Physical activity and exercise programs for kidney patients: an Italian survey of nephrology centres
Authors: Bulighin Francesca , Aucella Filippo , Bellizzi Vincenzo , Cupisti Adamasco , Faga Teresa , Gambaro Giovanni , Regolisti Giuseppe , Storari Alda , Capitanini Alessandro , Battaglia Yuri ,   On behalf of Working Group of Physical Exercise of Italian Society of Nephrology, Leoni Marco , Manes Massimo , Traversari Lorena , Collosi Alessandra , Lentini Paolo , Previti Antonino , Leone Valentina Fanny , Vernaglione Luigi , Leonardi Giuseppe , dalla Gassa Alessandra , Andreucci Michele , Diliberato Lorenzo , Patella Gemma , Piperno Rosa , Rapanà Mario Renato , Campolo Maria Angela , Piscitani Luca , Splendiani Giorgio , Ria Paolo , Parrini Manuela , Dugo Mauro , Vezzoli Giuseppe , Buskermolen Monique , Alfano Gaetano , Qassim Laila , Amicone Maria , Satta Ersilia , Marinelli Giancarlo , Guglielmetti Gabriele , Massara Carlo , Scaparrotta Giuseppe , Calandra Leonardo , Tosto Massimiliano , Fagugli Riccardo Maria , Baciga Federica , Scarpioni Roberto , Barilla Antonio , Giglio Elisa , Buscaroli Andrea , Mallamaci Francesca , Somenzi Danio , Favaro Antonio , Fiorini Fulvio , Naticchia Alessandro , Papalini Sandra , Baglio Veronica , La Rosa Sandra , Cenerelli Stefano , Amidone Marco , Micarelli David , Pozzato Marco , Valente Fabrizio , Rizzolo Monica , Bianco Francesco , Caletti Chiara , Gazo Antonietta , Albrizio Paolo 
Published: March 2024

Abstract
Background
Data on exercise activities in place, and on the interest for developing them in Nephrology Services in Italy is limited. To address this gap, we carried out this cross-sectional study to investigate the status of physical activity and exercise programs available in Italian Nephrology Centres. Additionally, research priorities on this topic were examined.

Methods
We developed a 14-item electronic survey, which consisted of multiple-choice questions covering exercise training programs, physical assessment, barriers to exercise practice and to exercise programs, exercise and physical activity counselling practices, perceived exercise benefits, literature evidence, and research priorities. Data on the characteristics of the centres were also collected.

Results
Sixty-two responses from Italian nephrology centres were collected. Ninety-three percent of the respondents were aware of the scientific evidence supporting the benefits of regular exercise programs for chronic kidney disease (CKD) patients. Additionally, in 75% of centres the nephrologists believed that physical activity counselling should be performed by the nephrologists. However, only 26% of centres provided exercise programs, mainly for dialysis patients, and 63% never or infrequently assessed physical activity in the context of patient management. Eighty-nine percent of centres reported barriers to implementing exercise programs, including lack of funding, institutional disinterest, patient refusal, and negative attitudes of the healthcare personnel. Forty-six research priorities related to exercise in CKD patients were suggested, with the majority focusing on impact of exercise programs and physical activity on cardiovascular, nutritional, and psychosocial outcomes.

Conclusion
This survey highlights the limited availability of exercise programs and physical activity evaluation in clinical practice in Italian Nephrology Centres. However, the survey also revealed a strong interest for counselling CKD patients on physical activity and implementing exercise prescriptions and interventions.

Graphical Abstract