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

Research output: Contribution to journalJournal articleResearchpeer-review


  • Paul N. Bennett
  • Masahiro Kohzuki
  • Clara Bohm
  • Baback Roshanravan
  • Stephan J.L. Bakker
  • João L. Viana
  • Jennifer M. MacRae
  • Thomas J. Wilkinson
  • Kenneth R. Wilund
  • Amaryllis H. Van Craenenbroeck
  • Giorgos K. Sakkas
  • Stefan Mustata
  • Kevin Fowler
  • Jamie McDonald
  • Geovana Martin Aleamañy
  • Kirsten Anding
  • Keith G. Avin
  • Gabriela Leal Escobar
  • Iwona Gabrys
  • Jill Goth
  • Myriam Isnard
  • Manisha Jhamb
  • Jun Chul Kim
  • John Wing Li
  • Courtney J. Lightfoot
  • Mara McAdams-DeMarco
  • Fabio Manfredini
  • Anthony Meade
  • Mølsted, Stig
  • Kristen Parker
  • Eva Seguri-Orti
  • Alice C. Smith
  • Nancy Verdin
  • Jing Zheng
  • Deb Zimmerman
  • Stephanie Thompson
  • Global Renal Exercise Network (GREX)

Objective: Impairment 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 Methods: Guided 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. Results: We 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. Conclusions: We 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.

Original languageEnglish
JournalJournal of Renal Nutrition
Issue number4
Pages (from-to)441-449
Publication statusPublished - 2022

Bibliographical note

Publisher Copyright:
© 2021 National Kidney Foundation, Inc.

ID: 301361823