TOPLINE:

Healthcare professionals in Western Europe overwhelmingly believed exercise as beneficial for patients with chronic kidney disease (CKD), yet most kidney units lacked dedicated exercise programmes, and only 6% had physiotherapy services available for these patients.

METHODOLOGY:

• Researchers conducted a study to assess attitudes and practices regarding exercise in patients with CKD among healthcare professionals and patients and to examine healthcare system support for exercise interventions.
• They included 352 nurses (65% women), 143 physicians (46% women), and 1235 patients with CKD from Sweden, Germany, Greece, Italy, and Spain; among the 1235 patients, 137 had CKD stages 4-5, 40 were on peritoneal dialysis, 30 were on home haemodialysis, 928 were on institutional haemodialysis, and 100 were kidney transplant recipients, with 37%-41% of all patients being women.
• Approximately one kidney unit per 4 million inhabitants was included for the analysis from each participating country. A kidney unit is a hospital or specialised facility providing care and treatment for patients with CKD, including dialysis and related therapies.
• Five validated questionnaires were used to assess national- and unit-level resources, nurses' and physicians' attitudes towards exercise, and patient experiences with exercise prescriptions in CKD care.

TAKEAWAY:

• Among healthcare professionals, 96% of nurses and 98% of physicians believed that exercise benefits patients with CKD; however, only 59% of physicians regularly prescribed or recommended it.
• Overall, 48% of healthcare facilities lacked a physiotherapy unit, 41% had one but not dedicated to patients with renal issues, and only 6% had units dedicated to those with kidney disease.
• Patient participation in exercise programmes was low: Only 14% of those with CKD stages 4-5, 37% of those on peritoneal dialysis, 14% of those on home haemodialysis, 11% of those on institutional haemodialysis, and 33% of kidney transplant recipients received an exercise programme.
• Sweden was the only country with dedicated physiotherapists for patients on institutional haemodialysis and comprehensive reimbursement for physiotherapy across all CKD stages and kidney replacement therapies.

IN PRACTICE:

"Healthcare professionals regard exercise as an important element of care in kidney patients, although, they do not assess patients' physical performance nor provide structured exercise programmes, mainly due to lack of physiotherapy resources and reimbursement strategies within the healthcare system," the authors wrote.

SOURCE:

This study was led by Naomi Clyne, Lund University, Skåne University Hospital, Lund, Sweden. It was published online on September 17, 2025, in Clinical Kidney Journal.

LIMITATIONS:

Participation rates differed across countries, which may have introduced selection bias. The pragmatic nature of the study prevented the exploration of potential internal bias and heterogeneity of attitudes, so the spectrum of views among healthcare professionals was not fully explored.

DISCLOSURES:

This study received small funds from a private legacy for nephrology research in Germany. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.