Original Paper Nephron Clin Pract 2014;128:67–72 DOI: 10.1159/000363453

Received: December 12, 2013 Accepted: May 2, 2014 Published online: October 29, 2014

Exercise Counselling Practices for Patients with Chronic Kidney Disease in the UK: A Renal Multidisciplinary Team Perspective Sharlene A. Greenwood a Pelagia Koufaki b Robert Rush b Iain C. Macdougall a Thomas H. Mercer b On behalf of the British Renal Society Rehabilitation Network King’s College Hospital, London, and b Queen Margaret University, Edinburgh, UK

Key Words Exercise · Counselling · Physical activity · Barriers · Rehabilitation · Chronic kidney disease

Abstract Background: Patients with chronic kidney disease (CKD) have elevated cardiovascular disease (CVD) risk. Physical activity (PA) is a strong and independent CVD risk factor, and despite the fact that current clinical practice guidelines recommend simultaneous treatment of multiple risk factors for optimum management of CKD, PA is rarely addressed by renal care teams. The aim of this observational cross-sectional survey was to document current exercise/PA practices across renal units in the UK, and capture views and experiences regarding the provision of PA/exercise options for patients with CKD. Methods: An 18-item online survey questionnaire regarding exercise counselling practice patterns was administered to 565 multidisciplinary renal care professionals. Results: 142 individuals (25% response rate) completed the questionnaire. Overall, 42% of respondents discussed and encouraged PA, but only 18 and 11% facilitated implementation of PA for their patients. Nephrologists (p < 0.003) were more likely to prescribe or recommend PA compared to professionals with a nursing background and believed that spe-

© 2014 S. Karger AG, Basel 1660–2110/14/1282–0067$39.50/0 E-Mail [email protected] www.karger.com/nec

cific renal rehabilitation services, including an active PA/exercise component, should be available to all patients (p < 0.01). The most commonly reported barriers for the development and implementation of PA/exercise options included lack of funding, time, and knowledgeable personnel, such as physiotherapists or other exercise professionals. Conclusion: Beliefs and attitudes towards PA amongst members of the renal multidisciplinary team are encouraging. However there is a big gap between believing in the benefits of PA and promoting/implementing PA for patient benefit. This gap needs to be minimised by at least trying to address some of the reported barriers. © 2014 S. Karger AG, Basel

Introduction

Physical inactivity is a prevalent but modifiable risk factor for the development and progression of cardiovascular and metabolic long-term conditions such as chronic kidney disease (CKD). Interventions designed to increase physical activity (PA) and reduce sedentary behaviours in patients at risk of cardiovascular disease (CVD) may improve health-related outcomes [1, 2] and be costeffective in the longer term [3]. Current UK-based PA Sharlene Greenwood Lead Renal Physiotherapist King’s College Hospital NHS Foundation Trust London SE5 9RS (UK) E-Mail sharlene.greenwood @ nhs.net

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Nephron Clin Pract 2014;128:67–72 DOI: 10.1159/000363453

services in the UK. We therefore, distributed an onlinebased survey that is an adaptation of a previous similar survey conducted by Johansen et al. [26] in the USA, to capture information from within the UK National Health System (NHS).

Methods The survey, developed by Johansen [24], was adapted by the authors with feedback and suggestions from the BRS RN steering group. A UK-wide survey was administered via the BRS email contact list, irrelevant of place of work/institution, using a free online survey software and questionnaire tool [19]. All members of the MDT who care for patients with CKD were eligible. The survey was deemed as not needing ethical consideration by the research and development department at the lead author’s institution as participants were recruited through the BRS, and not through the NHS. The survey consisted of 18 questions, utilizing 5-point Likert ratings anchored at every point, regarding MDT opinions and practices related to exercise counselling. The questionnaire required approximately 5–10 min to complete, was anonymous and was distributed between June 2012 and September 2012. Statistical Analysis All analyses were performed using SPSS version 20. We considered two-tailed p < 0.05 to signify statistical significance. Nephrologists were compared with nurses and the others category by using χ2 and Kruskal-Wallis analysis of variance, as appropriate. Reported barriers were reviewed and two independent researchers identified emerging themes. The frequency of responses was counted, and agreement was reached on the emerging themes.

Results

A total of 142, out of 565, completed questionnaires were returned (25% response rate): 75% of the respondents were female, 44% had a nursing background; 30% were nephrologists (of which 80% were consultants); 14% were dieticians; 5% were physiotherapists; 3% were exercise scientists, and 4% were other/miscellaneous respondents. Eighty-six percent of survey respondents were between 31 and 60 years of age, and 94% were from an NHS occupational setting, with the remainder being from the academic (7.4%) and private sectors (3%). Forty-one percent of 127 respondents reported having some type of exercise provision in their renal unit (fig. 1). Responses to specific question items can be found in tables 1 and 2. Existing exercise/PA services and human resources representing established services or as part of research projects across the UK are presented in figure 1. Barrier themes that emerged are presented in table 3. For analysis Greenwood  et al.  

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guidelines for people of all ages [4] emphasise the importance of regular PA of varying intensities and modes as well as the minimisation of time spent on sedentary activities. These recommendations are embraced by the clinical practice guidelines for CVD in CKD produced by the UK Renal Association [5], which suggest that exercise should be encouraged and implemented. CKD-specific research evidence indicates that reduced PA and cardiorespiratory fitness substantially increase the chances of premature morbidity, disability and mortality [6]. Both low peak oxygen uptake (VO2 peak 

Exercise counselling practices for patients with chronic kidney disease in the UK: a renal multidisciplinary team perspective.

Patients with chronic kidney disease (CKD) have elevated cardiovascular disease (CVD) risk. Physical activity (PA) is a strong and independent CVD ris...
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