Physical activity for people with chronic kidney disease: an international survey of nephrologist practice patterns and research priorities

Airis Astiani Taryana; Rathika Krishnasamy; Clara Bohm; Suetonia C Palmer; Natasha Wiebe; Neil Boudville; Jennifer MacRae; Jeff Scott Coombes; Carmel Hawley; Nicole Isbel; Stephanie Thompson

doi:10.1136/bmjopen-2019-032322

Physical activity for people with chronic kidney disease: an international survey of nephrologist practice patterns and research priorities

BMJ Open. 2019 Dec 18;9(12):e032322. doi: 10.1136/bmjopen-2019-032322.

Authors

Airis Astiani Taryana¹, Rathika Krishnasamy^{1

2}, Clara Bohm^{3

4}, Suetonia C Palmer⁵, Natasha Wiebe⁶, Neil Boudville⁷, Jennifer MacRae^{8

9}, Jeff Scott Coombes¹⁰, Carmel Hawley¹¹, Nicole Isbel¹¹, Stephanie Thompson¹²

Affiliations

¹ Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
² Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.
³ Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
⁴ Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.
⁵ Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.
⁶ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
⁷ Medical School, University of Western Australia, Perth, Western Australia, Australia.
⁸ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁹ Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹⁰ School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.
¹¹ Department of Nephrology, Princess Alexandra Hospital, South Brisbane, Queensland, Australia.
¹² Department of Medicine, University of Alberta, Edmonton, Alberta, Canada th11@ualberta.ca.

Abstract

Objectives: People with chronic kidney diseases (CKD) have identified exercise as a research priority. To inform the research agenda, we surveyed nephrologists on their practice patterns, available resources and research priorities for exercise and physical activity (PA) in CKD.

Design: Cross-sectional international survey.

Setting and participants: 19-item electronic survey was administered to practising nephrologists with publicly available email addresses in Canada (n=354) and Australia and New Zealand (ANZ) and via newsletters for the Australian and New Zealand Society of Nephrology (n=598).

Outcomes: Frequency and predictors of exercise and PA counselling in practice and research priorities.

Results: 189 respondents (20% response) completed the survey. Eighty-one per cent of ANZ and 42% of Canadian respondents reported that their renal programmes did not have any exercise programmes or resources. The most frequently reported barrier for exercise programme implementation was a lack of funding (77%). Ninety per cent of respondents thought regular exercise provides 'health benefits' for all CKD stages; 59% reported that exercise counselling was within the nephrologists' scope of practice and 47% reported 'frequently' or 'always' counselling patients. In multivariable analysis, female gender (OR 2.31; 95% CI 1.16 to 4.58) and older age (OR 1.94 per age category increase; 95% CI 1.15 to 3.26) were associated with exercise counselling. Out of 194 research priorities, 65 (34%) were clinical outcomes (cardiovascular parameters) and 30% were patient-reported outcomes (quality of life).

Conclusions: Most nephrologists consider exercise and PA counselling as within their scope of practice and beneficial but, due to competing priorities, do not regularly counsel patients. This suggests a need for the evaluation of effective and efficient counselling strategies and a role for the routine involvement of exercise specialists in kidney care. Cardiovascular parameters and quality of life were identified as important outcomes for future exercise trials.

Keywords: chronic kidney disease; exercise; nephrology; physical activity; survey.

MeSH terms

Adult
Aged
Attitude of Health Personnel*
Australia
Canada
Cross-Sectional Studies
Exercise*
Female
Humans
Male
Middle Aged
Nephrology / methods*
New Zealand
Practice Patterns, Physicians' / statistics & numerical data*
Renal Insufficiency, Chronic / therapy*
Research / statistics & numerical data
Surveys and Questionnaires