Opinions on exercise and rehabilitation of patients with CKD: survey results among practicing nephrologists

Introduction. Increased physical activity in patients with chronic kidney disease (CKD) is associated with numerous proven benefits. However, physical rehabilitation programs are rarelu integrated into standard clinical practice, and the reasons for this remain unclear. The study aimed to explore nephrologist’s opinions regarding exercise and physical activity in patients with CKD.

Methods. An anonymous survey was conducted among nephrologists working in outpatient dialysis units in the between May and July 2025.

Results. A total of 98 physicians from dialysis centers participated in the survey. The average age of respondents was 42(10) years, and their work experience was 14(9) years. Respondents themselves engaged in physical activity infrequently (median 1 time per week (<1 – 2‑3 times), yet 52% regularly ask their patients about activity levels, and 45% provide regular recommendations. Sixty percent of centers lacked physical rehabilitation programs, while 24% offered them for hemodialysis patients. Respondents identified the main barriers to program development as lack of funding (58%), transportation issues (44%), and lack of patients motivation (36%); less frequently, barriers included the attitude of the center management (31%) and staff (29%). The most recommended activities included walking (97%), swimming (67%), cycling (46%), flexibility exercises (39%), and coordination (29%). Regarding guidance, respondents believed physiotherapists (80%), nephrologists (56%), psychologists (34%), nutritionists, and nurses (27% each) should advise patients on physical activity, with 19% suggesting all listed specialists. Only 39% fully agreed that regular exercise is beneficial for patients with advanced stages of CKD and those on renal replacement theraphy, with most doubts (15%) arising in the predialysis stages.

Conclusions. There is a critical shortage of exercise programs for patients with CKD. Key obstacles include limited interest from staff and management of the centers, insufficient funding and gaps in knowledge about physical rehabilitation. Greater attention to these factors is essential to integrate structured exercise into CKD care.

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