FACTORS AFFECTING SELF REPORTED PARTICIPATION IN EXERCISE AMONG INDIVIDUALS WITH STAGE 3-4 CKD ATTENDING OUTPATIENT CARE

Despite robust evidence supporting exercise in CKD, its implementation in kidney care remains challenging. Understanding patient readiness and needs can support targeted exercise interventions in routine care. This study assessed self-reported exercise participation and willingness to engage in exercise among individuals with CKD stage 3-4 and explored how these attitudes relate to clinical data, subjective and objective physical function. 

A cross-sectional secondary analysis was conducted using routinely collected audit data (May 2024-March 2025) from a public nephrology outpatient clinic in Sydney, Australia. Data included demographics, comorbidities (clinically documented diagnoses), the Short Physical Performance Battery (SPPB), gait speed, IPOS-R mobility and KDQoL activities of daily living (KDQoL-ADL) scores. Participants responded to standardised exercise questions regarding current behaviours, willingness to start, and barriers. Analyses were descriptive with group comparisons by exercise status using one-way ANOVA with Bonferroni correction. 

The sample included 287 participants (mean age 75±12 years; 38% female; mean eGFR 34.5±11.8 ml/min/1.73m²). The cohort had a high comorbidity (mean 6±3 per person), the most common were heart disease (69%), dyslipidemia (68%), arthropathies (59%), diabetes (58%), mood disorders (47%) and osteopathies (36%). Physical function was reduced as demonstrated by slow gait speed (0.79+0.30 m/s), mean SPPB of 8±3/12, KDQoL-ADL of 22+5/30 indicating moderate difficulty with ADLs and from a practical standpoint 33% required a walking aid. Despite this, n=127 (44%) reported exercising regularly, including self-directed (e.g. walking), clinically tailored programs (e.g. physiotherapy) or recreational sport. Among non-exercisers, n=114 (40%) were willing to begin, while n=46 (16%) were not. Barriers for the unwilling group included pain or complex health concerns (39%), time constraints (26%), and personal preference (35%).  

Significant between-group differences were observed for gait speed and iPOS mobility (p<0.05), with trends noted for KDQoL-ADL and SPPB (p<0.07), while age, sex, eGFR and total comorbidities were not different. Post-hoc analysis showed slower gait speed in both the willing (0.8±0.2m/s) and unwilling groups (0.7±0.3m/s) compared to the exercise group (0.9±0.3m/s); both p<0.05. Only the unwilling group demonstrated a trend to lower SPPB compared to the exercise group (unwilling p=0.067, willing p=0.318). Compared to exercisers, subjective scores (iPOS mobility and KDQoL-ADL) were lower in the willing group (p=0.017 and p=0.071 respectively) but preserved in the unwilling group (p<0.4 both).  

Most adults with CKD stage 3-4 could benefit from, and were receptive to, exercise interventions. The complex interplay between perceived mobility limitation and objective functional status appears to influence willingness to engage with exercise. Given the older age and extensive multimorbidity demonstrated in this population, routine access to personalised exercise programming is essential.  These findings highlight a critical need for CKD-specific allied health support to implement tailored, effective exercise interventions for this large and underserved patient population.