TY - JOUR

T1 - Global Policy Barriers and Enablers to Exercise and Physical Activity in Kidney Care

AU - Global Renal Exercise Network (GREX)

AU - Bennett, Paul N

AU - Kohzuki, Masahiro

AU - Bohm, Clara

AU - Roshanravan, Baback

AU - Bakker, Stephan J L

AU - Viana, João L

AU - MacRae, Jennifer M

AU - Wilund, Kenneth R

AU - Van Craenenbroeck, Amaryllis H

AU - Sakkas, Giorgos K

AU - Mustata, Stefan

AU - Fowler, Kevin

AU - MacDonald, Jamie

AU - Aleamañy, Geovana Martin

AU - Anding, Kirsten

AU - Avin, Keith G

AU - Escobar, Gabriela Leal

AU - Gabrys, Iwona

AU - Goth, Jill

AU - Isnard, Myriam

AU - Jhamb, Manisha

AU - Kim, Jun Chul

AU - Li, John Wing

AU - Lightfoot, Courtney J

AU - McAdams-DeMarco, Mara

AU - Manfredini, Fabio

AU - Meade, Anthony

AU - Molsted, Stig

AU - Parker, Kristen

AU - Seguri-Orti, Eva

AU - Smith, Alice C

AU - Verdin, Nancy

AU - Zheng, Jing

AU - Zimmerman, Deb

AU - Thompson, Stephanie

N1 - Copyright © 2021 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

PY - 2022/7

Y1 - 2022/7

N2 - ObjectiveImpairment in physical function and physical performance leads to decreased independence and health-related quality of life in people living with chronic kidney disease and end-stage kidney disease. Physical activity and exercise in kidney care are not priorities in policy development. We aimed to identify global policy-related enablers, barriers, and strategies to increase exercise participation and physical activity behavior for people living with kidney disease.Design and MethodsGuided by the Behavior Change Wheel theoretical framework, 50 global renal exercise experts developed policy barriers and enablers to exercise program implementation and physical activity promotion in kidney care. The consensus process consisted of developing themes from renal experts from North America, South America, Continental Europe, United Kingdom, Asia, and Oceania. Strategies to address enablers and barriers were identified by the group, and consensus was achieved.ResultsWe found that policies addressing funding, service provision, legislation, regulations, guidelines, the environment, communication, and marketing are required to support people with kidney disease to be physically active, participate in exercise, and improve health-related quality of life. We provide a global perspective and highlight Japanese, Canadian, and other regional examples where policies have been developed to increase renal physical activity and rehabilitation. We present recommendations targeting multiple stakeholders including nephrologists, nurses, allied health clinicians, organizations providing renal care and education, and renal program funders.ConclusionsWe strongly recommend the nephrology community and people living with kidney disease take action to change policy now, rather than idly waiting for indisputable clinical trial evidence that increasing physical activity, strength, fitness, and function improves the lives of people living with kidney disease.

AB - ObjectiveImpairment in physical function and physical performance leads to decreased independence and health-related quality of life in people living with chronic kidney disease and end-stage kidney disease. Physical activity and exercise in kidney care are not priorities in policy development. We aimed to identify global policy-related enablers, barriers, and strategies to increase exercise participation and physical activity behavior for people living with kidney disease.Design and MethodsGuided by the Behavior Change Wheel theoretical framework, 50 global renal exercise experts developed policy barriers and enablers to exercise program implementation and physical activity promotion in kidney care. The consensus process consisted of developing themes from renal experts from North America, South America, Continental Europe, United Kingdom, Asia, and Oceania. Strategies to address enablers and barriers were identified by the group, and consensus was achieved.ResultsWe found that policies addressing funding, service provision, legislation, regulations, guidelines, the environment, communication, and marketing are required to support people with kidney disease to be physically active, participate in exercise, and improve health-related quality of life. We provide a global perspective and highlight Japanese, Canadian, and other regional examples where policies have been developed to increase renal physical activity and rehabilitation. We present recommendations targeting multiple stakeholders including nephrologists, nurses, allied health clinicians, organizations providing renal care and education, and renal program funders.ConclusionsWe strongly recommend the nephrology community and people living with kidney disease take action to change policy now, rather than idly waiting for indisputable clinical trial evidence that increasing physical activity, strength, fitness, and function improves the lives of people living with kidney disease.

U2 - 10.1053/j.jrn.2021.06.007

DO - 10.1053/j.jrn.2021.06.007

M3 - Article

C2 - 34393071

VL - 32

SP - 441

EP - 449

JO - Journal of Renal Nutrition

JF - Journal of Renal Nutrition

SN - 1051-2276

IS - 4

ER -