Background <p>Although kidney transplantation (KT) improves kidney function, children with chronic kidney disease (CKD) often show incomplete recovery of physical function. Physical activity is recommended, and telerehabilitation may enhance adherence. This study evaluated the effects of a telerehabilitation exercise program on functional capacity in pediatric KT recipients. Secondary outcomes included peripheral muscle strength, quality of life (QoL), laboratory measures, and program safety.</p> Methods <p>This single-blind randomized clinical trial included two groups: intervention (IG) and control (CG). Functional capacity (Modified Shuttle Walk Test – MSWT), handgrip strength, and laboratory measures were assessed before and after the intervention. Both groups participated in remote sessions twice weekly for six weeks. The IG performed age-appropriate physical exercises, while the CG completed simple ventilatory exercises and a structured interview.</p> Results <p>51 patients were randomized (IG = 25; CG = 26). There were no significant differences in baseline characteristics between groups. The IG showed a 90.6-m increase in MSWT distance, while the CG improved by only 0.8&#xa0;m. Both groups demonstrated gains in peripheral muscle strength, with greater improvements in the IG. Laboratory measures showed no significant changes. The program was feasible and safe.</p> Conclusion <p>Significant improvements in functional capacity were observed in pediatric KT patients. Although no statistically significant differences were observed in peripheral muscle strength or QoL between groups, both improved, especially in the IG. Laboratory parameters remained unchanged. The intervention was safe and demonstrated good adherence, highlighting its potential for post-transplant rehabilitation.</p> Trial Registration <p>Brazilian Registry of Clinical Trials (ReBEC), RBR-5gm65y8.</p> Graphical Abstract <p></p>