Awareness of exercise importance, information sources, and adherence in predialysis chronic kidney disease: a nationwide web-based cross-sectional study

Background Physical activity (PA) and exercise are key in the non-pharmacological management of chronic kidney disease (CKD). However, patient awareness, information sources, and adherence to advice are not well-established. Herein, we quantified the awareness of the importance of PA and exercise, identified information sources, described receipt of advice and adherence, and explored factors associated with poor adherence. Methods We conducted a nationwide web-based survey of adults with predialysis CKD in Japan. Inclusion criteria included being of age ≥ 50 years, physician-diagnosed CKD, no prior/active receipt of dialysis or transplant, ability to report recent serum creatinine or estimated glomerular filtration rates, and independence in activities of daily living. Questionnaires assessed awareness of importance (four-level scale), information sources, receipt of advice from healthcare professionals (yes/no), and adherence among recipients. Frailty was measured using the Kihon Checklist. Among recipients of exercise advice, correlates of poor adherence were examined using a modified Poisson regression with robust variance. Results Of the 312 respondents, 285 met the inclusion criteria. Awareness of the importance of PA/exercise was very or moderately evident in 72.7% of respondents, and diet awareness was similarly evident in 85.3%. Physicians (70.1%) and online articles (33.3%) were the most common information sources; physical therapists were rarely cited (4.4%). Overall, 71.6% of respondents reported receiving PA/exercise advice: 12.3% almost completely adhered, 51.0% mostly adhered, 31.9% did not adhere adequately, and 4.9% were unsure how to follow the advice. Frailty was independently associated with poor adherence. Conclusions In predialysis CKD, awareness of exercise lags behind that of diet, information sources are physician-centered, and adherence to advice is often suboptimal, particularly in patients with frailty. These findings reveal a gap in implementation and underscore the need to standardize structured clinical advice and monitoring, integrate exercise professionals into kidney care teams, and provide tailored support for frail patients.