An International Delphi Survey on Exercise Priorities in CKD

Abstract

Introduction Defining the role of exercise in chronic kidney disease (CKD) is a top research priority for people with CKD. We aimed to achieve consensus on specific research priorities in exercise and CKD among an international panel of stakeholders. Methods Using the Delphi method, patients/caregivers, researchers, clinicians, and policymakers submitted their top research priorities in round 1 and ranked their importance in rounds 2 and 3 using a 9-point Likert scale. The mean, median, and proportion of scores ranked 7 to 9 were calculated. Consensus was defined as priorities that scored above the overall mean and median score within each stakeholder panel. Qualitative description was used to understand participants’ rankings. Results Seventy participants (78% response) completed round 1: 15 (21.4%) clinicians, 33 (47.1%) researchers, 13 (18.6%) policymakers, and 9 (12.9%) patients; (85.7%) completed round 3. The top research priorities were defining exercise-related outcomes meaningful to patients, identifying patients’ motivation and perspective towards exercise, understanding the effect of exercise on the risk of institutionalization, mortality, and mobility, and understanding the effect of pre- and post-transplant exercise on postoperative recovery. Themes from the qualitative analysis were individualization, personal experience, and holistic approach to exercise (patients), the need to address common clinical problems (clinicians), developing targeted interventions (researchers), and the importance of evidence-based development versus implementation (policymakers). Conclusions Preventing physical disability was a common priority. Policymakers emphasized that more efficacy studies were needed. Other panels expressed the need for holistic and targeted exercise interventions and for outcomes that address common clinical problems.

How to Overcome Anabolic Resistance in Dialysis-Treated Patients?

“…ESRD patient are more commonly sedentary and tend to avoid exercise ( 191 ); additionally, the dialysis population is more often aged, frail, depressive and with many comorbid conditions which are major obstacles to exercising. Finally, often the HD personnel has lack of expertise or resource to start an exercise program ( 192 ).…”

“…Several studies have addressed the issue of the efficacy of this combined treatment in HD patients [see ref. ( 192 ) for review]. Likewise, early studies in HD patients has showed that a single bout of either endurance or resistance exercise enhances the anabolic response to nutritional supplements ( 194 ).…”

“…Many factors are likely to contribute to the modest advantages of exercise in HD patients, including limited exercise prescriptions and intradialytic training ( 192 ). A greater exercise dose or enhanced nutritional support may be needed to demonstrate the potentiated additive benefits of these treatments ( 192 ). Clearly, defining the role of exercise in CKD remains a top research priority.…”

Renal Rehabilitation: Exercise Intervention and Nutritional Support in Dialysis Patients

“…Since exercise therapy is the core of a comprehensive renal rehabilitation program, the relatively rich literature about exercise therapy for CKD patients was primarily reviewed. Thereafter, a number of systematic reviews for physical activity, renal function, lifestyle change in CKD including dialysis patients, as well as international surveys and editors' commentary, has been published in recent years [22][23][24][25][26][27][28][29][30][31][32].…”

An Exercise Prescription for Patients with Stroke and Sarcopenia Based on the Modified Delphi Study

“…Several studies on exercise as a treatment for sarcopenia using the Delphi method have been performed [ 23 , 24 ]. Research on exercise in other diseases, such as musculoskeletal or internal medicine, has also been conducted [ 25 , 26 , 27 , 28 , 29 ]. However, studies on exercise targeting patients with both stroke and preexisting sarcopenia are rare.…”