Importance of physical exercise prescription in patients with chronic kidney disease: results of the survey of the Grupo Español Multidisciplinar de Ejercicio Físico en el Enfermo Renal [Spanish Multidisciplinary Group of Physical Exercise in Kidney Patients] (GEMEFER)

Exercise and physical activity for people with chronic kidney disease: A national survey of nephrologist practice patterns in Saudi Arabia

A variety of health benefits are associated with physical activity (PA) in individuals with chronic kidney disease (CKD). The aim of this study was to examine nephrologist practice patterns concerning exercise and PA in CKD patients. This is an online cross-sectional survey study that was conducted between June 2023 and May 2024 in Saudi Arabia. Nephrology fellow, specialists, and consultants in Saudi Arabia formed the study population. A total of 96 physicians participated in this study. Only 9.4% of renal units have exercise programs available to patients. These programs are available mainly for advanced CKD (pre-dialysis) and in-center hemodialysis patients. The major barriers for initiating or expanding exercise programs at their centers are a lack of motivation/interest from front-line staff (55.2%), lack of interest from management (48.3%), and no funding (47.1). Around 56.2% of respondents ask patients about their level of PA. Additionally, 64.6% give patients specific advice on how to increase their level of PA. For the types of exercise most beneficial for people with CKD, 90.6% recommend walking. Around 34.4% of respondents believe that physiotherapists should take ownership in providing exercise counseling and resources to people with CKD. The majority agreed or strongly agreed to recommend exercise in patients with CKD (76.0%). The mean attitude score for the study participants was 32.1 (standard deviation: 3.9) out of 40 (equal to 80.3%); which demonstrates positive attitude towards recommending exercise for CKD patients. Binary logistic regression analysis identified that there is no statistically significant difference between physicians in term of their attitude towards recommending exercise for CKD patients (P > .05). This study highlights a critical gap in the availability of exercise programs for CKD patients. Key barriers include lack of interest by staff and management and funding issues. In spite of these barriers, a majority of physicians acknowledge the role of exercise in CKD patients and advice regarding PA on a frequent basis. It suggests recommendations in order to expand the programs, including increasing staff motivation, securing management support, and getting funding for exercise programs and identifying the role of physiotherapists in exercise counseling for CKD patients.

Physical activity and exercise programs for kidney patients: an Italian survey of nephrology centres

BACKGROUND

Data on exercise activities in place, and on the interest for developing them in Nephrology Services in Italy is limited. To address this gap, we carried out this cross-sectional study to investigate the status of physical activity and exercise programs available in Italian Nephrology Centres. Additionally, research priorities on this topic were examined.

METHODS

We developed a 14-item electronic survey, which consisted of multiple-choice questions covering exercise training programs, physical assessment, barriers to exercise practice and to exercise programs, exercise and physical activity counselling practices, perceived exercise benefits, literature evidence, and research priorities. Data on the characteristics of the centres were also collected.

RESULTS

Sixty-two responses from Italian nephrology centres were collected. Ninety-three percent of the respondents were aware of the scientific evidence supporting the benefits of regular exercise programs for chronic kidney disease (CKD) patients. Additionally, in 75% of centres the nephrologists believed that physical activity counselling should be performed by the nephrologists. However, only 26% of centres provided exercise programs, mainly for dialysis patients, and 63% never or infrequently assessed physical activity in the context of patient management. Eighty-nine percent of centres reported barriers to implementing exercise programs, including lack of funding, institutional disinterest, patient refusal, and negative attitudes of the healthcare personnel. Forty-six research priorities related to exercise in CKD patients were suggested, with the majority focusing on impact of exercise programs and physical activity on cardiovascular, nutritional, and psychosocial outcomes.

CONCLUSION

This survey highlights the limited availability of exercise programs and physical activity evaluation in clinical practice in Italian Nephrology Centres. However, the survey also revealed a strong interest for counselling CKD patients on physical activity and implementing exercise prescriptions and interventions.