplastics (NPs) (<1000 nm) after protracted physical, chemical, and/or biological degradations. A brief overview of the transport of micro- and nanoplastics in the aquatic, terrestrial, and atmospheric environments is presented. Details are provided on the exposure routes for these waste materials and their entry into humans and other biota through ingestion, inhalation, and dermal contact. The greatest concern is the cumulative impact of the heterogeneous secondary MPs and NPs on planetary and human health. Inhaled MPs and NPs have been shown to affect the upper respiratory tract, lower respiratory tract, and alveoli; prolonged exposure can lead to chronic inflammatory changes and systemic disease. These can also lead to autoimmune diseases and other chronic health conditions, including atherosclerosis and malignancy. Sustainable mitigation strategies to reduce the impact of MPs/NPs include source reduction, material substitution, filtration and purification, transformation of plastic waste into value-added materials, technological innovations, etc. Multidisciplinary collaborations across the fields of medicine, public health, environmental science, economics, and policy are required to help limit the detrimental effects of widespread MPs and NPs in the environment.

Physical activity is essential to interrupt the cycle of deconditioning associated with chronic kidney disease (CKD). However, access to targeted physical activity interventions remain under-supported due to limited funding and specialised staff. Digital interventions may address some of these factors. This systematic review sought to examine the evidence base of digital interventions focused on promoting physical activity or exercise and their effect on health outcomes for people living with CKD. Electronic databases (PubMed, CINAHL, Embase, Cochrane) were searched from 1 January 2000 to 1 December 2023. Interventions (smartphone applications, activity trackers, websites) for adults with CKD (any stage, including transplant) which promoted physical activity or exercise were included. Study quality was assessed, and a narrative synthesis was conducted. Of the 4057 records identified, eight studies (five randomised controlled trials, three single-arm studies) were included, comprising 550 participants. Duration ranged from 12-weeks to 1-year. The findings indicated acceptability and feasibility were high, with small cohort numbers and high risk of bias. There were inconsistent measures of physical activity levels, self-efficacy, body composition, physical function, and psychological outcomes which resulted in no apparent effects of digital interventions on these domains. Data were insufficient for meta-analysis. The evidence for digital interventions to promote physical activity and exercise for people living with CKD is limited. Despite popularity, there is little evidence that current digital interventions yield the effects expected from traditional face-to-face interventions. However, 14 registered trials were identified which may strengthen the evidence-base.